Evaluation of dose, volume, and outcome in children with localized, intracranial ependymoma treated with proton therapy within the prospective KiProReg Study

Peters, Sarah; Merta, Julien; Schmidt, Letícia Petersen; Jazmati, Danny; Kramer, Paul H.; Blase, C.; Tippelt, Stephan; Fleischhack, Gudrun; Stock, Annika; Bison, Brigitte; Rutkowski, Stefan; Pietsch, Torsten; Kortmann, Rolf‐Dieter; Timmermann, Beate

doi:10.1093/neuonc/noab301

Cited by 14 publications

(6 citation statements)

References 40 publications

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“…9 Non-randomised PBT studies for 95 localised paediatric ependymoma have shown comparable disease outcomes to photon irradiation. [10][11][12] In the largest series to date reporting the long-term outcomes of PBT for 386 paediatric patients with ependymoma, the 7-year local control and overall survival rates were 77% and 82.2%, respectively. 10 Currently, there is no randomised evidence comparing PBT with photon irradiation for paediatric ependymomas.…”

Section: Discussionmentioning

confidence: 99%

“…The standard treatment for paediatric patients with intracranial ependymomas of WHO grade 2/3 is maximal safe resection followed by local radiation therapy 9 . Non‐randomised PBT studies for localised paediatric ependymoma have shown comparable disease outcomes to photon irradiation 10–12 . In the largest series to date reporting the long‐term outcomes of PBT for 386 paediatric patients with ependymoma, the 7‐year local control and overall survival rates were 77% and 82.2%, respectively 10 .…”

Section: Discussionmentioning

confidence: 99%

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Is proton beam therapy always better than photon irradiation? Lessons from two cases

Li,

Yeo,

Gunewardena

et al. 2024

J of Medical Radiation Sci

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Proton beam therapy (PBT) is increasingly used to treat cancers, especially in the paediatric and adolescent and young adult (AYA) population. As PBT becomes more accessible, determining when PBT should be used instead of photon irradiation can be difficult. There is a need to balance patient, tumour and treatment factors when making this decision. Comparing the dosimetry between these two modalities plays an important role in this process. PBT can reduce low to intermediate doses to organs at risk (OAR), but photon irradiation has its dosimetric advantages. We present two cases with brain tumours, one paediatric and one AYA, in which treatment plan comparison between photons and protons showed dosimetric advantages of photon irradiation. The first case was an 18‐month‐old child diagnosed with posterior fossa ependymoma requiring adjuvant radiotherapy. Photon irradiation using volumetric modulated arc therapy (VMAT) had lower doses to the hippocampi but higher doses to the pituitary gland. The second case was a 21‐year‐old with an optic pathway glioma. There was better sparing of the critical optic structures and pituitary gland using fractionated stereotactic radiation therapy over PBT. The dosimetric advantages of photon irradiation over PBT have been demonstrated in these cases. This highlights the role of proton‐to‐photon comparative treatment planning to better understand which patients might benefit from photon irradiation versus PBT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is proton beam therapy always better than photon irradiation? Lessons from two cases

Li,

Yeo,

Gunewardena

et al. 2024

J of Medical Radiation Sci

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“…Methods of treatment and data collection have been previously published [ 15 ]. Face-to-face FU consultations with a radiation oncologist were scheduled after three months and annually thereafter at our center.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, disease itself can lead to neurocognitive symptoms. All of these factors may influence the condition of the child before RT and need to be taken into account for treatment planning as well as dose prescription [ 15 ]. Possibilities for dose reductions need to be considered, but are limited in order not to compromise the aim of high survival outcomes [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Proton Beam Therapy for Pediatric Tumors of the Central Nervous System—Experiences of Clinical Outcome and Feasibility from the KiProReg Study

Peters

Frisch²,

Stock

et al. 2022

Cancers

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As radiotherapy is an important part of the treatment in a variety of pediatric tumors of the central nervous system (CNS), proton beam therapy (PBT) plays an evolving role due to its potential benefits attributable to the unique dose distribution, with the possibility to deliver high doses to the target volume while sparing surrounding tissue. Children receiving PBT for an intracranial tumor between August 2013 and October 2017 were enrolled in the prospective registry study KiProReg. Patient’s clinical data including treatment, outcome, and follow-up were analyzed using descriptive statistics, Kaplan–Meier, and Cox regression analysis. Adverse events were scored according to the Common Terminology Criteria for Adverse Events (CTCAE) 4.0 before, during, and after PBT. Written reports of follow-up imaging were screened for newly emerged evidence of imaging changes, according to a list of predefined keywords for the first 14 months after PBT. Two hundred and ninety-four patients were enrolled in this study. The 3-year overall survival of the whole cohort was 82.7%, 3-year progression-free survival was 67.3%, and 3-year local control was 79.5%. Seventeen patients developed grade 3 adverse events of the CNS during long-term follow-up (new adverse event n = 7; deterioration n = 10). Two patients developed vision loss (CTCAE 4°). This analysis demonstrates good general outcomes after PBT.

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“…The ongoing SIOP-EP-II will further characterize the safety and efficacy of a stereotactic boost (8 Gy in 2 fractions) to unresected ependymoma (NCT02265770). Proton radiotherapy has also been found to be safe and result in similar outcomes compared to photon radiotherapy [75][76][77]; however, long-term toxicities comparing the two modalities remain limited [78].…”

Section: Ependymomamentioning

confidence: 99%

Radiotherapy for Primary Pediatric Central Nervous System Malignancies: Current Treatment Paradigms and Future Directions

Liu,

Haas-Kogan,

Elhalawani

2023

Pediatr Neurosurg

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Background: Central nervous system tumors are the most common solid tumors in childhood. Treatment paradigms for pediatric central nervous system malignancies depend on elements including tumor histology, age of patient, and stage of disease. Radiotherapy is an important modality of treatment for many pediatric central nervous system malignancies. Summary: While radiation contributes to excellent overall survival rates for many patients, radiation also carries significant risks of long-term side effects including neurocognitive decline, hearing loss, growth impairment, neuroendocrine dysfunction, strokes, and secondary malignancies. In recent decades, clinical trials have demonstrated that with better imaging and staging along with more sophisticated radiation planning and treatment set-up verification, smaller treatment volumes can be utilized without decrement in survival. Furthermore, the development of intensity-modulated radiotherapy and proton-beam radiotherapy has greatly improved conformality of radiation. Key Messages: Recent changes in radiation treatment paradigms have decreased risks of short- and long-term toxicity for common histologies and in different age groups. Future studies will continue to develop novel radiation regimens to improve outcomes in aggressive central nervous system tumors, integrate molecular subtypes to tailor radiation treatment, and decrease radiation-associated toxicity for long-term survivors.

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Evaluation of dose, volume, and outcome in children with localized, intracranial ependymoma treated with proton therapy within the prospective KiProReg Study

Cited by 14 publications

References 40 publications

Is proton beam therapy always better than photon irradiation? Lessons from two cases

Is proton beam therapy always better than photon irradiation? Lessons from two cases

Proton Beam Therapy for Pediatric Tumors of the Central Nervous System—Experiences of Clinical Outcome and Feasibility from the KiProReg Study

Radiotherapy for Primary Pediatric Central Nervous System Malignancies: Current Treatment Paradigms and Future Directions

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