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Toussaint L, Matysiak W, Alapetite C, Aristu J, Bannink-Gawryszuk A, Bolle S, Bolsi A, Calvo F, Cerron Campoo F, Charlwood F, Demoor-Goldschmidt C, Doyen J, Drosik-Rutowicz K, Dutheil P, Embring A, Engellau J, Goedgebeur A, Goudjil F, Harrabi S, Kopec R, Kristensen I, Lægsdmand P, Lütgendorf-Caucig C, Meijers A, Mirandola A, Missohou F, Montero Feijoo M, Muren LP, Ondrova B, Orlandi E, Pettersson E, Pica A, Plaude S, Righetto R, Rombi B, Timmermann B, Van Beek K, Vela A, Vennarini S, Vestergaard A, Vidal M, Vondracek V, Weber DC, Whitfield G, Zimmerman J, Maduro JH, Lassen-Ramshad Y. Clinical practice in European centres treating paediatric posterior fossa tumours with pencil beam scanning proton therapy. Radiother Oncol 2024; 198:110414. [PMID: 38942120 DOI: 10.1016/j.radonc.2024.110414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/17/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND PURPOSE As no guidelines for pencil beam scanning (PBS) proton therapy (PT) of paediatric posterior fossa (PF) tumours exist to date, this study investigated planning techniques across European PT centres, with special considerations for brainstem and spinal cord sparing. MATERIALS AND METHODS A survey and a treatment planning comparison were initiated across nineteen European PBS-PT centres treating paediatric patients. The survey assessed all aspects of the treatment chain, including but not limited to delineations, dose constraints and treatment planning. Each centre planned two PF tumour cases for focal irradiation, according to their own clinical practice but based on common delineations. The prescription dose was 54 Gy(RBE) for Case 1 and 59.4 Gy(RBE) for Case 2. For both cases, planning strategies and relevant dose metrics were compared. RESULTS Seventeen (89 %) centres answered the survey, and sixteen (80 %) participated in the treatment planning comparison. In the survey, thirteen (68 %) centres reported using the European Particle Therapy Network definition for brainstem delineation. In the treatment planning study, while most centres used three beam directions, their configurations varied widely across centres. Large variations were also seen in brainstem doses, with a brainstem near maximum dose (D2%) ranging from 52.7 Gy(RBE) to 55.7 Gy(RBE) (Case 1), and from 56.8 Gy(RBE) to 60.9 Gy(RBE) (Case 2). CONCLUSION This study assessed the European PBS-PT planning of paediatric PF tumours. Agreement was achieved in e.g. delineation-practice, while wider variations were observed in planning approach and consequently dose to organs at risk. Collaboration between centres is still ongoing, striving towards common guidelines.
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Affiliation(s)
- Laura Toussaint
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus N, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus N, Denmark.
| | - Witold Matysiak
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Claire Alapetite
- Institut Curie, Department of Radiation Oncology & Proton Centre, Paris, France
| | - Javier Aristu
- Clínica Universidad de Navarra, Proton Therapy Unit, Madrid, Spain
| | - Agata Bannink-Gawryszuk
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Stephanie Bolle
- Institut Curie, Department of Radiation Oncology & Proton Centre, Paris, France; Institut Gustave Roussy, Department of Radiation Oncology, Villejuif, France; Centro de Protonterapia Quironsalud, Madrid, Spain
| | - Alessandra Bolsi
- Paul Scherrer Institute, Centre for Proton Therapy, ETH Domain, Villigen, Switzerland
| | - Felipe Calvo
- Clínica Universidad de Navarra, Proton Therapy Unit, Madrid, Spain
| | | | - Frances Charlwood
- University of Manchester, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Charlotte Demoor-Goldschmidt
- Centre Regional Francois Baclesse, Department of Radiation Oncology, Caen, France; Angers University Hospital, Department of Paediatric Oncology, Angers, France
| | - Jérôme Doyen
- Centre Antoine Lacassagne, Department of Radiation Oncology, Nice, France
| | - Katarzyna Drosik-Rutowicz
- National Research Institute of Oncology Kraków/Gliwice branch, Department of Radiation Oncology, Kraków, Poland
| | - Pauline Dutheil
- Centre Regional Francois Baclesse, Department of Radiation Oncology, Caen, France
| | - Anna Embring
- Karolinska University Hospital, Department of Radiotherapy, Stockholm, Sweden
| | - Jacob Engellau
- Skåne University Hospital, Hematology, Oncology and Radiation Physics, Lund, Sweden
| | - Anneleen Goedgebeur
- PARTICLE Proton Therapy Centre University Hospital Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Farid Goudjil
- Institut Curie, Department of Radiation Oncology & Proton Centre, Paris, France
| | - Semi Harrabi
- Heidelberg Ion Beam Therapy Centre, University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
| | - Renata Kopec
- Institute of Nuclear Physics, Polish Academy of Sciences, Kraków, Poland
| | - Ingrid Kristensen
- Skåne University Hospital, Hematology, Oncology and Radiation Physics, Lund, Sweden
| | - Peter Lægsdmand
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus N, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus N, Denmark
| | | | - Arturs Meijers
- Paul Scherrer Institute, Centre for Proton Therapy, ETH Domain, Villigen, Switzerland
| | - Alfredo Mirandola
- Radiation Oncology Unit, Clinical Department, National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Fernand Missohou
- Centre Regional Francois Baclesse, Department of Radiation Oncology, Caen, France
| | | | - Ludvig P Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus N, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus N, Denmark
| | - Barbora Ondrova
- Proton Therapy Centre Czech, Department of Radiation Oncology, Prague, Czech Republic
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy; University of Pavia, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, Pavia, Italy
| | - Erik Pettersson
- Sahlgrenska University Hospital, Department of Therapeutic Radiation Physics, Medical Physics and Biomedical Engineering, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Department of Medical Radiation Sciences, Gothenburg, Sweden
| | - Alessia Pica
- Paul Scherrer Institute, Centre for Proton Therapy, ETH Domain, Villigen, Switzerland
| | - Sandija Plaude
- West German Proton Therapy Centre Essen (WPE), Essen University Hospital, Essen, Germany
| | | | - Barbara Rombi
- Trento Proton Therapy Centre,epartment of Radiation Oncology, APSS Trento, Italy
| | - Beate Timmermann
- West German Proton Therapy Centre Essen (WPE), Essen University Hospital, Essen, Germany; Department of Particle Therapy, University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Karen Van Beek
- PARTICLE Proton Therapy Centre University Hospital Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Anthony Vela
- Centre Regional Francois Baclesse, Department of Radiation Oncology, Caen, France
| | - Sabina Vennarini
- Paediatric Radiotherapy Unit, IRCCS Foundation Institute of Cancer, Milano, Italy
| | - Anne Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus N, Denmark
| | - Marie Vidal
- Centre Antoine Lacassagne, Department of Radiation Oncology, Nice, France
| | - Vladimir Vondracek
- Proton Therapy Centre Czech, Department of Radiation Oncology, Prague, Czech Republic
| | - Damien C Weber
- Paul Scherrer Institute, Centre for Proton Therapy, ETH Domain, Villigen, Switzerland
| | - Gillian Whitfield
- University of Manchester, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; University of Manchester, Royal Manchester Children's Hospital, The Children's Brain Tumour Research Network, Manchester, United Kingdom
| | - Jens Zimmerman
- Karolinska University Hospital, Department of Radiotherapy Physics and Engineering, Stockholm, Sweden
| | - John H Maduro
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, Groningen, the Netherlands
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2
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Sienna J, Kahalley LS, Mabbott D, Grosshans D, Santiago AT, Paulino ADC, Merchant TE, Manzar GS, Dama H, Hodgson DC, Chintagumpala M, Okcu MF, Whitehead WE, Laperriere N, Ramaswamy V, Bartels U, Tabori U, Bennett JM, Das A, Craig T, Tsang DS. Proton Therapy Mediates Dose Reductions to Brain Structures Associated With Cognition in Children With Medulloblastoma. Int J Radiat Oncol Biol Phys 2024; 119:200-207. [PMID: 38040059 PMCID: PMC11023754 DOI: 10.1016/j.ijrobp.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/27/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE Emerging evidence suggests proton radiation therapy may offer cognitive sparing advantages over photon radiation therapy, yet dosimetry has not been compared previously. The purpose of this study was to examine dosimetric correlates of cognitive outcomes in children with medulloblastoma treated with proton versus photon radiation therapy. METHODS AND MATERIALS In this retrospective, bi-institutional study, dosimetric and cognitive data from 75 patients (39 photon and 36 proton) were analyzed. Doses to brain structures were compared between treatment modalities. Linear mixed-effects models were used to create models of global IQ and cognitive domain scores. RESULTS The mean dose and dose to 40% of the brain (D40) were 2.7 and 4.1 Gy less among proton-treated patients compared with photon-treated patients (P = .03 and .007, respectively). Mean doses to the left and right hippocampi were 11.2 Gy lower among proton-treated patients (P < .001 for both). Mean doses to the left and right temporal lobes were 6.9 and 7.1 Gy lower with proton treatment, respectively (P < .001 for both). Models of cognition found statistically significant associations between higher mean brain dose and reduced verbal comprehension, increased right temporal lobe D40 with reduced perceptual reasoning, and greater left temporal mean dose with reduced working memory. Higher brain D40 was associated with reduced processing speed and global IQ scores. CONCLUSIONS Proton therapy reduces doses to normal brain structures compared with photon treatment. This leads to reduced cognitive decline after radiation therapy across multiple intellectual endpoints. Proton therapy should be offered to children receiving radiation for medulloblastoma.
