A Retrospective Evaluation of the Benefit of Referring Pediatric Cancer Patients to an External Proton Therapy Center

Per Munck af Rosenschold, Svend A. Engelholm, Nils P. Brodin, Morten Jørgensen, David R. Grosshans, Ronald X. Zhu, Matthew Palmer, Cody N. Crawford, Anita Mahajan

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Pediatric cancer patients requiring radiation therapy (RT) have been routinely assessed and referred to proton therapy (PT) at an external institution. The benefit of the delivered PT compared to the state-of-the-art intensity modulated x-ray RT (XT) at the home institution was evaluated.

PROCEDURE: Twenty-four consecutive children referred for PT during 2010-2013 for craniospinal (CSI, n = 10), localized intracranial (IC, n = 7), head/neck (HN, n = 4) or parameningeal (PM, n = 3) lesions were included. The median age was 8 years (2-16 years). XT plans were generated for each patient, blinded to the PT delivered. Dosimetry, estimated growth hormone deficiency (GHD), and neurocognitive dysfunction (NCD) risks were compared for PT and XT (Wilcoxon).

RESULTS: PT started (median) 5 weeks (± 1.3 weeks, 95% CI) after referral. For CSI patients, PT was clearly superior to XT plans with median dose reductions for the heart, lungs and thyroid of 17, 2.5 and 18 Gy, respectively (P = 0.005). The median estimated NCD and GHD risks were 1-3 (max 16) and 2 (max 61) percentage points, respectively, lower for PT compared to XT. The median of the mean doses to the brain, cochleae and pituitary gland was lower with PT than XT for the IC, H/N and PM patients (P < 0.039). For a single IC patient, the dose to hippocampi and optic chiasm was higher for PT compared to XT.

CONCLUSIONS: PT clearly benefitted the patients studied, except for IC disease where differences between PT and XT were modest, and comparative PT and XT treatment planning is warranted prior to referral.

Original languageEnglish (US)
Pages (from-to)262-269
Number of pages8
JournalPediatric blood & cancer
Volume63
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Proton Therapy
Pediatrics
Neoplasms
Growth Hormone
Radiotherapy
Referral and Consultation
Optic Chiasm
Cochlea
Pituitary Gland

Keywords

  • neurocognitive dysfunction
  • pediatric cancer
  • proton therapy
  • radiation therapy
  • radiobiological risk estimates

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Munck af Rosenschold, P., Engelholm, S. A., Brodin, N. P., Jørgensen, M., Grosshans, D. R., Zhu, R. X., ... Mahajan, A. (2016). A Retrospective Evaluation of the Benefit of Referring Pediatric Cancer Patients to an External Proton Therapy Center. Pediatric blood & cancer, 63(2), 262-269. https://doi.org/10.1002/pbc.25768

A Retrospective Evaluation of the Benefit of Referring Pediatric Cancer Patients to an External Proton Therapy Center. / Munck af Rosenschold, Per; Engelholm, Svend A.; Brodin, Nils P.; Jørgensen, Morten; Grosshans, David R.; Zhu, Ronald X.; Palmer, Matthew; Crawford, Cody N.; Mahajan, Anita.

In: Pediatric blood & cancer, Vol. 63, No. 2, 01.02.2016, p. 262-269.

Research output: Contribution to journalArticle

Munck af Rosenschold, P, Engelholm, SA, Brodin, NP, Jørgensen, M, Grosshans, DR, Zhu, RX, Palmer, M, Crawford, CN & Mahajan, A 2016, 'A Retrospective Evaluation of the Benefit of Referring Pediatric Cancer Patients to an External Proton Therapy Center', Pediatric blood & cancer, vol. 63, no. 2, pp. 262-269. https://doi.org/10.1002/pbc.25768
Munck af Rosenschold, Per ; Engelholm, Svend A. ; Brodin, Nils P. ; Jørgensen, Morten ; Grosshans, David R. ; Zhu, Ronald X. ; Palmer, Matthew ; Crawford, Cody N. ; Mahajan, Anita. / A Retrospective Evaluation of the Benefit of Referring Pediatric Cancer Patients to an External Proton Therapy Center. In: Pediatric blood & cancer. 2016 ; Vol. 63, No. 2. pp. 262-269.
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AU - Grosshans, David R.

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N2 - BACKGROUND: Pediatric cancer patients requiring radiation therapy (RT) have been routinely assessed and referred to proton therapy (PT) at an external institution. The benefit of the delivered PT compared to the state-of-the-art intensity modulated x-ray RT (XT) at the home institution was evaluated.PROCEDURE: Twenty-four consecutive children referred for PT during 2010-2013 for craniospinal (CSI, n = 10), localized intracranial (IC, n = 7), head/neck (HN, n = 4) or parameningeal (PM, n = 3) lesions were included. The median age was 8 years (2-16 years). XT plans were generated for each patient, blinded to the PT delivered. Dosimetry, estimated growth hormone deficiency (GHD), and neurocognitive dysfunction (NCD) risks were compared for PT and XT (Wilcoxon).RESULTS: PT started (median) 5 weeks (± 1.3 weeks, 95% CI) after referral. For CSI patients, PT was clearly superior to XT plans with median dose reductions for the heart, lungs and thyroid of 17, 2.5 and 18 Gy, respectively (P = 0.005). The median estimated NCD and GHD risks were 1-3 (max 16) and 2 (max 61) percentage points, respectively, lower for PT compared to XT. The median of the mean doses to the brain, cochleae and pituitary gland was lower with PT than XT for the IC, H/N and PM patients (P < 0.039). For a single IC patient, the dose to hippocampi and optic chiasm was higher for PT compared to XT.CONCLUSIONS: PT clearly benefitted the patients studied, except for IC disease where differences between PT and XT were modest, and comparative PT and XT treatment planning is warranted prior to referral.

AB - BACKGROUND: Pediatric cancer patients requiring radiation therapy (RT) have been routinely assessed and referred to proton therapy (PT) at an external institution. The benefit of the delivered PT compared to the state-of-the-art intensity modulated x-ray RT (XT) at the home institution was evaluated.PROCEDURE: Twenty-four consecutive children referred for PT during 2010-2013 for craniospinal (CSI, n = 10), localized intracranial (IC, n = 7), head/neck (HN, n = 4) or parameningeal (PM, n = 3) lesions were included. The median age was 8 years (2-16 years). XT plans were generated for each patient, blinded to the PT delivered. Dosimetry, estimated growth hormone deficiency (GHD), and neurocognitive dysfunction (NCD) risks were compared for PT and XT (Wilcoxon).RESULTS: PT started (median) 5 weeks (± 1.3 weeks, 95% CI) after referral. For CSI patients, PT was clearly superior to XT plans with median dose reductions for the heart, lungs and thyroid of 17, 2.5 and 18 Gy, respectively (P = 0.005). The median estimated NCD and GHD risks were 1-3 (max 16) and 2 (max 61) percentage points, respectively, lower for PT compared to XT. The median of the mean doses to the brain, cochleae and pituitary gland was lower with PT than XT for the IC, H/N and PM patients (P < 0.039). For a single IC patient, the dose to hippocampi and optic chiasm was higher for PT compared to XT.CONCLUSIONS: PT clearly benefitted the patients studied, except for IC disease where differences between PT and XT were modest, and comparative PT and XT treatment planning is warranted prior to referral.

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