title: Proton therapy for low-grade gliomas: Results from a prospective trial.
abstract: BACKGROUND
  In this prospective study, the authors evaluated potential treatment toxicity and progression-free survival in patients with low-grade glioma who received treatment with proton radiation therapy.
  
  
  METHODS
  Twenty patients with World Health Organization grade 2 glioma who were eligible for radiation therapy were enrolled in a prospective, single-arm trial of proton therapy. The patients received proton therapy at a dose of 54 Gy (relative biological effectiveness) in 30 fractions. Comprehensive baseline and regular post-treatment evaluations of neurocognitive function, neuroendocrine function, and quality of life (QOL) were performed.
  
  
  RESULTS
  All 20 patients (median age, 37.5 years) tolerated treatment without difficulty. The median follow-up after proton therapy was 5.1 years. At baseline, intellectual functioning was within the normal range for the group and remained stable over time. Visuospatial ability, attention/working memory, and executive functioning also were within normal limits; however, baseline neurocognitive impairments were observed in language, memory, and processing speed in 8 patients. There was no overall decline in cognitive functioning over time. New endocrine dysfunction was detected in 6 patients, and all but 1 had received direct irradiation of the hypothalamic-pituitary axis. QOL assessment revealed no changes over time. The progression-free survival rate at 3 years was 85%, but it dropped to 40% at 5 years.
  
  
  CONCLUSIONS
  Patients with low-grade glioma tolerate proton therapy well, and a subset develops neuroendocrine deficiencies. There is no evidence for overall decline in cognitive function or QOL.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Shih
authors.forename: Janet C
authors.initials: JC
authors.lastname: Sherman
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Nachtigall
authors.forename: Mary K
authors.initials: MK
authors.lastname: Colvin
authors.forename: Barbara C
authors.initials: BC
authors.lastname: Fullerton
authors.forename: Juliane
authors.initials: J
authors.lastname: Daartz
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Winrich
authors.forename: Tracy T
authors.initials: TT
authors.lastname: Batchelor
authors.forename: Lauren T
authors.initials: LT
authors.lastname: Thornton
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Mancuso
authors.forename: Michele K
authors.initials: MK
authors.lastname: Saums
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Oh
authors.forename: William T
authors.initials: WT
authors.lastname: Curry
authors.forename: Jay S
authors.initials: JS
authors.lastname: Loeffler
authors.forename: Beow Y
authors.initials: BY
authors.lastname: Yeap
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology; D003071:Cognition / Q000528:radiation effects; D018572:Disease-Free Survival; D005260:Female; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011446:Prospective Studies; D061766:Proton Therapy / Q000009:adverse effects; D011788:Quality of Life; D011522:Protons
chemical_list: D011522:Protons
keywords: late effects; low-grade glioma; neurocognitive function; neuroendocrine function; pituitary function; proton radiation; proton therapy; quality of life