鼻咽癌患者接受质子与光子放疗后放射性脑坏死的比较
Radiation-induced brain necrosis among patients with nasopharyngeal cancer treated with proton vs photon radiotherapy.
文献信息
| PMID | 42945740 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Hao-Shen Cheng |
| 作者单位 | Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. |
| 期刊 | European journal of cancer (Oxford, England : 1990) |
| SCI 分区 | Q1 |
| IF | 7.8 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
背景： 放射性脑坏死（RIBN）是放疗（RT）的晚期并发症。在鼻咽癌（NPC）中，质子治疗相对于光子治疗是否能降低这一风险仍不明确。
方法： 我们回顾性分析了2013年6月至2025年3月期间接受根治性光子调强放疗（IMRT）或质子放疗、且随访≥6个月的连续成人NPC患者。脑坏死（BN）的累积发生率以未发生BN的死亡作为竞争事件进行估计（Gray检验）；采用病因特异性Cox回归识别相关因素；总生存期（OS）采用log-rank检验进行比较。
结果： 256例患者中，79例（30.9%）接受质子治疗，177例（69.1%）接受IMRT；中位随访时间分别为43个月和87个月。质子组5/79例（6.3%）发生BN，光子组9/177例（5.1%）发生BN（P = .7674）。任何级别RIBN的2年和5年累积发生率，质子组为6.2%和9.7%，光子组为1.8%和5.2%（Gray P = .2342）；≥2级RIBN分别为4.7%和4.7% vs 1.2%和2.5%（Gray P = .3132）。在探索性单变量病因特异性Cox分析中，T4期疾病与更高的RIBN风险相关（HR，8.48；95% CI，1.83-39.30；P = .0063）。质子治疗与RIBN之间的关联无统计学显著性（HR，1.85；95% CI，0.60-5.68；P = .2832）。OS无差异（5年，质子组90.0% vs 光子组80.7%；log-rank P = .1573）。
结论： 在NPC中，质子治疗与光子治疗相比并未与更低的RIBN风险相关。探索性单变量分析显示T4期疾病与RIBN之间存在关联。两种治疗方式之间未观察到生存或毒性结局的统计学显著差异。
英文摘要
BACKGROUND: Radiation-induced brain necrosis (RIBN) is a late complication of radiotherapy (RT). Whether proton therapy reduces this risk relative to photon remains unclear in nasopharyngeal cancer (NPC).
METHODS: We retrospectively reviewed consecutive adults with NPC who received definitive RT with photon intensity-modulated radiotherapy (IMRT) or proton RT between June 2013 and March 2025 and had ≥ 6 months of follow-up. Cumulative incidence of brain necrosis (BN) was estimated treating death without BN as a competing event (Gray test); cause-specific Cox regression identified associated factors; overall survival (OS) was compared by log-rank test.
RESULTS: Of 256 patients, 79 (30.9%) received proton and 177 (69.1%) IMRT; median follow-up was 43 and 87 months, respectively. BN developed in 5/79 (6.3%) proton and 9/177 (5.1%) photon (P = .7674). The 2- and 5-year cumulative incidence of any-grade RIBN was 6.2% and 9.7% for proton versus 1.8% and 5.2% for photon (Gray P = .2342); for grade ≥ 2 RIBN, 4.7% and 4.7% versus 1.2% and 2.5% (Gray P = .3132). In exploratory univariable cause-specific Cox analyses, T4 disease was associated with a higher hazard of RIBN (HR, 8.48; 95% CI, 1.83-39.30; P = .0063). The association between proton therapy and RIBN was not statistically significant (HR, 1.85; 95% CI, 0.60-5.68; P = .2832). OS did not differ (5-year, 90.0% proton vs 80.7% photon; log-rank P = .1573).
CONCLUSIONS: Proton therapy was not associated with a lower risk of RIBN than photon in NPC. Exploratory univariable analysis showed an association between T4 disease and RIBN. No statistically significant differences in survival or toxicity outcomes were observed between modalities.