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Affiliation(s)
- Julianna Sienna
- Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.
| | - Lisa S Kahalley
- Division of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Donald Mabbott
- Department of Psychology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - David Grosshans
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anna Theresa Santiago
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gohar S Manzar
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hitesh Dama
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Murali Chintagumpala
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Mehmet Fatih Okcu
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - William E Whitehead
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie M Bennett
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anirban Das
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tim Craig
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Khan Q, Bowar B, Ismael H, Gainey J, Myers B, Dlouhy B, Hyer D, Grafft A, Khan M, Buatti JM, Kozak MM. Modern Radiation Treatment Planning Parameters and Outcomes in Pediatric Tectal Gliomas. Adv Radiat Oncol 2024; 9:101440. [PMID: 38778828 PMCID: PMC11110028 DOI: 10.1016/j.adro.2024.101440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/22/2023] [Indexed: 05/25/2024] Open
Abstract
Purpose Pediatric low-grade tectal gliomas are rare, indolent tumors of the brain stem. We reviewed outcomes of pediatric patients who received a diagnosis of low-grade tectal gliomas and report dosimetric parameters for those receiving radiation therapy (RT). Methods and Materials We retrospectively reviewed all pediatric patients (age <18 years) at our institution diagnosed with a low-grade glioma between 1993 and 2020 (n = 288). Twenty-three patients with tectal gliomas were identified. Patients who received RT (n = 8) had detailed dosimetric analyses performed. Doses to critical structures and any resulting toxicities were reviewed. Minimum follow-up was 2 years and complete follow-up was available for all patients. Results Twenty-three patients, with a median age of 8.9 years, were included (range, 0.5-16.2 years). At a median follow-up of 7.4 years (range, 2-24 years), all were alive at the end of the study period. Three patients (13%) were treated with upfront RT; none of these patients developed local failure (LF) after a median follow-up of 10.6 years. One patient was treated with upfront chemotherapy with no evidence of progression afterward. Nineteen patients were initially observed after diagnosis and 26% of them (n = 5) experienced local progression. All 5 were treated with salvage RT, with 1 patient requiring further treatment with chemotherapy. Fractionation schedules for patients undergoing upfront or salvage RT included 50.4 Gy in 28 fractions (n = 4), 54 Gy in 30 fractions (n = 2), and 51 Gy in 30 fractions (n = 2). For patients treated after 2007, the gross tumor volume was delineated on a T2 magnetic resonance imaging with an average gross tumor volume-to-planning target volume expansion of 4.5 mm (range, 3-5 mm). Detailed dosimetric parameters were available for all patients treated with RT. Conclusions Our review supports the indolent behavior for most tectal gliomas. For the subset of tumors with evidence of progression, modern photon RT results in excellent oncologic outcomes with minimal late effects.
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Affiliation(s)
- Qateeb Khan
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Breann Bowar
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Heba Ismael
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jordan Gainey
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bryn Myers
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Brian Dlouhy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daniel Hyer
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amanda Grafft
- Stead Family Department of Pediatrics, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | | | - John M. Buatti
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Margaret M. Kozak
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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4
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Khong J, Tee H, Gorayski P, Le H, Penniment M, Jessop S, Hansford J, Penfold M, Green J, Skelton K, Saran F. Proton beam therapy in paediatric cancer: Anticipating the opening of the Australian Bragg Centre for Proton Therapy and Research. J Med Imaging Radiat Oncol 2023. [PMID: 38146017 DOI: 10.1111/1754-9485.13614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
Proton Beam Therapy (PBT) has the potential to improve paediatric cancer care by reducing radiation exposure and thus long-term toxicities. Ethical concerns and debates surrounding the treatment, such as eligibility and accessibility, are ongoing in Australia. The Australian Bragg Centre for Proton Therapy and Research (ABCPTR) (named after Sir William Henry Bragg who described the Bragg peak in his laboratory at the University of Adelaide in 1903) aims to increase access to PBT in Australasia and offer a patient-centred care approach. Research is underway to assess PBT's safety and cost-effectiveness, using tools including Normal Tissue Complication Probability (NTCP) models. Collaborative efforts are focused on developing tailored survivorship clinics to enhance patient follow-up and quality of life. With the anticipated opening of the ABCPTR, Australia is preparing to take a significant step in radiation oncology, offering new research opportunities and creating a publicly funded treatment centre. The initiative aims to balance treatment efficacy with patient care, setting the stage for a future in which radiation therapy will reduce long-term side effects compared to the current standard of care. The implementation of PBT in Australia represents a complex and promising approach to paediatric oncology. This article provides an overview of the current landscape, highlighting the potential benefits and challenges of a treatment that could redefine the quality of survivorship and contribute to global research and best clinical practice.
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Affiliation(s)
- Jeremy Khong
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hui Tee
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Peter Gorayski
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, South Australia, Australia
- Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia, Australia
| | - Hien Le
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, South Australia, Australia
- Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia, Australia
| | - Michael Penniment
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, South Australia, Australia
| | - Sophie Jessop
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jordan Hansford
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Michael Rice Centre for Haematology and Oncology, Women's and Children's Hospital, Adelaide, South Australia, Australia
- South Australia ImmunoGenomics Cancer Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Melanie Penfold
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, South Australia, Australia
| | - Julia Green
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, South Australia, Australia
| | - Kelly Skelton
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, South Australia, Australia
- Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia, Australia
| | - Frank Saran
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia
- Australian Bragg Centre for Proton Therapy and Research, Adelaide, South Australia, Australia
- Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia, Australia
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5
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Berlin E, Eisenberg R, Hill-Kayser C, Lustig RA, Kurtz G, Cummings E, LaRiviere M. Delivery of re-irradiation and complex palliative radiotherapy using proton therapy in pediatric cancer patients. Pediatr Blood Cancer 2023; 70:e30708. [PMID: 37794575 DOI: 10.1002/pbc.30708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The intent of this study is to characterize indications for pediatric palliative-intent proton radiation therapy (PIPRT). PROCEDURE We retrospectively reviewed patients 21 years and younger who received PIPRT. We defined PIPRT as radiotherapy (RT) aimed to improve cancer-related symptoms/provide durable local control in the non-curative setting. Mixed proton/photon plans were included. Adjacent re-irradiation (reRT) was defined as a reRT volume within the incidental dose cloud of a prior RT target, whereas direct reRT was defined as in-field overlap with prior RT target. Acute toxicity during RT until first inspection visit was graded according to the Common Terminology Criteria for Adverse Events. The Kaplan-Meier method, measured from last PIPRT fraction, was used to assess progression-free survival (PFS) and overall survival (OS). RESULTS Eighteen patients underwent PIPRT between 2014 and 2020. Median age at treatment start was 10 years [2-21]. Median follow-up was 8.2 months [0-48]. Treatment sites included: brain/spine [10], abdomen/pelvis [3], thorax [3], and head/neck [2]. Indications for palliation included: durable tumor control [18], neurologic symptoms [4], pain [3], airway compromise [2], and great vessel compression [1]. Indications for protons included: reRT [15] (three adjacent, 12 direct), craniospinal irradiation [4], reduction of dose to normal tissues [3]. Sixteen experienced grade (G) 1-2 toxicity; two G3. There were no reports of radionecrosis. Median PFS was 5.3 months [95% confidence interval (CI): 2.7-16.3]. Median OS was 8.3 months [95% CI: 5.5-26.3]. CONCLUSIONS The most common indication for PIPRT was reRT to provide durable tumor control. PIPRT appears to be safe, with no cases of high-grade toxicity.
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Affiliation(s)
- Eva Berlin
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Eisenberg
- Albany Medical College, Albany Medical Center, Albany, New York, USA
| | - Christine Hill-Kayser
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert A Lustig
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Goldie Kurtz
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth Cummings
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael LaRiviere
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Das A, Gaikwad U, Krishnan G, Rajendran A, Patil S, Subramaniam P, Krishna U, Wakde MG, Chilukuri S, Jalali R. Successful Implementation of Image-Guided Pencil-Beam Scanning Proton Therapy in Medulloblastomas. Diagnostics (Basel) 2023; 13:3378. [PMID: 37958274 PMCID: PMC10647744 DOI: 10.3390/diagnostics13213378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
Medulloblastoma is the most common malignant brain tumour in children, while much rarer in adults. Although the prognosis and outcomes have greatly improved in the era of modern multidisciplinary management, long-term treatment-induced toxicities are common. Craniospinal irradiation followed by a boost to the primary and metastatic tumour sites forms the backbone of treatment. Proton therapy has been endorsed over conventional photon-based radiotherapy due to its superior dosimetric advantages and subsequently lower incidence and severity of toxicities. We report here our experience from South-East Asia's first proton therapy centre of treating 40 patients with medulloblastoma (38 children and adolescents, 2 adults) who received image-guided, intensity-modulated proton therapy with pencil-beam scanning between 2019 and 2023, with a focus on dosimetry, acute toxicities, and early survival outcomes. All patients could complete the planned course of proton therapy, with mostly mild acute toxicities that were manageable on an outpatient basis. Haematological toxicity was not dose-limiting and did not prolong the overall treatment time. Preliminary data on early outcomes including overall survival and disease-free survival are encouraging, although a longer follow-up and data on long-term toxicities are needed.
