An Update From the Pediatric Proton Consortium Registry

Hess, Clayton B.; Indelicato, Daniel J.; Paulino, Arnold C.; Hartsell, William F.; Hill‐Kayser, Christine; Perkins, Stephanie M.; Mahajan, Anita; Laack, Nadia N.; Ermoian, Ralph; Chang, Andrew L.; Wolden, Suzanne L.; Mangona, V.S.; Kwok, Young; Breneman, John C.; Perentesis, John P.; Gallotto, Sara L.; Weyman, Elizabeth A.; Bajaj, B.; Lawell, Miranda P.; Yeap, Beow Y.; Yock, Torunn I.

doi:10.3389/fonc.2018.00165

Cited by 41 publications

(31 citation statements)

References 24 publications

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“…It is a concomitant focus on improving survival while optimizing quality of life that has spawned several ongoing efforts within the pediatric radiation oncology community. These include collaborations across institutions such as through the Pediatric Proton/Photon Consortium Registry (PPCR) [27,28] and Pediatric Normal Tissue Effects in the Clinic (PENTEC) [29], among others. Late effects stemming from RT for pediatric brain tumor patients are dependent on anatomic location of the radiation target and can include neurocognitive dysfunction, neuroendocrine dysfunction, ototoxicity, brainstem toxicity, alopecia, and second malignant and non-malignant neoplasms [3,5,9,[30][31][32][33][34].…”

Section: Late Effectsmentioning

confidence: 99%

Modern Radiotherapy for Pediatric Brain Tumors

DeNunzio

Yock

2020

Cancers

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Cancer is a leading cause of death in children with tumors of the central nervous system, the most commonly encountered solid malignancies in this population. Radiotherapy (RT) is an integral part of managing brain tumors, with excellent long-term survival overall. The tumor histology will dictate the volume of tissue requiring treatment and the dose. However, radiation in developing children can yield functional deficits and/or cosmetic defects and carries a risk of second tumors. In particular, children receiving RT are at risk for neurocognitive effects, neuroendocrine dysfunction, hearing loss, vascular anomalies and events, and psychosocial dysfunction. The risk of these late effects is directly correlated with the volume of tissue irradiated and dose delivered and is inversely correlated with age. To limit the risk of developing these late effects, improved conformity of radiation to the target volume has come from adopting a volumetric planning process. Radiation beam characteristics have also evolved to achieve this end, as exemplified through development of intensity modulated photons and the use of protons. Understanding dose limits of critical at-risk structures for different RT modalities is evolving. In this review, we discuss the physical basis of the most common RT modalities used to treat pediatric brain tumors (intensity modulated radiation therapy and proton therapy), the RT planning process, survival outcomes for several common pediatric malignant brain tumor histologies, RT-associated toxicities, and steps taken to mitigate the risk of acute and late effects from treatment.

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Section: Late Effectsmentioning

confidence: 99%

Modern Radiotherapy for Pediatric Brain Tumors

DeNunzio

Yock

2020

Cancers

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“…91 The European Particle Therapy Network (EPTN) is one example. 92 The preliminary results of the US Pediatric Proton Consortium Registry are promising, 93 and plans are underway to launch an International Pediatric Proton Therapy Consortium. 94 New PT centres such as the Christie Proton Therapy Centre in the United Kingdom exemplify the model of embedding clinical operations within a network of research and clinical trial units, supported by funding bodies that will allow for properly conducted trials and radiotherapy quality assurance.…”

Section: The Way Forwardmentioning

confidence: 99%

Particle therapy tumour outcomes: An updated systematic review

Hwang

Gorayski

et al. 2020

J Med Imag Rad Onc

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Particle therapy (PT) offers the potential for reduced normal tissue damage as well as escalation of target dose, thereby enhancing the therapeutic ratio in radiation therapy. Reflecting the building momentum of PT use worldwide, construction has recently commenced for The Australian Bragg Centre for Proton Therapy and Research in Adelaidethe first PT centre in Australia. This systematic review aims to update the clinical evidence base for PT, both proton beam and carbon ion therapy. The purpose is to inform clinical decision-making for referral of patients to PT centres in Australia as they become operational and overseas in the interim. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and thirty-six studies were included, two-thirds related to proton beam therapy alone. PT at the very least provides equivalent tumour outcomes compared to photon controls with the possibility of improved control in the case of carbon ion therapy. There is suggestion of reduced morbidities in a range of tumour sites, supporting the predictions from dosimetric modelling and the wide international acceptance of PT for specific indications based on this. Though promising, this needs to be counterbalanced by the overall low quality of evidence found, with 90% of studies of level IV (case series) evidence. Prospective comparative clinical trials, supplemented by database-derived outcome information, preferably conducted within international and national networks, are strongly recommended as PT is introduced into Australasia.

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“…In a recent study from the Pediatric Proton Consortium Registry, more than half of children treated with protons had brain tumors. For extracranial tumors, rhabdomyosarcoma was the most common tumor treated, and only 55 (3%) had a diagnosis of neuroblastoma . Because of the small number of patients treated with protons, limited data exist on the effectiveness of proton therapy for local control in neuroblastoma at both the primary and treated metastatic sites.…”

Section: Introductionmentioning

confidence: 99%

“…For extracranial tumors, rhabdomyosarcoma was the most common tumor treated, and only 55 (3%) had a diagnosis of neuroblastoma. 7 Because of the small number of patients treated with protons, limited data exist on the effectiveness of proton therapy for local control in neuroblastoma at both the primary and treated metastatic sites. The purpose of this study was to review the local control outcomes of children with high-risk and locally recurrent neuroblastoma treated at our proton facility.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of proton therapy in children with high‐risk and locally recurrent neuroblastoma

Bagley

Grosshans

Philip

et al. 2019

Pediatric Blood & Cancer

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Purpose Proton therapy is currently used in the management of pediatric tumors to decrease late toxicities. However, one of the criticisms of proton therapy is the limited data regarding efficacy on disease control. The purpose of this study was to examine local and distant control rates after proton therapy for neuroblastoma. Methods and materials Eighteen patients with high‐risk (n = 16) and locally recurrent neuroblastoma (n = 2) were treated with curative intent and received proton therapy to the primary site and up to three post‐induction MIBG‐avid metastatic sites. Primary sites (n = 18) were treated to 21–36 Gy (relative biological effectiveness [RBE]), and metastatic sites (n = 16) were treated to 21–24 Gy (RBE). Local control and survival rates were calculated using the Kaplan–Meier method. Results With a median follow‐up of 60.2 months, two‐ and five‐year local control rates at the irradiated primary site were 94% and 87%, respectively. No failures at irradiated distant metastatic sites were observed. The five‐year progression‐free survival (PFS) was 64%, and the five‐year overall survival (OS) was 94%. The extent of surgical resection was not associated with local control, PFS, or OS. No radiation‐related nephropathy or hepatopathy was reported. Conclusions Excellent local control was achieved using proton therapy to the primary and post‐induction MIBG‐positive distant sites. The predominant site of failure is progression in post‐induction non‐MIBG‐avid distant sites. Although proton therapy provides high rates of local control with acceptable toxicity for neuroblastoma, further advances in systemic therapy are needed for the improved control of systemic disease.

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An Update From the Pediatric Proton Consortium Registry

Cited by 41 publications

References 24 publications

Modern Radiotherapy for Pediatric Brain Tumors

Modern Radiotherapy for Pediatric Brain Tumors

Particle therapy tumour outcomes: An updated systematic review

Efficacy of proton therapy in children with high‐risk and locally recurrent neuroblastoma

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