Salvage Boron Neutron Capture Therapy for Malignant Brain Tumor Patients in Compliance with Emergency and Compassionate Use: Evaluation of 34 Cases in Taiwan
2021
Yi-Wei Chen | Yi-Yen Lee | Chun-Fu Lin | Po-Shen Pan | Jen-Kun Chen | Chun-Wei Wang | Shih-Ming Hsu | Yu-Cheng Kuo | Tien-Li Lan | Sanford P. C. Hsu | Muh-Lii Liang | Robert Hsin-Hung Chen | Feng-Chi Chang | Chih-Chun Wu | Shih-Chieh Lin | Hsiang-Kuang Liang | Jia-Cheng Lee | Shih-Kuan Chen | Hong-Ming Liu | Jinn-Jer Peir | Ko-Han Lin | Wen-Sheng Huang | Kuan-Hsuan Chen | Yu-Mei Kang | Shueh-Chun Liou | Chun-Chieh Wang | Ping-Ching Pai | Chih-Wei Li | Daniel Quah Song Chiek | Tai-Tong Wong | Shih-Hwa Chiou | Yee Chao | Hiroki Tanaka | Fong-In Chou | Koji Ono
Although boron neutron capture therapy (BNCT) is a promising treatment option for malignant brain tumors, the optimal BNCT parameters for patients with immediately life-threatening, end-stage brain tumors remain unclear. We performed BNCT on 34 patients with life-threatening, end-stage brain tumors and analyzed the relationship between survival outcomes and BNCT parameters. Before BNCT, MRI and <sup>18</sup>F-BPA-PET analyses were conducted to identify the tumor location/distribution and the tumor-to-normal tissue uptake ratio (T/N ratio) of <sup>18</sup>F-BPA. No severe adverse events were observed (grade ≥ 3). The objective response rate and disease control rate were 50.0% and 85.3%, respectively. The mean overall survival (OS), cancer-specific survival (CSS), and relapse-free survival (RFS) times were 7.25, 7.80, and 4.18 months, respectively. Remarkably, the mean OS, CSS, and RFS of patients who achieved a complete response were 17.66, 22.5, and 7.50 months, respectively. Kaplan–Meier analysis identified the optimal BNCT parameters and tumor characteristics of these patients, including a T/N ratio ≥ 4, tumor volume < 20 mL, mean tumor dose ≥ 25 Gy-E, MIB-1 ≤ 40, and a lower recursive partitioning analysis (RPA) class. In conclusion, for malignant brain tumor patients who have exhausted all available treatment options and who are in an immediately life-threatening condition, BNCT may be considered as a therapeutic approach to prolong survival.
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