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@ARTICLE{Eichkorn:179932,
      author       = {T. Eichkorn and J. Bauer and E. Bahn$^*$ and J. W. Lischalk
                      and E. Meixner and E. Sandrini and S. Regnery and T. Held
                      and J. Hörner-Rieber$^*$ and M. Alber$^*$ and K. Herfarth
                      and J. Debus$^*$ and L. König and S. Harrabi},
      title        = {{R}adiation-induced contrast enhancement following proton
                      radiotherapy for low-grade glioma depends on tumor
                      characteristics and is rarer in children than adults.},
      journal      = {Radiotherapy and oncology},
      volume       = {172},
      issn         = {0167-8140},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2022-00981},
      pages        = {54-64},
      year         = {2022},
      note         = {Volume 172, July 2022, Pages 54-64},
      abstract     = {Proton beam radiotherapy (PRT) is used in the treatment of
                      low-grade glioma (LGG) to mitigate long-term sequelae.
                      Following PRT, increased rates of radiation-induced contrast
                      enhancements (RICE) are suspected but poorly understood.We
                      analyzed consecutive 227 patients (42 children and 185
                      adults) treated with PRT (54Gy RBE) for LGG from 2010 to
                      2020 and followed with serial clinical exams and magnetic
                      resonance imaging for in median 5.6 years.Tumors were graded
                      WHO 1 in a minority (n = 22, $12\%)$ of adults, but a
                      majority of children (n = 29, $69\%).$ In contrast, tumors
                      were graded WHO 2 in the majority (n = 160, $87\%)$ of
                      adults and a minority of children (n = 10, $24\%).$
                      Five-year overall survival following PRT was $81\%$ in
                      adults and $91\%$ in children. The risk of RICE was 5-fold
                      more frequent in adults $(25\%)$ versus children $(5\%)$ (p
                      = 0.0043). In children and adults, RICE were symptomatic in
                      $50\%$ and $55\%$ (n=1 and 26) of cases with CTCAE grade 0
                      in $47\%$ (n=23), grade 1 in $25\%$ (n=12), $0\%$ grade 2
                      (n=0) and $29\%$ grade 3 (n=14), respectively. In adults,
                      RICE risk was associated to WHO grading $(8\%$ in WHO grade
                      1 vs. $24\%$ in WHO grade 2, p = 0.026), independent of age
                      (p=0.44) and irradiation dose (p=0.005), but not independent
                      of IDH mutational status.These data demonstrate
                      effectiveness of PRT for LGG in both children and adults.
                      The RICE risk is lower in children which are a main target
                      group for PRT and differs with WHO grading.},
      keywords     = {Low-grade glioma (Other) / Pediatrics (Other) / Proton
                      radiotherapy (Other) / Pseudoprogression/Radiation necrosis
                      (Other) / Radiation-induced contrast enhancements (RICE)
                      (Other)},
      cin          = {E010 / E050 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)E010-20160331 / I:(DE-He78)E050-20160331 /
                      I:(DE-He78)HD01-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:35568281},
      doi          = {10.1016/j.radonc.2022.05.005},
      url          = {https://inrepo02.dkfz.de/record/179932},
}