Alireza Mansouri Highlights Proton vs. Photon Radiation Breakthrough in Leptomeningeal Disease
Alireza Mansouri, Associate Professor at Penn State Health, shared shared an article by Jonathan T. Yang et al. on LinkedIn, adding:
”Innovating in Oncology: Proton vs. Photon Radiation for Leptomeningeal Disease (LMD)
LMD poses a major challenge, with cancer spreading to the meninges around the brain and spine. In this phase 2 randomized trial from Memorial Sloan Kettering, proton craniospinal irradiation (CSI) was tested against conventional photon-involved field radiotherapy (IFRT). Proton CSI showed superior CNS progression-free survival and overall survival for solid tumor patients.
What makes protons potentially better? Their precise energy delivery stops at the tumor (via the Bragg peak), minimizing damage to healthy tissues compared to photons, which exit the body and can cause more toxicity. This enables comprehensive CSI with reduced risks.
Study highlights:
1. CNS progression strongly correlated with increased CNS-related deaths, underscoring the value of robust CNS control.
2. Younger age was associated with improved OS, outweighing factors like Karnofsky Performance Status (KPS) for patient functionality.
3. Lack of active systemic disease at baseline emerged as a key predictor of positive outcomes.
4. No association between baseline CSF circulating tumor DNA (ctDNA) levels/changes and treatment response – possibly due to the trial’s limited sample size. Other biomarkers, such as those from proteomics, might prove more effective.
5. A encouraging trend toward enhanced cognitive preservation with proton CSI, vital for patient quality of life!
Excited for the upcoming phase 3 trial through the NRG Oncology group (NCT06500481).
Note: An erratum is anticipated for the mislabeled Figure 2.
Thoughts on how this shapes future treatments?
Full article here.”
Title: Proton Craniospinal Irradiation for Patients With Leptomeningeal Metastasis
Authors: Jonathan T. Yang, Divya Yerramilli, Elena Pentsova, Suzanne Wolden, Robert J. Young, Denise D. Correa, Brandon S. Imber, N. Ari Wijetunga, Alexander G. Goglia, Zhigang Zhang, Junting Zheng, Raymond Baser, Ashley Bernstein, Leah Kratochvil, Julie Xiao, Jona Hattangadi-Gluth, Alexandra M. Miller, Jessica A. Wilcox, Allison Betof Warner, Helena Yu, Mark G. Kris, Andrew D. Seidman, Simon N. Powell, Adrienne Boire
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