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Affiliation(s)
- Anindita Das
- Neuro-Oncology Cancer Management Team, Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, India; (A.D.)
| | - Utpal Gaikwad
- Neuro-Oncology Cancer Management Team, Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, India; (A.D.)
| | - Ganapathy Krishnan
- Department of Medical Physics, Apollo Proton Cancer Centre, Chennai 600041, India
| | - Adhithyan Rajendran
- Department of Diagnostic and Intervention Radiology, Apollo Proton Cancer Centre, Chennai 600041, India
| | - Sushama Patil
- Department of Pathology, Apollo Proton Cancer Centre, Chennai 600041, India
| | - Preethi Subramaniam
- Neuro-Oncology Cancer Management Team, Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, India; (A.D.)
| | - Uday Krishna
- Neuro-Oncology Cancer Management Team, Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, India; (A.D.)
| | - Manoj G. Wakde
- Neuro-Oncology Cancer Management Team, Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, India; (A.D.)
| | - Srinivas Chilukuri
- Paediatric Oncology Cancer Management Team, Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, India
| | - Rakesh Jalali
- Neuro-Oncology Cancer Management Team, Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai 600041, India; (A.D.)
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7
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Friedrich C, Boekhoff S, Bischoff M, Beckhaus J, Sowithayasakul P, Calaminus G, Eveslage M, Valentini C, Bison B, Harrabi SB, Krause M, Timmermann B, Müller HL. Outcome after proton beam therapy versus photon-based radiation therapy in childhood-onset craniopharyngioma patients-results of KRANIOPHARYNGEOM 2007. Front Oncol 2023; 13:1180993. [PMID: 37965466 PMCID: PMC10641508 DOI: 10.3389/fonc.2023.1180993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background Proton beam therapy (PBT) is being increas16ingly used to treat residual craniopharyngioma (CP) after hypothalamus-sparing surgery. Compared to photon-based radiation therapy (XRT) with PBT, less irradiation in the penumbra reduces the scattered dose to critical organs neighboring but outside the area of treatment, minimizing the risk of sequelae. Patients and methods Between 2007 and 2019, 99 of 290 (34%) childhood-onset CP patients recruited in KRANIOPHARYNGEOM 2007 received external radiation therapy (RT) (65% PBT, 35% XRT). Outcome was analyzed in terms of survival, endocrinological and anthropometric parameters (BMI and height SDS), quality of life (QoL using PEDQOL), and functional capacity (FMH) with special regard to irradiation technique. Results PBT became predominant (used in 43% and 72% of all irradiated patients registered within the first and second halves of the recruitment period, between 2008 and 2013 and 2013 and 2018, respectively). Five-year event-free survival rates after PBT or XRT were comparable (92% ± 4% vs. 91% ± 4%, p = 0.42) and higher than for the whole cohort since diagnosis, including non-RT patients (37% ± 4%). Radiation doses to the hypothalamus and pituitary did not differ between PBT and XRT. Endocrine deficits due to disturbances of the hypothalamic-pituitary axis (HPA) were already common before irradiation. During the first 5 years after CP diagnosis/RT, no differences between PBT, XRT, and non-RT CP patients concerning functional capacity and anthropometric parameters have been obtained. Only for the PEDQOL domain "physical function", parental-assessed QoL was lower 12 months after PBT versus XRT or non-RT patients. Conclusion QoL, functional capacity, degree of obesity, and endocrinopathy varied over time from diagnosis, but by 5 years, there was no significant difference between PBT and XRT upfront or delayed, nor was there any compromise in historic survival rates, which remained high >90%. RT of any type is extremely effective at stabilizing disease after hypothalamic-sparing surgery. The purported specific benefits of PBT-reducing sequelae are not proven in this study where the organ of critical interest is itself diseased, increasing an urgent need to better address and treat the tumor-induced endocrine harm from diagnosis in dedicated pituitary services. Other hypothesized benefits of PBT versus XRT on vascular events and secondary cancers await longer comparison. Clinical trial registration number https://clinicaltrials.gov/study/, identifier NCT01272622.
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Affiliation(s)
- Carsten Friedrich
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Svenja Boekhoff
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Martin Bischoff
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany
| | - Julia Beckhaus
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
| | - Panjarat Sowithayasakul
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
- Department of Pediatrics, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand
| | - Gabriele Calaminus
- Department of Pediatric Hematology/Oncology, University of Bonn Medical Center, Bonn, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Chiara Valentini
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Semi B. Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mechthild Krause
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT) Dresden with German Cancer Research Center (DKFZ), University Hospital and Faculty of Medicine Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
- German Cancer Consortium (DKTK), Dresden and German Cancer Research Center (DKFZ) Heidelberg, Dresden, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Centre (WTZ) and German Cancer Consortium (DKTK), Essen, Germany
| | - Hermann L. Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, University Children’s Hospital, Carl von Ossietzky University Oldenburg, Klinikum Oldenburg AöR, Oldenburg, Germany
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8
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Iannalfi A, Riva G, Ciccone L, Orlandi E. The role of particle radiotherapy in the treatment of skull base tumors. Front Oncol 2023; 13:1161752. [PMID: 37350949 PMCID: PMC10283010 DOI: 10.3389/fonc.2023.1161752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023] Open
Abstract
The skull base is an anatomically and functionally critical area surrounded by vital structures such as the brainstem, the spinal cord, blood vessels, and cranial nerves. Due to this complexity, management of skull base tumors requires a multidisciplinary approach involving a team of specialists such as neurosurgeons, otorhinolaryngologists, radiation oncologists, endocrinologists, and medical oncologists. In the case of pediatric patients, cancer management should be performed by a team of pediatric-trained specialists. Radiation therapy may be used alone or in combination with surgery to treat skull base tumors. There are two main types of radiation therapy: photon therapy and particle therapy. Particle radiotherapy uses charged particles (protons or carbon ions) that, due to their peculiar physical properties, permit precise targeting of the tumor with minimal healthy tissue exposure. These characteristics allow for minimizing the potential long-term effects of radiation exposure in terms of neurocognitive impairments, preserving quality of life, and reducing the risk of radio-induced cancer. For these reasons, in children, adolescents, and young adults, proton therapy should be an elective option when available. In radioresistant tumors such as chordomas and sarcomas and previously irradiated recurrent tumors, particle therapy permits the delivery of high biologically effective doses with low, or however acceptable, toxicity. Carbon ion therapy has peculiar and favorable radiobiological characteristics to overcome radioresistance features. In low-grade tumors, proton therapy should be considered in challenging cases due to tumor volume and involvement of critical neural structures. However, particle radiotherapy is still relatively new, and more research is needed to fully understand its effects. Additionally, the availability of particle therapy is limited as it requires specialized equipment and expertise. The purpose of this manuscript is to review the available literature regarding the role of particle radiotherapy in the treatment of skull base tumors.
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9
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Vázquez M, Bachmann N, Pica A, Bolsi A, De Angelis C, Lomax AJ, Weber DC. Early outcome after craniospinal irradiation with pencil beam scanning proton therapy for children, adolescents and young adults with brain tumors. Pediatr Blood Cancer 2023; 70:e30087. [PMID: 36377685 DOI: 10.1002/pbc.30087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
Central nervous system (CNS) tumors are the most common solid malignancies in children and adolescents and young adults (C-AYAs). Craniospinal irradiation (CSI) is an essential treatment component for some malignancies, but it can also lead to important toxicity. Pencil beam scanning proton therapy (PBSPT) allows for a minimization of dose delivered to organs at risk and, thus, potentially reduced acute and late toxicity. This study aims to report the clinical outcomes and toxicity rates after CSI for C-AYAs treated with PBSPT. Seventy-one C-AYAs (median age: 7.4 years) with CNS tumors were treated with CSI between 2004 and 2021. Medulloblastoma (n = 42: 59%) and ependymoma (n = 8; 11%) were the most common histologies. Median prescribed total PBSPT dose was 54 GyRBE (range: 18-60.4), and median prescribed craniospinal dose was 24 GyRBE (range: 18-36.8). Acute and late toxicities were coded according to Common Terminology Criteria for Adverse Events. After a median follow-up of 24.5 months, the estimated 2-year local control, distant control, and overall survival were 86.3%, 80.5%, and 84.7%, respectively. Late grade ≥3 toxicity-free rate was 92.6% at 2 years. Recurrent and metastatic tumors were associated with worse outcome. In conclusion, excellent tumor control with low toxicity rates was observed in C-AYAs with brain tumors treated with CSI using PBSPT.
