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A Retrospective Evaluation of the Benefit of Referring Pediatric Cancer Patients to an External Proton Therapy Center

Munck af Rosenschold, Per LU orcid ; Engelholm, Svend A. ; Brodin, Patrik N. ; Jørgensen, Morten ; Grosshans, David R. ; Zhu, Ronald X. ; Palmer, Matthew ; Crawford, Cody N. and Mahajan, Anita (2016) In Pediatric Blood and Cancer 63(2). p.262-269
Abstract

Background: Pediatric cancer patients requiring radiation therapy (RT) have been routinely assessed and referred to proton therapy (PT) at an external institution. The benefit of the delivered PT compared to the state-of-the-art intensity modulated x-ray RT (XT) at the home institution was evaluated. Procedure: Twenty-four consecutive children referred for PT during 2010–2013 for craniospinal (CSI, n = 10), localized intracranial (IC, n = 7), head/neck (HN, n = 4) or parameningeal (PM, n = 3) lesions were included. The median age was 8 years (2–16 years). XT plans were generated for each patient, blinded to the PT delivered. Dosimetry, estimated growth hormone deficiency (GHD), and neurocognitive dysfunction (NCD) risks were compared... (More)

Background: Pediatric cancer patients requiring radiation therapy (RT) have been routinely assessed and referred to proton therapy (PT) at an external institution. The benefit of the delivered PT compared to the state-of-the-art intensity modulated x-ray RT (XT) at the home institution was evaluated. Procedure: Twenty-four consecutive children referred for PT during 2010–2013 for craniospinal (CSI, n = 10), localized intracranial (IC, n = 7), head/neck (HN, n = 4) or parameningeal (PM, n = 3) lesions were included. The median age was 8 years (2–16 years). XT plans were generated for each patient, blinded to the PT delivered. Dosimetry, estimated growth hormone deficiency (GHD), and neurocognitive dysfunction (NCD) risks were compared for PT and XT (Wilcoxon). Results: PT started (median) 5 weeks (± 1.3 weeks, 95% CI) after referral. For CSI patients, PT was clearly superior to XT plans with median dose reductions for the heart, lungs and thyroid of 17, 2.5 and 18 Gy, respectively (P = 0.005). The median estimated NCD and GHD risks were 1–3 (max 16) and 2 (max 61) percentage points, respectively, lower for PT compared to XT. The median of the mean doses to the brain, cochleae and pituitary gland was lower with PT than XT for the IC, H/N and PM patients (P < 0.039). For a single IC patient, the dose to hippocampi and optic chiasm was higher for PT compared to XT. Conclusions: PT clearly benefitted the patients studied, except for IC disease where differences between PT and XT were modest, and comparative PT and XT treatment planning is warranted prior to referral.

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author
; ; ; ; ; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
neurocognitive dysfunction, pediatric cancer, proton therapy, radiation therapy, radiobiological risk estimates
in
Pediatric Blood and Cancer
volume
63
issue
2
pages
262 - 269
publisher
John Wiley & Sons Inc.
external identifiers
  • pmid:26397177
  • scopus:84945280963
ISSN
1545-5009
DOI
10.1002/pbc.25768
language
English
LU publication?
no
additional info
Publisher Copyright: © 2015 Wiley Periodicals, Inc.
id
3c7dad46-f2cb-4523-8202-a1d04b8788b1
date added to LUP
2023-07-19 17:07:33
date last changed
2024-02-03 15:18:57
@article{3c7dad46-f2cb-4523-8202-a1d04b8788b1,
  abstract     = {{<p>Background: Pediatric cancer patients requiring radiation therapy (RT) have been routinely assessed and referred to proton therapy (PT) at an external institution. The benefit of the delivered PT compared to the state-of-the-art intensity modulated x-ray RT (XT) at the home institution was evaluated. Procedure: Twenty-four consecutive children referred for PT during 2010–2013 for craniospinal (CSI, n = 10), localized intracranial (IC, n = 7), head/neck (HN, n = 4) or parameningeal (PM, n = 3) lesions were included. The median age was 8 years (2–16 years). XT plans were generated for each patient, blinded to the PT delivered. Dosimetry, estimated growth hormone deficiency (GHD), and neurocognitive dysfunction (NCD) risks were compared for PT and XT (Wilcoxon). Results: PT started (median) 5 weeks (± 1.3 weeks, 95% CI) after referral. For CSI patients, PT was clearly superior to XT plans with median dose reductions for the heart, lungs and thyroid of 17, 2.5 and 18 Gy, respectively (P = 0.005). The median estimated NCD and GHD risks were 1–3 (max 16) and 2 (max 61) percentage points, respectively, lower for PT compared to XT. The median of the mean doses to the brain, cochleae and pituitary gland was lower with PT than XT for the IC, H/N and PM patients (P &lt; 0.039). For a single IC patient, the dose to hippocampi and optic chiasm was higher for PT compared to XT. Conclusions: PT clearly benefitted the patients studied, except for IC disease where differences between PT and XT were modest, and comparative PT and XT treatment planning is warranted prior to referral.</p>}},
  author       = {{Munck af Rosenschold, Per and Engelholm, Svend A. and Brodin, Patrik N. and Jørgensen, Morten and Grosshans, David R. and Zhu, Ronald X. and Palmer, Matthew and Crawford, Cody N. and Mahajan, Anita}},
  issn         = {{1545-5009}},
  keywords     = {{neurocognitive dysfunction; pediatric cancer; proton therapy; radiation therapy; radiobiological risk estimates}},
  language     = {{eng}},
  month        = {{02}},
  number       = {{2}},
  pages        = {{262--269}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Pediatric Blood and Cancer}},
  title        = {{A Retrospective Evaluation of the Benefit of Referring Pediatric Cancer Patients to an External Proton Therapy Center}},
  url          = {{http://dx.doi.org/10.1002/pbc.25768}},
  doi          = {{10.1002/pbc.25768}},
  volume       = {{63}},
  year         = {{2016}},
}