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Thurin E, Nyström PW, Smits A, Werlenius K, Bäck A, Liljegren A, Daxberg EL, Jakola AS. Proton therapy for low-grade gliomas in adults: A systematic review. Clin Neurol Neurosurg 2018; 174:233-238. [PMID: 30292166 DOI: 10.1016/j.clineuro.2018.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 12/31/2022]
Abstract
For adult patients with diffuse low-grade glioma (LGG) proton therapy is an emerging radiotherapy modality. The number of proton facilities is rapidly increasing. However, there is a shortage of published data concerning the clinical effectiveness compared to photon radiotherapy and potential proton-specific toxicity. This study aimed to systematically review and summarize the relevant literature on proton therapy for adult LGG patients, including dosimetric comparisons, the type and frequency of acute and long-term toxicity and the clinical effectiveness. A systematic search was performed in several medical databases and 601 articles were screened for relevance. Nine articles were deemed eligible for in-depth analysis using a standardized data collection form by two independent researchers. Proton treatment plans compared favorably to photon-plans regarding dose to uninvolved neural tissue. Fatigue (27-100%), alopecia (37-85%), local erythema (78-85%) and headache (27-75%) were among the most common acute toxicities. One study reported no significant long-term cognitive impairments. Limited data was available on long-term survival. One study reported a 5-year overall survival of 84% and 5-year progression-free survival of 40%. We conclude that published data from clinical studies using proton therapy for adults with LGG are scarce. As the technique becomes more available, controlled clinical studies are urgently warranted to determine if the potential benefits based on comparative treatment planning translate into clinical benefits.
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Affiliation(s)
- Erik Thurin
- Institute of Physiology and Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Petra W Nyström
- The Skandion Clinic, Uppsala, Sweden; Danish Centre for Particle Therapy, Aarhus, Denmark
| | - Anja Smits
- Institute of Physiology and Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Katja Werlenius
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgrenska Cancer Center, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Anna Bäck
- The Skandion Clinic, Uppsala, Sweden; Therapeutic Radiation Physics, Sahlgrenska University Hospital, Göteborg, Sweden; Department of Radiation Physics, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ann Liljegren
- Medical Library, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva-Lotte Daxberg
- Medical Library, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Asgeir Store Jakola
- Institute of Physiology and Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
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