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Affiliation(s)
- Miriam Vázquez
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Nicolas Bachmann
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Claudio De Angelis
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, University Hospital of Zürich, Zürich, Switzerland
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10
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Grippin AJ, McGovern SL. Proton therapy for pediatric diencephalic tumors. Front Oncol 2023; 13:1123082. [PMID: 37213290 PMCID: PMC10196353 DOI: 10.3389/fonc.2023.1123082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/03/2023] [Indexed: 05/23/2023] Open
Abstract
Diencephalic tumors tend to be low grade tumors located near several critical structures, including the optic nerves, optic chiasm, pituitary, hypothalamus, Circle of Willis, and hippocampi. In children, damage to these structures can impact physical and cognitive development over time. Thus, the goal of radiotherapy is to maximize long term survival while minimizing late effects, including endocrine disruption leading to precocious puberty, height loss, hypogonadotropic hypogonadism, and primary amenorrhea; visual disruption including blindness; and vascular damage resulting in cerebral vasculopathy. Compared to photon therapy, proton therapy offers the potential to decrease unnecessary dose to these critical structures while maintaining adequate dose to the tumor. In this article, we review the acute and chronic toxicities associated with radiation for pediatric diencephalic tumors, focusing on the use of proton therapy to minimize treatment-related morbidity. Emerging strategies to further reduce radiation dose to critical structures will also be considered.
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11
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Pan-Canadian consensus recommendations for proton beam therapy access in Canada. Radiother Oncol 2022; 176:228-233. [PMID: 36228758 DOI: 10.1016/j.radonc.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/21/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Proton Beam Therapy (PBT)is a treatment option for select cancer patients. It is currently not available in Canada. Assessment and referral processes for out-of-country treatment for eligible patients vary by jurisdiction, leading to variability in access to this treatment for Canadian cancer patients. The purpose of this initiative was to develop a framework document to inform consistent and equitable PBT access for appropriate patients through the creation of pan-Canadian PBT access consensus recommendations. MATERIALS AND METHODS A modified Delphiprocess was used to develop pan-Canadian recommendations with input from 22 PBT clinical and administrative experts across all provinces, external peer-review by provincial cancer and system partners, and feedback from a targeted community consultation. This was conducted by electronic survey and live discussion. Consensus threshold was set at 70% agreement. RESULTS Fourconsensus rounds resulted in a final set of 27 recommendations divided into three categories: patient eligibility (n = 9); program level (n = 10); and system level (n = 8). Patient eligibility included: anatomic site (n = 4), patient characteristics (n = 3), clinical efficacy (n = 2). Program level included: regulatory and staff requirements (n = 5), equipment and technologies (n = 4), quality assurance (n = 1). System level included: referral process (n = 5), costing, budget impact and quality adjusted life years (n = 2), eligible patient estimates (n = 1). Recommendations were released nationally in June 2021 and distributed to all 43 cancer programs in Canada. CONCLUSION A pan-Canadian consensus-building approach was successful in creating an evidence-based, peer-reviewed suite of recommendations thatsupportapplication of consistent clinical criteria to inform treatment options, facility set-up and access to high quality proton therapy.
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12
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Mak DY, Siddiqui Z, Liu ZA, Dama H, MacDonald SM, Wu S, Murphy ES, Hall MD, Malkov V, Onar-Thomas A, Ahmed S, Dhall G, Tsang DS. Photon versus proton whole ventricular radiotherapy for non-germinomatous germ cell tumors: A report from the Children's Oncology Group. Pediatr Blood Cancer 2022; 69:e29697. [PMID: 35373903 PMCID: PMC9329212 DOI: 10.1002/pbc.29697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To determine if proton therapy reduces doses to cranial organs at risk (OARs) as compared to photon therapy in children with non-germinomatous germ cell tumors (NGGCT) receiving whole ventricular radiotherapy (WVRT). METHODS AND MATERIALS Dosimetric data for patients with NGGCT prospectively enrolled in stratum 1 of the Children's Oncology Group study ACNS1123 who received 30.6 Gy WVRT were compared. Target segmentation was standardized using a contouring atlas. Doses to cranial OARs were compared between proton and photon treatments. Clinically relevant dose-volume parameters that were analyzed included mean dose and dose to 40% of the OAR volume (D40). RESULTS Mean and D40 doses to the supratentorial brain, cerebellum, and bilateral temporal, parietal, and frontal lobes were statistically significantly lower amongst proton-treated patients, as compared to photon-treated patients. In a subgroup analysis of patients uniformly treated with a 3-mm planning target volume, patients who received proton therapy continued to have statistically significantly lower doses to brain OARs. CONCLUSIONS Children treated with proton therapy for WVRT had lower doses to normal brain structures, when compared to those treated with photon therapy. Proton therapy should be considered for patients receiving WVRT for NGGCT.
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Affiliation(s)
- David Y. Mak
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Zain Siddiqui
- Division of Radiation Oncology, Cancer Center of Southeastern Ontario, Kingston, Ontario
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Hitesh Dama
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Shannon M. MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erin S. Murphy
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Matthew D. Hall
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Victor Malkov
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sameera Ahmed
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Girish Dhall
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Derek S. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario
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13
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Kollitz E, Han H, Kim CH, Pinto M, Schwarz M, Riboldi M, Kamp F, Belka C, Newhauser WD, Dedes G, Parodi K. A patient-specific hybrid phantom for calculating radiation dose and equivalent dose to the whole body. Phys Med Biol 2021; 67. [PMID: 34969024 DOI: 10.1088/1361-6560/ac4738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE As cancer survivorship increases, there is growing interest in minimizing the late effects of radiation therapy such as radiogenic second cancer, which may occur anywhere in the body. Assessing the risk of late effects requires knowledge of the dose distribution throughout the whole body, including regions far from the treatment field, beyond the typical anatomical extent of clinical CT scans. APPROACH A hybrid phantom was developed which consists of in-field patient CT images extracted from ground truth whole-body CT (WBCT) scans, out-of-field mesh phantoms scaled to basic patient measurements, and a blended transition region. Four of these hybrid phantoms were created, representing male and female patients receiving proton therapy treatment in pelvic and cranial sites. To assess the performance of the hybrid approach, we simulated treatments using the hybrid phantoms, the scaled and unscaled mesh phantoms, and the ground truth whole-body CTs. We calculated absorbed dose and equivalent dose in and outside of the treatment field, with a focus on neutrons induced in the patient by proton therapy. Proton and neutron dose was calculated using a general purpose Monte Carlo code. MAIN RESULTS The hybrid phantom provided equal or superior accuracy in calculated organ dose and equivalent dose values relative to those obtained using the mesh phantoms in 78% in all selected organs and calculated dose quantities. Comparatively the default mesh and scaled mesh were equal or superior to the other phantoms in 21% and 28% of cases respectively. SIGNIFICANCE The proposed methodology for hybrid synthesis provides a tool for whole-body organ dose estimation for individual patients without requiring CT scans of their entire body. Such a capability would be useful for personalized assessment of late effects and risk-optimization of treatment plans.
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Affiliation(s)
- Erika Kollitz
- Department of Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Garching, Bayern, 85748, GERMANY
| | - Haegin Han
- Department of Nuclear Engineering, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seongdong-gu, Seoul, 04763, Korea (the Republic of)
| | - Chan Hyeong Kim
- Department of Nuclear Engineering, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seongdong-gu, Seoul, 04763, Korea (the Republic of)
| | - Marco Pinto
- Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Garching, Bayern, 85748, GERMANY
| | - Marco Schwarz
- Provincia autonoma di Trento Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, Trento, Trentino-Alto Adige, 38123, ITALY
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Munchen, Bayern, 85748, GERMANY
| | - Florian Kamp
- Radiotherapy, Klinikum der Universitat Munchen, Marchioninistraße 15, Munich, 81377, GERMANY
| | - Claus Belka
- Department of Radiation Oncology, Klinikum der Universitat Munchen, Marchioninistraße 15, Munchen, Bayern, 81377, GERMANY
| | - Wayne David Newhauser
- Department of Physics & Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana, 70803, UNITED STATES
| | - Georgios Dedes
- Department of Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Munchen, Bayern, 85748, GERMANY
| | - Katia Parodi
- Experimental Physics Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Munchen, Bayern, 85748, GERMANY
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14
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J F, A S, V E, F P, P M, B T, Sw W. New aspects and innovations in the local treatment of renal and urogenital pediatric tumors. Semin Pediatr Surg 2021; 30:151081. [PMID: 34412882 DOI: 10.1016/j.sempedsurg.2021.151081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Local treatment plays a key role for patients' outcome in tumors of the urogenital tract in children. Despite a great variety of different etiologies, the specific localization of pediatric urogenital tumors renders several characteristic demands to the treating personnel. Surgery and radiotherapy are the main elements of local treatment in this group of neoplasms. Numerous new guidelines and innovative technical developments of surgery and radiotherapy have recently been integrated into treatment concepts for pediatric urogenital tumors. Due to the broadness of the field it is not possible to give a full overview over all aspects. Therefore, this article highlights the most important innovations and new guidelines of surgery and radiotherapy of pediatric urogenital tumors.
