Prospective analysis of radiation-induced contrast enhancement (RICE) and health-related quality of life following proton therapy for CNS and skull base tumors

Carola Lütgendorf-Caucig, Maciej Pelak*, Eugen Hug, Birgit Flechl, Birgit Surböck, Christine Marosi, Ulrike Mock, Leor Zach, Yael Mardor, Orit Furman, Harald Hentschel, Joanna Gora, Piero Fossati, Markus Stock, Uwe Graichen, Sascha Klee, Petra Georg

*Corresponding author for this work

Research output: Journal article (peer-reviewed)Journal article

Abstract

INTRODUCTION: Intracerebral radiation-induced contrast enhancement (RICE) can occur after photon as well as proton beam therapy (PBT). This study evaluated the incidence, characteristics and risk factors of RICE after PBT delivered to, or in direct proximity to, the brain and its impact on health-related quality of life (HRQoL).

MATERIAL AND METHOD: Four hundred and twenty-one patients treated by pencil beam-scanning PBT between 2017 and 2021 were included. Follow-up included clinical evaluation and contrast-enhanced MRI at 3, 6 and 12 months after treatment completion and annually thereafter. RICE was graded according to CTCAE v4 criteria and HRQoL parameters were assessed by EORTC-QLQ C30 questionnaires.

RESULTS: Median follow-up was 24 months (range: 6-54) and median dose to 1% relative volume of non-involved CNS (D1%CNS) was 54.3 Gy RBE (range 30-76 Gy RBE). The cumulative RICE incidence was 15% (n=63), of which 10.5% (n=44) were grade 1, 3.1% (n=13) were grade 2 and 1.4% (n=6) were grade 3. No grade 4 or 5 events were observed. Twenty-six out of 63 RICE (41.3%) had resolved at latest follow-up. The median onset following PBT and duration of RICE in patients in whom the lesions resolved were 11.8 and 9.0 months, respectively. On multivariable analysis, D1%CNS > 57.6 Gy RBE, previous in-field radiation and diabetes mellitus were identified as significant risk factors for RICE development. Previous radiation was the only factor influencing the risk of symptomatic RICE. Following PBT, general HRQoL parameters were not compromised. In a matched cohort analysis of 54/50 patients with and without RICE, no differences in global health score, functional and symptom scales were seen.

CONCLUSION: The overall incidence of clinically-relevant RICE following PBT is very low and has no significant negative impact on long-term patient QoL.

Original languageEnglish
JournalInternational Journal of Radiation Oncology Biology Physics
DOIs
Publication statusE-pub ahead of print - 18 Jan 2024

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