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Comparative proton and photon treatment plans in children treated for neuroblastoma

Embring, Anna ; Kristensen, Ingrid LU ; Nilsson, Martin P. LU ; Engellau, Jacob LU ; Blomstrand, Malin ; Fröjd, Charlotta ; Agrup, Måns ; Flejmer, Anna ; Svärd, Anna Maja and Asklid, Anna (2025) In Acta Oncologica 64. p.939-945
Abstract

Background and purpose: Neuroblastoma is the most common extracranial solid tumour in children. Radiotherapy is commonly part of the multimodal treatment for high-risk patients. The aim of this study is to analyse doses to organs at risk (OAR) in comparative proton and photon treatment plans for children treated for neuroblastoma and report side effects. Patient/material and methods: All children in Sweden treated with curative intent radiotherapy for abdominal neuroblastoma in 2017–2024 with comparative proton and photon treatment plans were retrospectively identified through a national registry (RADTOX), where data on side effects were collected. Doses to OAR were compared in each patient’s proton and photon treatment plans. Results:... (More)

Background and purpose: Neuroblastoma is the most common extracranial solid tumour in children. Radiotherapy is commonly part of the multimodal treatment for high-risk patients. The aim of this study is to analyse doses to organs at risk (OAR) in comparative proton and photon treatment plans for children treated for neuroblastoma and report side effects. Patient/material and methods: All children in Sweden treated with curative intent radiotherapy for abdominal neuroblastoma in 2017–2024 with comparative proton and photon treatment plans were retrospectively identified through a national registry (RADTOX), where data on side effects were collected. Doses to OAR were compared in each patient’s proton and photon treatment plans. Results: A total of 30 children with a median age of 45 months (range 11–150) were included. The lowdose spread was significantly lower in the proton compared to the photon treatment plans measured as Body V5Gy and V10Gy (p < 0.001). Furthermore, the mean doses to the bowel bag, kidneys, liver, pancreas, and spleen were significantly lower in the proton plans. The median follow-up was 14 months (1–61), and the 2-year overall survival was 75.3%. While acute radiotherapy related grade ≥ 2 side effects were experienced by 12 patients (40%), late side effects were experienced by 7 patients (13%). The most common side effects were haematological and from the upper gastrointestinal tract. Interpretation: In selected cases, proton treatment can offer lower doses to OAR and less low-dose exposure compared to photon treatment in children treated for abdominal neuroblastoma. Whether this translates into a clinical benefit is currently unclear and should be evaluated in future studies.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
adverse effects, Neuroblastoma, paediatrics, photons, protons, radiotherapy
in
Acta Oncologica
volume
64
pages
7 pages
publisher
Taylor & Francis
external identifiers
  • scopus:105012230083
  • pmid:40697182
ISSN
0284-186X
DOI
10.2340/1651-226X.2025.43865
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s).
id
5cb41e50-4a25-4bea-9cda-944185e82146
date added to LUP
2026-01-22 13:24:36
date last changed
2026-01-23 03:00:13
@article{5cb41e50-4a25-4bea-9cda-944185e82146,
  abstract     = {{<p>Background and purpose: Neuroblastoma is the most common extracranial solid tumour in children. Radiotherapy is commonly part of the multimodal treatment for high-risk patients. The aim of this study is to analyse doses to organs at risk (OAR) in comparative proton and photon treatment plans for children treated for neuroblastoma and report side effects. Patient/material and methods: All children in Sweden treated with curative intent radiotherapy for abdominal neuroblastoma in 2017–2024 with comparative proton and photon treatment plans were retrospectively identified through a national registry (RADTOX), where data on side effects were collected. Doses to OAR were compared in each patient’s proton and photon treatment plans. Results: A total of 30 children with a median age of 45 months (range 11–150) were included. The lowdose spread was significantly lower in the proton compared to the photon treatment plans measured as Body V5Gy and V10Gy (p &lt; 0.001). Furthermore, the mean doses to the bowel bag, kidneys, liver, pancreas, and spleen were significantly lower in the proton plans. The median follow-up was 14 months (1–61), and the 2-year overall survival was 75.3%. While acute radiotherapy related grade ≥ 2 side effects were experienced by 12 patients (40%), late side effects were experienced by 7 patients (13%). The most common side effects were haematological and from the upper gastrointestinal tract. Interpretation: In selected cases, proton treatment can offer lower doses to OAR and less low-dose exposure compared to photon treatment in children treated for abdominal neuroblastoma. Whether this translates into a clinical benefit is currently unclear and should be evaluated in future studies.</p>}},
  author       = {{Embring, Anna and Kristensen, Ingrid and Nilsson, Martin P. and Engellau, Jacob and Blomstrand, Malin and Fröjd, Charlotta and Agrup, Måns and Flejmer, Anna and Svärd, Anna Maja and Asklid, Anna}},
  issn         = {{0284-186X}},
  keywords     = {{adverse effects; Neuroblastoma; paediatrics; photons; protons; radiotherapy}},
  language     = {{eng}},
  pages        = {{939--945}},
  publisher    = {{Taylor & Francis}},
  series       = {{Acta Oncologica}},
  title        = {{Comparative proton and photon treatment plans in children treated for neuroblastoma}},
  url          = {{http://dx.doi.org/10.2340/1651-226X.2025.43865}},
  doi          = {{10.2340/1651-226X.2025.43865}},
  volume       = {{64}},
  year         = {{2025}},
}