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Affiliation(s)
- Fuchs J
- Department of Pediatric Surgery and Pediatric Urology, University Children´s Hospital Tuebingen, Tuebingen, Germany.
| | - Schmidt A
- Department of Pediatric Surgery and Pediatric Urology, University Children´s Hospital Tuebingen, Tuebingen, Germany
| | - Ellerkamp V
- Department of Pediatric Surgery and Pediatric Urology, University Children´s Hospital Tuebingen, Tuebingen, Germany
| | - Paulsen F
- Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | - Melchior P
- Department of Radiotherapy and Radiation Oncology, University Hospital, Homburg, Germany
| | - Timmermann B
- Department of Particle Therapy, West German Proton Therapy Centre, University Hospital Essen, Essen, Germany
| | - Warmann Sw
- Department of Pediatric Surgery and Pediatric Urology, University Children´s Hospital Tuebingen, Tuebingen, Germany
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15
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Spiotto MT, McGovern SL, Gunn GB, Grosshans D, McAleer MF, Frank SJ, Paulino AC. Proton Radiotherapy to Reduce Late Complications in Childhood Head and Neck Cancers. Int J Part Ther 2021; 8:155-167. [PMID: 34285943 PMCID: PMC8270100 DOI: 10.14338/ijpt-20-00069.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/07/2020] [Indexed: 11/21/2022] Open
Abstract
In most childhood head and neck cancers, radiotherapy is an essential component of treatment; however, it can be associated with problematic long-term complications. Proton beam therapy is accepted as a preferred radiation modality in pediatric cancers to minimize the late radiation side effects. Given that childhood cancers are a rare and heterogeneous disease, the support for proton therapy comes from risk modeling and a limited number of cohort series. Here, we discuss the role of proton radiotherapy in pediatric head and neck cancers with a focus on reducing radiation toxicities. First, we compare the efficacy and expected toxicities in proton and photon radiotherapy for childhood cancers. Second, we review the benefit of proton radiotherapy in reducing acute and late radiation toxicities, including risks for secondary cancers, craniofacial development, vision, and cognition. Finally, we review the cost effectiveness for proton radiotherapy in pediatric head and neck cancers. This review highlights the benefits of particle radiotherapy for pediatric head and neck cancers to improve the quality of life in cancer survivors, to reduce radiation morbidities, and to maximize efficient health care use.
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Affiliation(s)
- Michael T Spiotto
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Grosshans
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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16
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Tsang DS, Vargo JA, Goddard K, Breneman JC, Kalapurakal JA, Marcus KJ. Palliative radiation therapy for children with cancer. Pediatr Blood Cancer 2021; 68 Suppl 2:e28292. [PMID: 33818881 DOI: 10.1002/pbc.28292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/03/2020] [Accepted: 03/14/2020] [Indexed: 11/08/2022]
Abstract
Radiation therapy (RT) is often used as a palliative treatment for children with recurrent malignant disease to ameliorate or prevent symptoms. However, no guidelines exist regarding the clinical indications or dose fractionation for palliative RT. The goal of this report is to provide guidelines for the use of palliative RT in children with cancer. In this guideline, appropriate indications for palliative RT, recommended dose-fractionation schedules, relevant toxicities, and avenues for future research are explored. RT is an effective palliative treatment for bone, brain, liver, lung, abdominopelvic and head-and-neck metastases, spinal cord compression, superior vena cava syndrome, and bleeding. Single-fraction regimens (8 Gy in one fraction) for children with short life expectancy are recommended for simple, uncomplicated bone metastases and can be considered for some patients with lung or liver metastases. A short, hypofractionated regimen (20 Gy in five fractions) may be used for other indications to minimize overall burden of therapy. There are little data supporting use of more prolonged fractionation regimens, though they may be considered for patients with very good performance status. Future research should focus on response and outcomes data collection, and to rigorously evaluate the role of stereotactic body RT in well-designed, prospective studies.
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Affiliation(s)
- Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
| | - John Austin Vargo
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Karen Goddard
- Department of Surgery, University of British Columbia, Vancouver, Canada
| | - John C Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern Medicine, Chicago, Illinois
| | - Karen J Marcus
- Division of Radiation Oncology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
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17
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Halperin EC. Current challenges facing pediatric radiation oncology viewed through an economics lens. Pediatr Blood Cancer 2021; 68 Suppl 2:e28686. [PMID: 32991071 DOI: 10.1002/pbc.28686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/12/2022]
Abstract
This commentary addresses two problems facing pediatric radiation oncology: workforce education and the cost of technology. The tools of economics can help us understand these problems. Because cancer in children is relatively infrequent and the role of pediatric radiotherapy (RT) is limited, there are a small number of cases of children requiring RT in the US compared to the number of radiation oncology trainees. This creates a paucity of necessary clinical training material. Proton RT, rather than photon RT, is being recommended in many situations when RT is indicated in children. Cost, however, is a significant concern. The arguments for and against proton RT continue and a consensus on this matter has not emerged.
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Affiliation(s)
- Edward C Halperin
- Department of Radiation Oncology, Pediatrics, and History, New York Medical College and the Touro College and University System, Valhalla, New York
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Nicholas O, Prosser S, Mortensen HR, Radhakrishna G, Hawkins MA, Gwynne SH. The Promise of Proton Beam Therapy for Oesophageal Cancer: A Systematic Review of Dosimetric and Clinical Outcomes. Clin Oncol (R Coll Radiol) 2021; 33:e339-e358. [PMID: 33931290 DOI: 10.1016/j.clon.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/08/2021] [Accepted: 04/13/2021] [Indexed: 12/25/2022]
Abstract
AIMS Due to its physical advantages over photon radiotherapy, proton beam therapy (PBT) has the potential to improve outcomes from oesophageal cancer. However, for many tumour sites, high-quality evidence supporting PBT use is limited. We carried out a systematic review of published literature of PBT in oesophageal cancer to ascertain potential benefits of this technology and to gauge the current state-of-the-art. We considered if further evaluation of this technology in oesophageal cancer is desirable. MATERIALS AND METHODS A systematic literature search of Medline, Embase, Cochrane Library and Web of Science using structured search terms was carried out. Inclusion criteria included non-metastatic cancer, full articles and English language studies only. Articles deliberating technical aspects of PBT planning or delivery were excluded to maintain a clinical focus. Studies were divided into two sections: dosimetric and clinical studies; qualitatively synthesised. RESULTS In total, 467 records were screened, with 32 included for final qualitative synthesis. This included two prospective studies with the rest based on retrospective data. There was heterogeneity in treatment protocols, including treatment intent (neoadjuvant or definitive), dose, fractionation and chemotherapy used. Compared with photon radiotherapy, PBT seemed to reduce dose to organs at risk, especially lung and heart, although not for all reported parameters. Toxicity outcomes, including postoperative complications, were reduced compared with photon radiotherapy. Survival outcomes were reported to be at least comparable with photon radiotherapy. CONCLUSION There is a paucity of high-quality evidence supporting PBT use in oesophageal cancer. Wide variation in intent and treatment protocols means that the role and 'gold-standard' treatment protocol are yet to be defined. Current literature suggests significant benefit in terms of toxicity reduction, especially in the postoperative period, with comparable survival outcomes. PBT in oesophageal cancer holds significant promise for improving patient outcomes but requires robust systematic evaluation in prospective studies.
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Affiliation(s)
- O Nicholas
- South West Wales Cancer Centre, Swansea, UK; Swansea University Medical School, Swansea, UK.
| | - S Prosser
- South West Wales Cancer Centre, Swansea, UK
| | - H R Mortensen
- The Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - M A Hawkins
- University College Hospital NHS Foundation Trust, London, UK
| | - S H Gwynne
- South West Wales Cancer Centre, Swansea, UK; Swansea University Medical School, Swansea, UK
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19
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Uh J, Merchant TE, Conklin HM, Ismael Y, Li Y, Han Y, Sabin ND, Babajani-Feremi A, Indelicato DJ, Hua CH. Diffusion Tensor Imaging-Based Analysis of Baseline Neurocognitive Function and Posttreatment White Matter Changes in Pediatric Patients With Craniopharyngioma Treated With Surgery and Proton Therapy. Int J Radiat Oncol Biol Phys 2021; 109:515-526. [PMID: 32898610 DOI: 10.1016/j.ijrobp.2020.08.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine the preirradiation baseline association of white matter integrity with neurocognitive function and to assess posttreatment changes in pediatric patients with craniopharyngioma treated with proton therapy. METHODS AND MATERIALS Ninety children and adolescents (2-20 years old) with craniopharyngioma were treated with proton therapy (54 Gy[RBE]) in a prospective therapeutic trial. Neurocognitive performance at the postoperative baseline before proton therapy and diffusion tensor imaging (DTI) data acquired at baseline and at annual follow-up were analyzed. Tract-based spatial statistics and structural connectomics were used to derive global and local white matter features from DTI. Baseline DTI features were compared for patients with average and below-average neurocognitive performance. Longitudinal DTI data were analyzed to determine the proton dose effect on white matter structures in relation to the irradiated brain volume and baseline age. RESULTS Before proton therapy, patients with below-average working memory, processing speed, verbal fluency, verbal learning, or fine motor dexterity exhibited more globally degraded white matter structures compared with their counterparts with average performance, as indicated by lower mean fractional anisotropy, decreased global efficiency, or higher modularity. Surgery, obstructive hydrocephalus, and preoperative hypothalamic involvement appeared to be related to this degradation. In local analyses, tract-based spatial statistics revealed left-lateralized associations with verbal and motor functions, which supported surgical approaches to midline tumors via the right hemisphere. The mean fractional anisotropy of the brain and the global efficiency derived from DTI increased over the 5 years after proton therapy. The rate of increase was lower with larger irradiated brain volumes and in older children. CONCLUSIONS Below-average baseline neurocognitive performance in patients with craniopharyngioma before proton therapy appeared to be related to structural degradation of white matter tracts. Posttherapy longitudinal DTI showed improving trends in global integrity and efficiency measures, particularly in children in whom a smaller brain volume was irradiated.
