Oncological Outcomes, Long-Term Toxicities, Quality of Life and Sexual Health after Pencil-Beam Scanning Proton Therapy in Patients with Low-Grade Glioma
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Study Design
2.3. Treatment and Follow-Up
2.4. Statistical Analysis
3. Results
3.1. Patient and Treatment Characteristics
3.2. Oncological Outcomes and Patterns of Failure
3.3. Toxicity
3.4. Quality of Life
3.5. Sexual Health
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Overall (N = 89) |
---|---|
Age | |
Median (IQR) in years | 25.4 (12.3–38.1) |
Sex | |
female | 49 (55.1%) |
male | 40 (44.9%) |
Subtype | |
Oligodendroglioma | 21 (23.6%) |
Astrocytoma | 27 (30.3%) |
Oligoastrocytoma | 2 (2.2%) |
Pilocytic | 21 (23.6%) |
Pilomyxoid | 6 (6.7%) |
Other/unknown | 12 (13.5%) |
WHO grade | |
2 | 58 (65.2%) |
1 | 17 (19.1%) |
Unknown or radiographically diagnosed | 14 (15.7%) |
Location | |
Frontotemporal | 31 (34.8%) |
Visual/thalamic | 43 (48.3%) |
Other | 15 (16.9%) |
Laterality | |
Right | 27 (30.3%) |
Left | 25 (28.1%) |
Central | 37 (41.6%) |
IDH status | |
Wild type | 4 (4.5%) |
Mutated | 47 (52.8%) |
Unknown | 38 (42.7%) |
1p19q status | |
Wild type | 18 (20.2%) |
Co-deleted | 17 (19.1%) |
Unknown | 54 (60.7%) |
Neurofibromatosis type 1 | |
No | 85 (95.5%) |
Yes | 4 (4.5%) |
Pathology confirmation | |
Radiological | 10 (11.2%) |
Biopsy | 18 (20.2%) |
Surgery | 61 (68.5%) |
Tumor type | |
Primary | 46 (51.7%) |
Recurrence/progression | 43 (48.3%) |
Treatment indication | |
Primary, definitive | 18 (20.2%) |
Primary, postoperative | 28 (31.5%) |
Recurrence/progression, definitive | 33 (37.1%) |
Recurrence/progression, postoperative | 10 (11.2%) |
Radiotherapy dose | |
Median (interquartile range; range) in Gy (RBE) | 54 (52.2–54; 46–64) |
Previous chemotherapy | |
No | 65 (73.0%) |
Yes | 24 (27.0%) |
Concomitant chemotherapy | |
No | 85 (95.5%) |
Yes | 4 (4.5%) |
Adjuvant chemotherapy | |
No | 61 (68.5%) |
Yes | 28 (31.5%) |
Current Study | Reference | |||||
---|---|---|---|---|---|---|
Total | Mean | Standard Deviation | Total | Mean | Standard Deviation | |
Sexual satisfaction | 14 | 44.86 | 22.77 | 152 | 42.80 | 26.39 |
Sexual pain | 12 | 6.57 | 13.79 | 151 | 19.98 | 27.50 |
Importance of sexual activity | 14 | 36.11 | 33.21 | 153 | 45.53 | 32.84 |
Decreased libido | 14 | 41.67 | 35.18 | 153 | 46.84 | 36.56 |
Worry incontinence | 14 | 13.89 | 26.43 | 154 | 17.97 | 29.80 |
Fatigue | 14 | 36.11 | 33.21 | 151 | 37.97 | 35.70 |
Treatment effect on sexuality | 13 | 30.56 | 33.21 | 152 | 51.32 | 39.47 |
Communication with professionals | 14 | 91.67 | 20.72 | 151 | 17.44 | 29.02 |
Insecurity with partner | 13 | 25.00 | 28.87 | 144 | 29.63 | 35.06 |
Confidence erection | 5 | 25.00 | 31.92 | 55 | 39.39 | 37.46 |
Body image (male) | 5 | 16.67 | 19.24 | 56 | 39.88 | 35.63 |
Vaginal dryness | 9 | 37.50 | 37.53 | 88 | 46.21 | 39.93 |
Body image female | 9 | 25.00 | 29.55 | 96 | 34.03 | 37.14 |
First Author, Year | Design | Patients | Main Inclusion Criteria | Median Follow-Up (Years) | Outcomes | Toxicity |
---|---|---|---|---|---|---|
Shih, 2015 [16] | Prospective single-arm | 20 | LGG WHO grade 2 ≥19 years of age No baseline cognitive deficits to compromise neurocognitive assessment No prior cranial irradiation | 5.1 | PFS at 3 years 85%, at 5 years 40% | No changes in QoL, cognitive function Baseline neurocognitive impairment in 8 patients New endocrine dysfunction in 6 patients |
Greenberger, 2014 [13] | Retrospective database | 32 | LGG WHO 1 and 2 Location in brain or spinal cord ≤21 years of age | 7.6 | PFS at 6 years 89.7%, at 8-year 82.8% OS at 8 years 100% | No significant declines in neurocognition Subgroup analysis indicated significant neurocognitive decline for young children (<7 years) and those with higher dose to the left temporal lobe/hippocampus |
Indelicato, 2019 [29] | Prospective single-arm | 174 | LGG WHO 1 and 2 Location in brain or spinal cord ≤21 years of age | 4.4 | 5-year actuarial local control 85% 5-year actuarial PFS 84% 5-year actuarial OS 92% | 4% of patients with serious toxicities, including brainstem necrosis requiring corticosteroids, symptomatic vasculopathy, radiation retinopathy, epilepsy, and death from radiation-induced high-grade glioma Central hormone deficiency in 39 patients |
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Willmann, J.; Leiser, D.; Weber, D.C. Oncological Outcomes, Long-Term Toxicities, Quality of Life and Sexual Health after Pencil-Beam Scanning Proton Therapy in Patients with Low-Grade Glioma. Cancers 2023, 15, 5287. https://doi.org/10.3390/cancers15215287
Willmann J, Leiser D, Weber DC. Oncological Outcomes, Long-Term Toxicities, Quality of Life and Sexual Health after Pencil-Beam Scanning Proton Therapy in Patients with Low-Grade Glioma. Cancers. 2023; 15(21):5287. https://doi.org/10.3390/cancers15215287
Chicago/Turabian StyleWillmann, Jonas, Dominic Leiser, and Damien Charles Weber. 2023. "Oncological Outcomes, Long-Term Toxicities, Quality of Life and Sexual Health after Pencil-Beam Scanning Proton Therapy in Patients with Low-Grade Glioma" Cancers 15, no. 21: 5287. https://doi.org/10.3390/cancers15215287