Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India

Abstract

PURPOSE Proton beam therapy (PBT) has been a preferred modality in pediatric malignancies requiring radiotherapy. We report our preliminary experience of treating consecutive patients younger than 25 years with image-guided pencil beam scanning PBT from the first and only center on the Indian subcontinent. METHODS Patients were selected for PBT on the basis of a multidisciplinary tumor board decision. Patient demographic data, as well as tumor and treatment-related characteristics of the cohort, were captured. Patient and treatment-related factors and their association with acute toxicities were analyzed using univariable and multivariable analyses. RESULTS Forty-seven patients (27 with CNS and 20 with non-CNS tumors) with a median age of 9 years (range, 2-25 years) were evaluated. Most common diagnoses were ependymoma, rhabdomyosarcoma, and glioma. Seventy-seven percent of patients traveled more than 500 km, and 70% of them lived in metropolitan cities. Forty-nine percent of patients had recurrent disease at presentation, and 15% had received a previous course of radiation. The median dose delivered was 54.8 cobalt gray equivalents (range, 40.0-70.4 cobalt gray equivalents) to a median clinical target volume of 175 mL (range, 18.7-3,083.0 mL), with 34% of patients requiring concurrent chemotherapy (CCT). Acute grade 2 and grade 3 dermatitis, mucositis, and hematologic toxicity was noted in 45% and 2%, 34% and 0%, and 38% and 30% of patients, respectively. Grade 2 fatigue was noted in 26% of patients. On multivariable analysis, for CNS tumors, both CCT and craniospinal irradiation were independently associated with ≥ 2 grade hematologic toxicity, whereas among non-CNS tumors, a clinical target volume > 150 mL was associated with ≥ 2 grade fatigue, head and neck irradiation was associated with ≥ 2 grade mucositis, and CCT was associated with grade ≥ 2 hematologic toxicity. CONCLUSION This study demonstrates safe implementation of a PBT program for children and young adults on the Indian subcontinent. Image-guided pencil beam scanning PBT in judiciously selected patients is feasible and can be delivered with acceptable acute toxicities.

Encouraging Early Outcomes with Image Guided Pencil Beam Proton Therapy for Cranio-Spinal Irradiation and Unique Considerations for Paediatric Population – First Report From India

“…As a rst modern proton therapy centre in South East Asia, we treated more than 500 patients over past two years and CNS tumours constituted maximum bulk of it. We have reported our preliminary experience in children and young adults (13,14).…”

Encouraging early outcomes with image guided pencil beam proton therapy for cranio-spinal irradiation: first report from India

“…As a first modern proton therapy centre in South East Asia, we treated more than 500 patients over past two years and CNS tumours constituted maximum bulk of it. We have reported our preliminary experience in children and young adults [15,16].…”

Clinical Profile, Patterns of Care and Outcomes of Childhood CNS Tumours in India

“…This is possible due to superior dose conformity and lower normal tissue dose, offering better Quality of Life (QoL) for childhood cancer patients and survivors [24]. Chilkuri et al demonstrated a low incidence of grade 3 acute toxicities despite a median dose of 54 CGE for CNS tumours with overall, 62%, 26%, and 0% of patients having grade 1, grade 2, and grade 3 fatigue, respectively [25].…”