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A B S T R A C T PurposeWe describe the health-related quality of life (HRQoL) of a cohort of children with brain tumors treated with proton radiotherapy. Patients and MethodsWe recruited 142 pediatric patients with brain tumors (age 2 to 18 years) and parents of such patients treated with proton radiation at Massachusetts General Hospital from 2004 to 2010. HRQoL was assessed using the PedsQL core, brain tumor, and cancer modules (range, 0 to 100). Assessments took place during radiation and annually thereafter. We examined correlations of HRQoL with disease, treatment, and cognitive and behavioral data. ResultsOverall reports of HRQoL during treatment were 74.8 and 78.1 for child self-report (CSR) and 67.0 and 74.8 for parent proxy report (PPR) for the core and brain tumor modules, respectively. PPR demonstrated lower HRQoL scores than CSR, but the two were highly correlated. Higher HRQoL scores were significantly associated with Wechsler Full Scale Intelligence Quotient scores (administered via the age-appropriate version) and better scores on two behavioral measures. Disease type also correlated with PPR core total HRQoL score at the beginning of treatment: medulloblastoma or primitive neuroectodermal tumors, 57.8; germ cell tumors, 63.5; ependymoma or high-grade glioma, 69.8; low-grade glioma, 71.5; and other low-grade neoplasms, 78.0 (P ϭ .001). Craniospinal irradiation and chemotherapy were negatively correlated with HRQoL. ConclusionThis is the first study to our knowledge of HRQoL in a cohort of children with brain tumors treated with proton radiation. This prospective study demonstrates the effect of disease type and intensity of treatment on HRQoL. It further suggests that where CSR is not possible, PPR is appropriate in most circumstances.

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BACKGROUND There are conflicting data regarding age as a prognostic factor in osteosarcoma. The authors conducted a study evaluating the impact of age on prognosis in children and young adults with osteosarcoma enrolled on North American cooperative group trials. METHODS Patients with high-grade osteosarcoma of any site enrolled on North American cooperative group trials CCG-7943, POG-9754, INT-0133, and AOST0121 were included in this study. Primary tumor site, age, sex, ethnicity, histologic response, and presence of metastatic disease at diagnosis were evaluated for their impact on overall survival (OS) and event-free survival (EFS). RESULTS A total of 1054 patients were eligible and had complete data available for the study. Age was not significantly associated with any other presenting covariate analyzed except sex. Age 18 or older was associated with a statistically significant poorer EFS (P = .019) and OS (P = .043). The 10-year EFS and OS in patients <10, 10 to 17, and ≥18 years old were 55%, 55%, 37% and 68%, 60%, 41%, respectively. The poorer EFS in patients ≥18 years old was because of an increased rate of relapse. Presence of metastatic disease at diagnosis, poor histologic response, and pelvic tumor site were also associated with a poorer prognosis. In multivariate analysis, age continued to be associated with poorer EFS (P = .019) and OS (P = .049). CONCLUSIONS In osteosarcoma, age 18 to 30 years is associated with a statistically significant poorer outcome because of an increased rate of relapse. Poorer outcome in adolescent and young adult patients is not explained by tumor location, histologic response, or metastatic disease at presentation.

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Median hypothalamic and pituitary radiation dose, younger age, and longer follow-up time were associated with increased rates of endocrinopathy in children and young adults treated with radiotherapy for brain tumors.

Proton radiotherapy may reduce the risk of some, but not all, radiation-associated late endocrine abnormalities.

Purpose To assess clinical outcome and the role of proton-therapy (PT) for local control (LC) of osteosarcoma (OSA). Methods All patients who received PT or mixed photon-proton radiotherapy from 1983–2009 at the Massachusetts General Hospital were reviewed. Criteria for PT were the need for high dose in the context of highly conformal radiotherapy of unresected or partially resected OSA, positive postoperative margins, postoperative imaging studies with macroscopic disease, or incomplete resection as defined by the surgeon. The primary endpoint was local control (LC) of the site treated; secondary endpoints were disease-free survival (DFS), overall survival (OS), long term toxicity, and prognostic factors associated with clinical outcome. Results 55 patients with a median age of 29 (2 to 76) were offered PT. The mean dose was 68.4 Gy, (standard deviation 5.4 Gy). 58.2% (11–100%) of the total dose was delivered with protons. LC after three and five years was 82 % and 72 %, respectively. The distant failure rate was 26% after three and five years. The five-year DFS was 65%, and the five-year OS was 67%. The extent of surgical resection did not correlate with outcome. Risk factors for local failure were ≥2 grade disease (p<0.0001) and total treatment length (p=0.008). Grade 3–4 late toxicity was seen in 30.1 % of patients. One patient died from treatment-associated acute lymphocytic leukemia, and one from secondary carcinoma of the maxilla. Conclusion PT to deliver high RT doses allows organ-preserving locally curative treatment with high doses for unresectable or incompletely resected OSA.