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Affiliation(s)
- Jinsoo Uh
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yousef Ismael
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yimei Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yuanyuan Han
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Noah D Sabin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Abbas Babajani-Feremi
- Department of Pediatrics and Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, and Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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20
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Baumann BC, Mitra N, Harton JG, Xiao Y, Wojcieszynski AP, Gabriel PE, Zhong H, Geng H, Doucette A, Wei J, O'Dwyer PJ, Bekelman JE, Metz JM. Comparative Effectiveness of Proton vs Photon Therapy as Part of Concurrent Chemoradiotherapy for Locally Advanced Cancer. JAMA Oncol 2020; 6:237-246. [PMID: 31876914 DOI: 10.1001/jamaoncol.2019.4889] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Concurrent chemoradiotherapy is the standard-of-care curative treatment for many cancers but is associated with substantial morbidity. Concurrent chemoradiotherapy administered with proton therapy might reduce toxicity and achieve comparable cancer control outcomes compared with conventional photon radiotherapy by reducing the radiation dose to normal tissues. Objective To assess whether proton therapy in the setting of concurrent chemoradiotherapy is associated with fewer 90-day unplanned hospitalizations (Common Terminology Criteria for Adverse Events, version 4 [CTCAEv4], grade ≥3) or other adverse events and similar disease-free and overall survival compared with concurrent photon therapy and chemoradiotherapy. Design, Setting, and Participants This retrospective, nonrandomized comparative effectiveness study included 1483 adult patients with nonmetastatic, locally advanced cancer treated with concurrent chemoradiotherapy with curative intent from January 1, 2011, through December 31, 2016, at a large academic health system. Three hundred ninety-one patients received proton therapy and 1092, photon therapy. Data were analyzed from October 15, 2018, through February 1, 2019. Interventions Proton vs photon chemoradiotherapy. Main Outcomes and Measures The primary end point was 90-day adverse events associated with unplanned hospitalizations (CTCAEv4 grade ≥3). Secondary end points included Eastern Cooperative Oncology Group (ECOG) performance status decline during treatment, 90-day adverse events of at least CTCAEv4 grade 2 that limit instrumental activities of daily living, and disease-free and overall survival. Data on adverse events and survival were gathered prospectively. Modified Poisson regression models with inverse propensity score weighting were used to model adverse event outcomes, and Cox proportional hazards regression models with weighting were used for survival outcomes. Propensity scores were estimated using an ensemble machine-learning approach. Results Among the 1483 patients included in the analysis (935 men [63.0%]; median age, 62 [range, 18-93] years), those receiving proton therapy were significantly older (median age, 66 [range, 18-93] vs 61 [range, 19-91] years; P < .01), had less favorable Charlson-Deyo comorbidity scores (median, 3.0 vs 2.0; P < .01), and had lower integral radiation dose to tissues outside the target (mean [SD] volume, 14.1 [6.4] vs 19.1 [10.6] cGy/cc × 107; P < .01). Baseline grade ≥2 toxicity (22% vs 24%; P = .37) and ECOG performance status (mean [SD], 0.62 [0.74] vs 0.68 [0.80]; P = .16) were similar between the 2 cohorts. In propensity score weighted-analyses, proton chemoradiotherapy was associated with a significantly lower relative risk of 90-day adverse events of at least grade 3 (0.31; 95% CI, 0.15-0.66; P = .002), 90-day adverse events of at least grade 2 (0.78; 95% CI, 0.65-0.93; P = .006), and decline in performance status during treatment (0.51; 95% CI, 0.37-0.71; P < .001). There was no difference in disease-free or overall survival. Conclusions and Relevance In this analysis, proton chemoradiotherapy was associated with significantly reduced acute adverse events that caused unplanned hospitalizations, with similar disease-free and overall survival. Prospective trials are warranted to validate these results.
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Affiliation(s)
- Brian C Baumann
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia.,Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
| | - Joanna G Harton
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | | | - Peter E Gabriel
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Haoyu Zhong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Huaizhi Geng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Abigail Doucette
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia
| | - Jenny Wei
- currently a medical student at Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Peter J O'Dwyer
- Division of Medical Oncology, University of Pennsylvania, Philadelphia.,Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - Justin E Bekelman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Abramson Cancer Center, University of Pennsylvania, Philadelphia
| | - James M Metz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia.,Abramson Cancer Center, University of Pennsylvania, Philadelphia
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Chilukuri S, Burela N, Uppuluri R, Indumathi D, Nangia S, Panda PK, Shamurailatpam DS, Raj R, Raja T, Jalali R. Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India. JCO Glob Oncol 2020; 6:1736-1745. [PMID: 33180633 PMCID: PMC7713582 DOI: 10.1200/go.20.00319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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.
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22
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Chilukuri S, Jalali R. Reassuring quality of life in younger childhood (<4 y) brain tumor survivors treated with proton beam therapy. Neuro Oncol 2020; 22:1243-1244. [DOI: 10.1093/neuonc/noaa173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Srinivas Chilukuri
- Neuro Oncology Cancer Management Team, Apollo Proton Cancer Centre, Chennai, India
| | - Rakesh Jalali
- Neuro Oncology Cancer Management Team, Apollo Proton Cancer Centre, Chennai, India
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23
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Murphy L, Cantwell J, Chard J, Cheuk R, Harrington C, Hindson B, Salkeld A, Saran F, Wheeler G, Wiltshire K, Ahern V. Quality improvement in paediatric radiation oncology through peer review. J Med Imaging Radiat Oncol 2020; 64:697-703. [PMID: 32715642 DOI: 10.1111/1754-9485.13092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/16/2020] [Accepted: 07/04/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Around 300 children in Australia and New Zealand (ANZ) undergo a course of radiation treatment (RT) each year. A fortnightly videoconference for radiation oncologists managing children started in 2013. We conducted an audit of the videoconference to assess its influence on the care of children who receive RT in ANZ. METHODS De-identified data from minutes (August 2013-December 2019) were analysed retrospectively using three categories: meeting participation, case presentations and management decisions. RESULTS There were 119 meetings and 334 children discussed over the six-year audit period with regular attendance from four of 11 centres treating children in ANZ. Most cases (80%) were discussed prior to RT. A change in the overall management plan was recommended for around one in eight patients (35/334, 13%). RT plan reviews were performed in 79 cases (23%). Adjustments were made to the target volume contours or treatment plan in 8% (6/79). CONCLUSION Increasing the frequency of the meeting to weekly and compliant with the RANZCR Peer Review Audit Tool has the capacity to review all paediatric RT patients in ANZ prior to RT and initiate changes for as many as one in eight children treated by RT each year. The meeting should be considered a core component necessary to maintain expertise in paediatric RT in all centres providing RT for children in ANZ while also acting as a proton referral panel as more children are referred abroad for proton therapy before the Australian Bragg Centre for Proton Therapy opens in Adelaide in 2024.
