Early experience in the treatment of malignant gliomas by proton heavy ion particles.

Malignant high-level gliomas (high-grade gliomas, HGG), including polymorphic glioma multiforme, GBM, and interstitial astrocytoma (anaplastic astrocytoma, AA), diffusely impregnated growth, progression, can not be completely removed. Although after
, the recurrence rate was very high, although high-dose radiotherapy.
the application of new radiotherapy techniques, such as dose increase, multi-level radiotherapy and increased stereotactic radiation therapy, but has not yet formed a standardized standard of radiation therapy.
slightly improved overall survival rate (OS) after combination with the treatment of promozola, especially in patients with MGMT promoter methylation.
in general, patients with medium survival remained short,
, and the OS rates of high-level gliomas were also not significantly improved.
proton heavy ions have superior physical properties, as well as a higher linear energy transfer (LET) effect, which can directly cause significant damage to tumor cells through the double strands of DNA.
Lin Kong of the Shanghai Proton Heavy Ion Center and others report on the results of a group of proton heavy ion particles in the 2020 journal Cancer.

research methods
between June 2015 and October 2018, 50 patients with HGG were treated at the Shanghai Proton Heavy Ion Center, of which 34 were GBM and 16 cases of AA.
24 cases received proton radiotherapy, 60Gy/30d, and 26 cases received proton-carbon ion radiotherapy (CIRT), each using a different dose increment scheme.
all patients treated with a combination of submethylation based on age or MGMT.

50 patients followed up for 4.8-39.6 months after proton reion radiation therapy, with a median follow-up time of 14.3 months. the OS rates for the 12 and 18 months of
were 87.8% (95% CI, 77.6%-98.0%) and 72.8% (95% CI, 56.7%-88.9%), respectively; The Non-ProgressLess Survival (PFS) rates were 74.2% (95% CI, 60.9%-87.5%) and 59.8% (95% CI, 43.1%-76.5%) respectively (Figure 1). The 12-month and 18-month OS rates were 77.4% and 61% respectively for patients with
HGG, and 61.3% and 42.7% respectively.
and WHO Grade III tumor patients had 100% OS and PFS rates for 12 and 18 months.
Figure 1. The total lifetime (A) and no progression survival (B) curves of HGG patients after proton heavy ion therapy.

results
follow-up results after radiotherapy found significant local necrosis or progression in 12 patients' particle radiotherapy areas.
3 patients with the recurrence of tumors outside the radiation treatment area, but none of them had recurrence sours of the limbic tumor in the radiation treatment area.
1 patient was diagnosed with disease progression on MRI imaging 6 months after particle radiation therapy, and then surgically removed, and a pathological examination confirmed the false progression.

29 patients developed level 1 dermatitis or hair loss during particle radiotherapy.
seven cases of false progression, followed by a decline or pathological confirmation of the false progression.
in addition, 6 cases of advanced radionesic necrosis of level 1 and 5 of 2 occurred in 11 patients, while no acute or late-stage radioactive toxicreactions of level s3, 4 and 5 were observed.
single-variable log-rank test analysis shows that age (?50: 50 years old), WHO grading (3:4) and Karnofsky score (-80:80) are significant factors in predicting OS rates.
IDH mutants and WHO grading are significant in predicting PFS.
in addition, MGMT initiation submethylation, functional status, and age have trends in predicting PFS.
multivariate analysis did not find significant factors predicting PFS or OS.

Conclusion Finally, the authors point out that the 18-month OS rate and PFS rate were 72.8% and 59.8% in patients with HGG treatment with a dose of 60Gyin in combination with dymomine, respectively;
, proton heavy ion particle radiotherapy is a safe and potentially effective means of treating high-level gliomas.
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