Proton therapy for pediatric cranial tumors: Preliminary report on treatment and disease-related morbidities

Bruce Mcallister, John O. Archambeau, M. Connie Nguyen, Jerry D. Slater, Lilia Loredo, Reinhard Schulte, Ofelia Alvarez, Antranik A. Bedros, Thomas Kaleita, Michael Movers, Daniel Miller, James M. Slater

Research output: Contribution to journalArticle

55 Scopus citations

Abstract

Purpose: Accelerated protons were used in an attempt to limit treatment- related morbidity in children with tumors in or near the developing brain, by reducing the integral dose to adjacent normal tissues. Methods and Materials: Children treated with protons at Loma Linda University Medical Center between August 1991 and December 1994 were analyzed retrospectively. Twenty-eight children, aged 1 to 18 years, were identified as at risk for brain injury from treatment. Medical records, physical examinations, and correspondence with patients, their parents, and referring physicians were analyzed. The investigators tabulated post-treatment changes in pre-treatment signs and symptoms and made judgments as to whether improvement, no change, or worsening related to disease or treatment had supervened. Magnetic resonance images were correlated with clinical findings and radiographic impressions were tabulated. Results: Follow-up ranged from 7 to 49 months (median 25 months). Four instances of treatment-related morbidity were identified. Forty-one instances of site-specific, disease-related morbidity were identified: 15 improved or resolved and 26 remained unchanged after treatment. Four patients had radiographic evidence of local failure. Three of these patients, including two with high-grade glioma, have died. Conclusion: Early treatment-related morbidity associated with proton therapy is low. Tumor progression remains a problem when treating certain histologies such as high-grade glioma. Escalating the dose delivered to target volumes may benefit children with tumors associated with poor rates of local control. Long-term follow-up, including neurocognitive testing, is in progress to assess integral-dose effects on cognitive, behavioral and developmental outcomes in children with cranial tumors.

Original languageEnglish (US)
Pages (from-to)455-460
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume39
Issue number2 SUPPL.
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

Keywords

  • Br ain
  • Conformal
  • Fractionated
  • Pediatric
  • Precision
  • Proton
  • Radiation morbidity
  • Radiotherapy
  • Three- dimensional
  • Tumors

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

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    Mcallister, B., Archambeau, J. O., Nguyen, M. C., Slater, J. D., Loredo, L., Schulte, R., Alvarez, O., Bedros, A. A., Kaleita, T., Movers, M., Miller, D., & Slater, J. M. (1997). Proton therapy for pediatric cranial tumors: Preliminary report on treatment and disease-related morbidities. International Journal of Radiation Oncology Biology Physics, 39(2 SUPPL.), 455-460. https://doi.org/10.1016/S0360-3016(97)00079-5