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Affiliation(s)
- Laura Murphy
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jessica Cantwell
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jennifer Chard
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | - Robyn Cheuk
- Cancer Care Services - Department of Radiation Oncology, Royal Brisbane and Womens' Hospital, Brisbane, Queensland, Australia.,Radiation Oncology PA Raymond Terrace, Cancer Services Princess Alexandra Hospital, Metro South Health, Brisbane, Queensland, Australia
| | - Christopher Harrington
- Canterbury Regional Cancer and Haematology Service, Christchurch Hospital, Christchurch, New Zealand
| | - Ben Hindson
- Canterbury Regional Cancer and Haematology Service, Christchurch Hospital, Christchurch, New Zealand
| | - Alison Salkeld
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney University, Sydney, New South Wales, Australia
| | - Frank Saran
- Auckland City Hospital, Auckland, New Zealand
| | - Greg Wheeler
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kirsty Wiltshire
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Verity Ahern
- Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, Sydney University, Sydney, New South Wales, Australia
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24
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Kahalley LS, Peterson R, Ris MD, Janzen L, Okcu MF, Grosshans DR, Ramaswamy V, Paulino AC, Hodgson D, Mahajan A, Tsang DS, Laperriere N, Whitehead WE, Dauser RC, Taylor MD, Bouffet E, Chintagumpala M, Mabbott D. Reply to S.A. Milgrom et al. J Clin Oncol 2020; 38:2212-2213. [PMID: 32374644 DOI: 10.1200/jco.20.00344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lisa S Kahalley
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Rachel Peterson
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - M Douglas Ris
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Laura Janzen
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - M Fatih Okcu
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - David R Grosshans
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Arnold C Paulino
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - David Hodgson
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Anita Mahajan
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Derek S Tsang
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Normand Laperriere
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - William E Whitehead
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Robert C Dauser
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Michael D Taylor
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Eric Bouffet
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Murali Chintagumpala
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
| | - Donald Mabbott
- Lisa S. Kahalley, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Rachel Peterson, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Douglas Ris, PhD, Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX; Laura Janzen, PhD, Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; M. Fatih Okcu, MPH, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; David R. Grosshans, MD, PhD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Vijay Ramaswamy, MD, PhD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Arnold C. Paulino, MD, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; David Hodgson, MPH, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Anita Mahajan, MD, Department of Radiation Oncology, The Mayo Clinic, Rochester, MN; Derek S. Tsang, MSc, MD and Normand Laperriere, MD, Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; WilliamE. Whitehead, MPH, MD and Robert C.Dauser, MD, Department of Neurosurgery, Division of Pediatric Neurosurgery, Baylor College of Medicine, Houston, TX; Michael D. Taylor, MD, PhD, Division of Neurosurgery, The Hospital for Sick Children, and Department of Surgery, The University of Toronto, Toronto, Ontario, Canada; Eric Bouffet, MD, Division of Haematology/Oncology, The Hospital for Sick Children, and Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada; Murali Chintagumpala, MD, Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, TX; and Donald Mabbott, PhD, Program in Neurosciences and Mental Health, Research Institute, The Hospital for Sick Children, and Department of Psychology, The University of Toronto, Toronto, Ontario, Canada
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Martinez-Barbera JP, Andoniadou CL. Biological Behaviour of Craniopharyngiomas. Neuroendocrinology 2020; 110:797-804. [PMID: 32126562 DOI: 10.1159/000506904] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/02/2020] [Indexed: 11/19/2022]
Abstract
Jakob Erdheim (1874-1937) first described craniopharyn-giomas (CPs) as "hypophyseal duct tumours" and postulated the existence of two tumour types based on their histological features: (1) an aggressive type showing similarities to adamantinomas (tumours of the jaw) and (2) a more benign form characterised by the presence of papillary structures. More than a century later, these initial observations have been confirmed; based on their distinct genetic, epigenetic, and histological features, the WHO classifies CPs into two types: adamantinomatous CPs (ACPs) and papillary CPs (PCPs). Considerable knowledge has been generated on the biology of CPs in the last 20 years. Mutations in CTNNB1 (encoding β-catenin) are prevalent in ACP, whilst PCPs frequently harbour mutations in BRAF (p.BRAF-V600E). The consequence of these mutations is the activation of either the WNT/β-catenin (ACP) or the MAPK/ERK (PCP) pathway. Murine models support a critical role for these mutations in tumour formation and have provided important insights into tumour pathogenesis, mostly in ACP. A critical role for cellular senescence has been uncovered in murine models of ACP with relevance to human tumours. Several gene profiling studies of human and murine ACP tumours have identified potential targetable pathways, and novel therapeutic agents are being used in clinical and pre-clinical research, in some cases with excellent results. In this review, we will present the accumulated knowledge on the biological features of these tumours and summarise how these advances are being translated into potential novel treatments.
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Affiliation(s)
- Juan Pedro Martinez-Barbera
- Developmental Biology and Cancer, Birth Defect Research Centre, GOS Institute of Child Health, University College London, London, United Kingdom,
| | - Cynthia Lilian Andoniadou
- Centre for Craniofacial and Regenerative Biology, Faculty of Dental, Oral, and Craniofacial Sciences, King's College London, London, United Kingdom
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Price J, Hall E, West C, Thomson D. TORPEdO - A Phase III Trial of Intensity-modulated Proton Beam Therapy Versus Intensity-modulated Radiotherapy for Multi-toxicity Reduction in Oropharyngeal Cancer. Clin Oncol (R Coll Radiol) 2020; 32:84-88. [PMID: 31604604 DOI: 10.1016/j.clon.2019.09.052] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/14/2019] [Indexed: 11/26/2022]
Affiliation(s)
- J Price
- The Christie NHS Foundation Trust, Manchester, UK
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - C West
- Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - D Thomson
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
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Sardaro A, Carbonara R, Petruzzelli MF, Turi B, Moschetta M, Scardapane A, Stabile Ianora AA. Proton therapy in the most common pediatric non-central nervous system malignancies: an overview of clinical and dosimetric outcomes. Ital J Pediatr 2019; 45:170. [PMID: 31881905 PMCID: PMC6935184 DOI: 10.1186/s13052-019-0763-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/17/2019] [Indexed: 11/20/2022] Open
Abstract
Radiation therapy represents an important approach in the therapeutic management of children and adolescents with malignant tumors and its application with modern techniques – including Proton Beam Therapy (PBT) – is of great interest. In particular, potential radiation-induced injuries and secondary malignancies – also associated to the prolonged life expectancy of patients – are still questions of concern that increase the debate on the usefulness of PBT in pediatric treatments. This paper presents a literary review of current applications of PBT in non-Central Nervous System pediatric tumors (such as retinoblastoma, Hodgkin Lymphoma, Wilms tumor, bone and soft tissues sarcomas). We specifically reported clinical results achieved with PBT and dosimetric comparisons between PBT and the most common photon-therapy techniques. The analysis emphasizes that PBT minimizes radiation doses to healthy growing organs, suggesting for reduced risks of late side-effects and radiation-induced secondary malignancies. Extended follow up and confirms by prospective clinical trials should support the effectiveness and long-term tolerance of PBT in the considered setting.
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Affiliation(s)
- Angela Sardaro
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Roberta Carbonara
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy.
| | - Maria Fonte Petruzzelli
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Barbara Turi
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Marco Moschetta
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
| | - Amato Antonio Stabile Ianora
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari, p.zza Giulio Cesare nr.11, 70124, Bari, Italy
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Ludmir EB, Mahajan A, Ahern V, Ajithkumar T, Alapetite C, Bernier-Chastagner V, Bindra RS, Bishop AJ, Bolle S, Brown PD, Carrie C, Chalmers AJ, Chang EL, Chung C, Dieckmann K, Esiashvili N, Gandola L, Ghia AJ, Gondi V, Grosshans DR, Harrabi SB, Horan G, Indelicato DJ, Jalali R, Janssens GO, Krause M, Laack NN, Laperriere N, Laprie A, Li J, Marcus KJ, McGovern SL, Merchant TE, Merrell KW, Padovani L, Parkes J, Paulino AC, Schwarz R, Shih HA, Souhami L, Sulman EP, Taylor RE, Thorp N, Timmermann B, Wheeler G, Wolden SL, Woodhouse KD, Yeboa DN, Yock TI, Kortmann RD, McAleer MF. Assembling the brain trust: the multidisciplinary imperative in neuro-oncology. Nat Rev Clin Oncol 2019; 16:521-522. [PMID: 31150024 DOI: 10.1038/s41571-019-0235-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Ethan B Ludmir
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Verity Ahern
- Sydney West Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, New South Wales, Australia
| | | | - Claire Alapetite
- Department of Radiation Oncology, Institut Curie, Paris and Orsay, France
| | | | - Ranjit S Bindra
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew J Bishop
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephanie Bolle
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Christian Carrie
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | | | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Caroline Chung
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karin Dieckmann
- Department of Radiation Oncology, Universität Klinik für Strahlentherapie und Strahlenbiologie, Vienna, Austria
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA, USA
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Amol J Ghia
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinai Gondi
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Semi B Harrabi
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Gail Horan
- Department of Oncology, Cambridge University Hospitals, Cambridge, UK
| | - Danny J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mechthild Krause
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Normand Laperriere
- Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anne Laprie
- Department of Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Jing Li
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karen J Marcus
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Susan L McGovern
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Laetitia Padovani
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Arnold C Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rudolf Schwarz
- Department of Radiation Oncology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Luis Souhami
- Department of Radiation Oncology, McGill University Health Centre, Cedars Cancer Centre, Montréal, Quebec, Canada
| | - Erik P Sulman
- Department of Radiation Oncology, New York University Langone School of Medicine, New York, NY, USA
| | | | - Nicola Thorp
- Department of Oncology, The Clatterbridge Cancer Centre, Liverpool, UK
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, West German Cancer Center, German Cancer Consortium, Essen, Germany
| | - Greg Wheeler
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristina D Woodhouse
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debra N Yeboa
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mary Frances McAleer
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ajithkumar T, Kortmann R. “Indeed, Cure is Not Enough” – A Reflection on Paediatric Radiation Oncology. Clin Oncol (R Coll Radiol) 2019; 31:135-138. [DOI: 10.1016/j.clon.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 10/27/2022]
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30
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Patterns of proton therapy use in pediatric cancer management in 2016: An international survey. Radiother Oncol 2019; 132:155-161. [DOI: 10.1016/j.radonc.2018.10.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/10/2018] [Accepted: 10/22/2018] [Indexed: 01/19/2023]
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31
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Experimental Set-up for FLASH Proton Irradiation of Small Animals Using a Clinical System. Int J Radiat Oncol Biol Phys 2018; 102:619-626. [DOI: 10.1016/j.ijrobp.2018.06.403] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 06/15/2018] [Accepted: 06/30/2018] [Indexed: 11/18/2022]
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Chow EJ, Antal Z, Constine LS, Gardner R, Wallace WH, Weil BR, Yeh JM, Fox E. New Agents, Emerging Late Effects, and the Development of Precision Survivorship. J Clin Oncol 2018; 36:2231-2240. [PMID: 29874142 PMCID: PMC6053298 DOI: 10.1200/jco.2017.76.4647] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Incremental improvements in the treatment of children and adolescents with cancer have led to 5-year survival rates reaching nearly 85%. In the past decade, impressive progress has been made in understanding the biology of many pediatric cancers. With that understanding, multiple new agents have become available that offer the promise of more-effective and less-toxic treatment. These include agents that target various cell surface antigens and engage the adaptive immune system, as well as those that interfere with key signaling pathways involved in tumor development and growth. For local control, surgery and radiation techniques also have evolved, becoming less invasive or featuring new techniques and particles that more precisely target the tumor and limit the dose to normal tissue. Nevertheless, targeted agents, like conventional chemotherapy, radiotherapy, and surgery, may have off-target effects and deserve long-term follow-up of their safety and efficacy. These include injury to the endocrine, cardiovascular, and immunologic systems. New radiation and surgical techniques that theoretically reduce morbidity and improve long-term quality of life must also be validated with actual patient outcomes. Finally, with advances in genomics, information on host susceptibility to late effects is beginning to emerge. Such knowledge, coupled with improved metrics that better describe the spectrum of potential late effects across the entire lifespan, can lead to the development of decision models that project the potential long-term health outcomes associated with various treatment and follow-up strategies. These developments will help extend the current focus on precision medicine to precision survivorship, where clinicians, patients, and families will have a better grasp of the potential risks, benefits, and tradeoffs associated with the growing number of cancer treatment options.
