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Complications after proton radiotherapy in children, focusing on severe late complications. A complete Swedish cohort 2008–2019

Martinsson, Ulla ; Svärd, Anna Maja ; Witt Nyström, Petra ; Embring, Anna ; Asklid, Anna ; Agrup, Måns ; Haugen, Hedda ; Fröjd, Charlotta ; Engellau, Jacob LU and Nilsson, Martin P. LU , et al. (2023) In Acta Oncologica 62(10). p.1348-1356
Abstract

Background: Proton radiotherapy (RT) is an attractive tool to deliver local therapy with minimal dose to uninvolved tissue, however, not suitable for all patients. The aim was to explore complications, especially severe late complications (grades 3–4), following proton RT delivered to a complete Swedish cohort of paediatric patients aged <18 years treated 2008–2019. Material and Methods: Data was downloaded from a national registry. Complications with a possible causation with RT are reported. Proton treatments until July 2015 was performed with a fixed horizontal 172 MeV beam (The Svedberg Laboratory (TSL), Uppsala) in a sitting position and thereafter with gantry-based pencil-beam scanning technique (Skandion Clinic, Uppsala) in a... (More)

Background: Proton radiotherapy (RT) is an attractive tool to deliver local therapy with minimal dose to uninvolved tissue, however, not suitable for all patients. The aim was to explore complications, especially severe late complications (grades 3–4), following proton RT delivered to a complete Swedish cohort of paediatric patients aged <18 years treated 2008–2019. Material and Methods: Data was downloaded from a national registry. Complications with a possible causation with RT are reported. Proton treatments until July 2015 was performed with a fixed horizontal 172 MeV beam (The Svedberg Laboratory (TSL), Uppsala) in a sitting position and thereafter with gantry-based pencil-beam scanning technique (Skandion Clinic, Uppsala) in a supine position. Results: 219 courses of proton RT (77 at TSL and 142 at Skandion) were delivered to 212 patients (mean age 9.2 years) with various tumour types (CNS tumours 58%, sarcomas 26%, germ cell tumours 7%). Twenty-five patients had severe acute complications (skin, mucous membrane, pharynx/oesophagus, larynx, upper gastrointestinal canal, lower gastrointestinal canal, eyes, ears). Fifteen patients had severe late complications; with increased proportion over time: 4% at 1-year follow-up (FU), 5% at 3-year, 11% at 5-year. Organs affected were skin (1 patient), subcutaneous tissue (4), salivary glands (1), upper GI (1), bone (7), joints (2), CNS (2), PNS (1), eyes (1) and ears (5). Twenty-one of the 28 patients with 10-year FU had at least one late complication grades 1–4 and fourteen of them had more than one (2–5 each). Conclusion: The most important result of our study is the relatively low proportion of severe late complications, comparable with other proton studies on various tumours. Furthermore, the numbers of late complications are lower than our own data set on a mixed population of photon and proton treated paediatric patients, assuring the safety of using proton therapy also in the clinical practice.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adolescents, children, complications, late effects, Proton radiotherapy
in
Acta Oncologica
volume
62
issue
10
pages
9 pages
publisher
Taylor & Francis
external identifiers
  • pmid:37768736
  • scopus:85173932225
ISSN
0284-186X
DOI
10.1080/0284186X.2023.2260946
language
English
LU publication?
yes
id
3037ac26-017c-479e-b8b7-589b556e2091
date added to LUP
2023-12-22 15:02:10
date last changed
2024-04-21 00:18:03
@article{3037ac26-017c-479e-b8b7-589b556e2091,
  abstract     = {{<p>Background: Proton radiotherapy (RT) is an attractive tool to deliver local therapy with minimal dose to uninvolved tissue, however, not suitable for all patients. The aim was to explore complications, especially severe late complications (grades 3–4), following proton RT delivered to a complete Swedish cohort of paediatric patients aged &lt;18 years treated 2008–2019. Material and Methods: Data was downloaded from a national registry. Complications with a possible causation with RT are reported. Proton treatments until July 2015 was performed with a fixed horizontal 172 MeV beam (The Svedberg Laboratory (TSL), Uppsala) in a sitting position and thereafter with gantry-based pencil-beam scanning technique (Skandion Clinic, Uppsala) in a supine position. Results: 219 courses of proton RT (77 at TSL and 142 at Skandion) were delivered to 212 patients (mean age 9.2 years) with various tumour types (CNS tumours 58%, sarcomas 26%, germ cell tumours 7%). Twenty-five patients had severe acute complications (skin, mucous membrane, pharynx/oesophagus, larynx, upper gastrointestinal canal, lower gastrointestinal canal, eyes, ears). Fifteen patients had severe late complications; with increased proportion over time: 4% at 1-year follow-up (FU), 5% at 3-year, 11% at 5-year. Organs affected were skin (1 patient), subcutaneous tissue (4), salivary glands (1), upper GI (1), bone (7), joints (2), CNS (2), PNS (1), eyes (1) and ears (5). Twenty-one of the 28 patients with 10-year FU had at least one late complication grades 1–4 and fourteen of them had more than one (2–5 each). Conclusion: The most important result of our study is the relatively low proportion of severe late complications, comparable with other proton studies on various tumours. Furthermore, the numbers of late complications are lower than our own data set on a mixed population of photon and proton treated paediatric patients, assuring the safety of using proton therapy also in the clinical practice.</p>}},
  author       = {{Martinsson, Ulla and Svärd, Anna Maja and Witt Nyström, Petra and Embring, Anna and Asklid, Anna and Agrup, Måns and Haugen, Hedda and Fröjd, Charlotta and Engellau, Jacob and Nilsson, Martin P. and Isacsson, Ulf and Kristensen, Ingrid and Blomstrand, Malin}},
  issn         = {{0284-186X}},
  keywords     = {{adolescents; children; complications; late effects; Proton radiotherapy}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1348--1356}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Oncologica}},
  title        = {{Complications after proton radiotherapy in children, focusing on severe late complications. A complete Swedish cohort 2008–2019}},
  url          = {{http://dx.doi.org/10.1080/0284186X.2023.2260946}},
  doi          = {{10.1080/0284186X.2023.2260946}},
  volume       = {{62}},
  year         = {{2023}},
}