Treatment age and neurocognitive outcomes following proton beam radiotherapy for pediatric low‐ and intermediate‐grade gliomas

Heitzer, Andrew M.; Kahalley, Lisa S.; Minard, Charles G.; Stafford, Claire; Grosshans, David R.; Okcu, M. Fatih; Raghubar, Kimberly P.; Gragert, Marsha; McCurdy, Matthew R.; Warren, Emily; Gómez, J. Pastor; Ris, M. Douglas; Paulino, Arnold C.; Chintagumpala, Murali

doi:10.1002/pbc.29096

Cited by 3 publications

(2 citation statements)

References 15 publications

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“…The most frequent new high-grade neurotoxicity was memory impairment. Even if this is a well-described issue, incidences and methods of reporting differ within the literature [ 37 , 38 , 39 , 40 ]. Latest reviews suggest low incidences after focal PBT [ 41 ].…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Proton-beam radiotherapy can also be considered for these etiologies with comparable outcomes [122][123][124][125]. A recent study with a small cohort of 18 pediatric patients with LGGs showed no significant decline in neurocognitive function after proton radiotherapy [126].…”

Section: Low-grade Glioma and Benign Histologiesmentioning

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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Case report: Pediatric low-grade gliomas: a fine balance between treatment options, timing of therapy, symptom management and quality of life

Joh-Carnella,

Bauman,

Yock

et al. 2024

Front. Oncol.

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IntroductionPediatric low-grade gliomas (pLGG) are the most common brain tumor in children and encompass a wide range of histologies. Treatment may pose challenges, especially in those incompletely resected or those with multiple recurrence or progression.Case descriptionWe report the clinical course of a girl diagnosed with pilocytic astrocytoma and profound hydrocephalus at age 12 years treated with subtotal resection, vinblastine chemotherapy, and focal proton radiotherapy. After radiotherapy the tumor increased in enhancement temporarily with subsequent resolution consistent with pseudoprogression. Despite improvement in imaging and radiographic local control, the patient continues to have challenges with headaches, visual and auditory concerns, stroke-like symptoms, and poor quality of life.ConclusionpLGG have excellent long-term survival; thus, treatments should focus on maintaining disease control and limiting long-term toxicities. Various treatment options exist including surgery, chemotherapy, targeted agents, and radiation therapy. Given the morbidity associated with pLGG, individualized treatment approaches are necessary, with a multi-disciplinary approach to care focused on minimizing treatment side effects, and promoting optimal quality of life for patients.

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Treatment age and neurocognitive outcomes following proton beam radiotherapy for pediatric low‐ and intermediate‐grade gliomas

Cited by 3 publications

References 15 publications

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

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

Case report: Pediatric low-grade gliomas: a fine balance between treatment options, timing of therapy, symptom management and quality of life

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