Long‐term follow‐up after proton beam therapy for pediatric tumors: a Japanese national survey

Mizumoto, Masashi; Murayama, Shigeyuki; Akimoto, Tetsuo; Demizu, Yusuke; Fukushima, Takashi; Ishida, Yuji; Oshiro, Yoshiko; Numajiri, Haruko; Fuji, Hiroshi; Okumura, Toshiyuki; Shirato, Hiroki; Sakurai, Hideyuki

doi:10.1111/cas.13140

Cited by 46 publications

(27 citation statements)

References 18 publications

(39 reference statements)

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“…Experiments by various groups [19,20] One centre has published a serious neurological toxicity (blindness and brain necrosis) of around 12.3% [30], a result that would be unacceptable after photon-based therapy. Also, long-term results of children treated with protons in Japan show significant grade 3 toxicities of 6%, 17% and 17% at five, ten and twenty years respectively [31].…”

Section: Radiobiological Data and Modellingmentioning

confidence: 99%

The Radiobiology of Proton Therapy: Challenges and Opportunities Around Relative Biological Effectiveness

2018

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With the current UK expansion of proton therapy there is a great opportunity for clinical oncologists to develop a translational interest in the associated scientific base and clinical results. In particular, the underpinning controversy regarding the conversion of photon dose to proton dose by the relative biological effectiveness (RBE) must be understood, including its important implications. At the present time, the proton prescribed dose includes an RBE of 1.1 regardless of tissue, tumour and dose fractionation. A body of data has emerged against this pragmatic approach, including a critique of the existing evidence base, due to choice of dose, use of only acute-reacting in vivo assays, analysis methods and the reference radiations used to determine the RBE. Modelling systems, based on the best available scientific evidence, and which include the clinically useful biological effective dose (BED) concept, have also been developed to estimate proton RBEs for different dose and linear energy transfer (LET) values. The latter reflect ionisation density, which progressively increases along each proton track. Late-reacting tissues, such as the brain, where α/β = 2 Gy, show a higher RBE than 1.1 at a low dose per fraction (1.2-1.8 Gy) at LET values used to cover conventional target volumes and can be much higher. RBE changes with tissue depth seem to vary depending on the method of beam delivery used. To reduce unexpected toxicity, which does occasionally follow proton therapy, a more rational approach to RBE allocation, using a variable RBE that depends on dose per fraction and the tissue and tumour radiobiological characteristics such as α/β, is proposed.

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Section: Radiobiological Data and Modellingmentioning

confidence: 99%

The Radiobiology of Proton Therapy: Challenges and Opportunities Around Relative Biological Effectiveness

2018

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“…In recent years, the number of general anesthesia has tended to increase in and outside of the operating room due to increase with an increase in cancer patients, with cerebrovascular disease and with changes of disease structure. While there are many reports on PBT showing high therapeutic results in cancer treatment (15,16), a high-level treatment plan is required for highly accurate treatment, which requires time for proper alignment, immobilization during irradiation, and general anesthesia or sedation to suppress body movement. Given that general anesthesia and sedation need to be performed several times daily, it is important to properly select subjects at risk.…”

Section: Discussionmentioning

confidence: 99%

Age as a decisive factor in general anesthesia use in pediatric proton beam therapy.

Shimazu

Otsuki

Murakani

et al. 2019

Preprint

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Background: Proton therapy for pediatric cancer patients is effective treatments. Young children have difficulties staying still during irradiation, so general anesthesia is often required. This study investigated the indication for general anesthesia in pediatric proton therapy.Methods: We focused on cancer patients under 15 years old who underwent proton therapy at Southern TOHOKU General Hospital, Fukushima, Japan from April 2016 to December 2018. Background information and anesthesia/treatment protocols were retrospectively extracted from the electronic medical record. The anesthesia and non-anesthesia group were compared to evaluate factors determining the need for general anesthesia .Results: We analyzed 32 patients who received 285 irradiations. The median age was 5 years old (range: 1–15), and 13 patients (40.6%) were female. Twelve (37.5%) patients were treated with general anesthesia. In the general anesthesia group, airway management using laryngeal mask was performed in 11 patients (91.6%). Age was significantly lower in the general anesthesia group than in the non-anesthetized group (p < 0.001). Considering all background factors, only age was strongly associated with anesthesia in the univariate logistic regression models: odds ratio 0.55 [95% confidence interval 0.35–0.86] (P < 0.01). Adverse events included nausea and vomiting during and after irradiation, and no fatal complications were observed.Conclusion: Age is one of the most important factors determining the need for general anesthesia for PBT in children. it will be necessary to determine the guidelines for accumulation and collection of data between institutions and the indication of general anesthesia/sedation for radiation therapy including PBT.

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“…PBT for a pediatric tumor is mainly used to reduce late toxicity and secondary cancer [19] [20]. For pediatric chordoma, the dose of PBT is high and longer survival is likely, which further emphasizes the need for longer follow-up.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Result of Hyperfractionated High-Dose Proton Beam Radiotherapy for Pediatric Skull Base Chordomas

Mizumoto¹,

Akutsu²,

Yamamoto³

et al. 2017

JCT

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Objective: Proton beam therapy (PBT) may provide good local control for skull base chordoma and reduced toxicities, especially for pediatric patients. Methods: We evaluated the efficacy and safety of hyperfractionated high-dose PBT in6 pediatric patients with newly-diagnosed skull basechordoma who were treated with PBT at our institute from 2011 to 2015. The patients were 5 males and one female, and the median age was 9 years old (range: 5 -13). All patients received surgery before PBT. The median period between surgery and PBT was 57 days (range: 34 -129 days). The treatment dose was 78.4 GyE in 56 fractions (twice per day). Results: All patients received PBT without severe acute toxicity. The median follow-up period was 27 months (range: 21 -71 months). At the last follow-up, all patients were alive and all tumors were well controlled. Acute and late toxicities were generally acceptable, with only grade 1 and 2 events. Late toxicities included growth hormone abnormality and cortical hormone abnormality. One patient needed growth hormone and cortical hormone replacement therapy. Conclusion: Although the number of pediatric patients was small, our overall findings in the 6 cases indicate that hyperfractionated high-dose PBT is safe and effective for pediatric patients with skull base chordoma.

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Long‐term follow‐up after proton beam therapy for pediatric tumors: a Japanese national survey

Cited by 46 publications

References 18 publications

The Radiobiology of Proton Therapy: Challenges and Opportunities Around Relative Biological Effectiveness

The Radiobiology of Proton Therapy: Challenges and Opportunities Around Relative Biological Effectiveness

Age as a decisive factor in general anesthesia use in pediatric proton beam therapy.

Preliminary Result of Hyperfractionated High-Dose Proton Beam Radiotherapy for Pediatric Skull Base Chordomas

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