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Affiliation(s)
- Eric J Chow
- Eric J. Chow and Rebecca Gardner, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and University of Washington, Seattle, WA; Zoltan Antal, Weill Cornell Medical College, New York Presbyterian Hospital, and Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; W. Hamish Wallace, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom; Brent R. Weil and Jennifer M. Yeh, Boston Children's Hospital, Harvard Medical School, Boston, MA; and Elizabeth Fox, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Zoltan Antal
- Eric J. Chow and Rebecca Gardner, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and University of Washington, Seattle, WA; Zoltan Antal, Weill Cornell Medical College, New York Presbyterian Hospital, and Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; W. Hamish Wallace, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom; Brent R. Weil and Jennifer M. Yeh, Boston Children's Hospital, Harvard Medical School, Boston, MA; and Elizabeth Fox, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Louis S Constine
- Eric J. Chow and Rebecca Gardner, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and University of Washington, Seattle, WA; Zoltan Antal, Weill Cornell Medical College, New York Presbyterian Hospital, and Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; W. Hamish Wallace, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom; Brent R. Weil and Jennifer M. Yeh, Boston Children's Hospital, Harvard Medical School, Boston, MA; and Elizabeth Fox, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Rebecca Gardner
- Eric J. Chow and Rebecca Gardner, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and University of Washington, Seattle, WA; Zoltan Antal, Weill Cornell Medical College, New York Presbyterian Hospital, and Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; W. Hamish Wallace, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom; Brent R. Weil and Jennifer M. Yeh, Boston Children's Hospital, Harvard Medical School, Boston, MA; and Elizabeth Fox, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - W Hamish Wallace
- Eric J. Chow and Rebecca Gardner, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and University of Washington, Seattle, WA; Zoltan Antal, Weill Cornell Medical College, New York Presbyterian Hospital, and Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; W. Hamish Wallace, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom; Brent R. Weil and Jennifer M. Yeh, Boston Children's Hospital, Harvard Medical School, Boston, MA; and Elizabeth Fox, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Brent R Weil
- Eric J. Chow and Rebecca Gardner, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and University of Washington, Seattle, WA; Zoltan Antal, Weill Cornell Medical College, New York Presbyterian Hospital, and Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; W. Hamish Wallace, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom; Brent R. Weil and Jennifer M. Yeh, Boston Children's Hospital, Harvard Medical School, Boston, MA; and Elizabeth Fox, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Jennifer M Yeh
- Eric J. Chow and Rebecca Gardner, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and University of Washington, Seattle, WA; Zoltan Antal, Weill Cornell Medical College, New York Presbyterian Hospital, and Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; W. Hamish Wallace, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom; Brent R. Weil and Jennifer M. Yeh, Boston Children's Hospital, Harvard Medical School, Boston, MA; and Elizabeth Fox, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Fox
- Eric J. Chow and Rebecca Gardner, Fred Hutchinson Cancer Research Center, Seattle Children's Hospital, and University of Washington, Seattle, WA; Zoltan Antal, Weill Cornell Medical College, New York Presbyterian Hospital, and Memorial Sloan Kettering Cancer Center, New York; Louis S. Constine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; W. Hamish Wallace, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom; Brent R. Weil and Jennifer M. Yeh, Boston Children's Hospital, Harvard Medical School, Boston, MA; and Elizabeth Fox, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
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Kenney LB, Antal Z, Ginsberg JP, Hoppe BS, Bober SL, Yu RN, Constine LS, van Santen HM, Skinner R, Green DM. Improving Male Reproductive Health After Childhood, Adolescent, and Young Adult Cancer: Progress and Future Directions for Survivorship Research. J Clin Oncol 2018; 36:2160-2168. [PMID: 29874140 DOI: 10.1200/jco.2017.76.3839] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Reproductive health is a common concern and often a source of distress for male childhood, adolescent, and young adult cancer survivors. Clinical and epidemiologic research in survivor populations has identified alkylating agent chemotherapy, testicular radiation, and surgery or radiation to the genitourinary organs, lower spine, or the hypothalamic-pituitary region as risk factors for adverse reproductive outcomes, including impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction. Much of the research on male survivors has focused on the outcome of fertility, using spermatogenesis, serum gonadotropins, and paternity as the measures. However, these studies often fail to account for the clinically relevant but difficult-to-quantify aspects of fertility such as sexual function, cancer-related delayed psychosocial development, medical comorbidities, and socioeconomic concerns. Clinical and basic science research has made significant contributions to improving reproductive outcomes for survivors, with recent advancements in the areas of fertility preservation, clinical assessment of reproductive function, and treatment of adverse reproductive outcomes. Furthermore, there is an emerging qualitative literature addressing the psychosexual aspects of male reproductive health, the clinical application of which will improve quality of life for survivors. This review summarizes the current survivorship literature on reproductive health outcomes for male survivors, including the epidemiology of impaired spermatogenesis, testosterone insufficiency, and sexual dysfunction; clinical and laboratory assessment of reproductive function; and established and investigational interventions to preserve reproductive function for patients newly diagnosed and survivors. Although survivorship research has made significant contributions to improving reproductive outcomes, additional scientific progress is needed in the areas of fertility preservation, risk assessment, and psychosexual support with the aim of optimizing reproductive health for current and future survivors.
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Affiliation(s)
- Lisa B Kenney
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Zoltan Antal
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Jill P Ginsberg
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Bradford S Hoppe
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Sharon L Bober
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Richard N Yu
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Louis S Constine
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Hanneke M van Santen
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Roderick Skinner
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
| | - Daniel M Green
- Lisa B. Kenney, Sharon L. Bober, and Richard N. Yu, Harvard Medical School, Boston, MA; Zoltan Antal, Weill Cornell Medical College, New York; Louis S. Constine, University of Rochester Medical Center, Rochester, NY; Jill P. Ginsberg, University of Pennsylvania, Philadelphia, PA; Bradford S. Hoppe, University of Florida Gainesville, FL; Hanneke M. van Santen, University Medical Center Utrecht, Utrecht, the Netherlands; Roderick Skinner, Newcastle University, Newcastle upon Tyne, United Kingdom; and Daniel M. Green, St Jude Children's Research Hospital, Memphis, TN
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Mokhtech M, Rotondo RL, Bradley JA, Sandler ES, Nanda R, Logie N, Aldana PR, Morris CG, Indelicato DJ. Early outcomes and patterns of failure following proton therapy for nonmetastatic intracranial nongerminomatous germ cell tumors. Pediatr Blood Cancer 2018; 65:e26997. [PMID: 29380526 DOI: 10.1002/pbc.26997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/15/2017] [Accepted: 12/29/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although dosimetric comparisons demonstrate the advantage of proton therapy (PT) over conventional radiotherapy for nongerminomatous germ cell tumors (NGGCT), clinical outcome data for this rare tumor are lacking. We sought to evaluate outcomes for children with NGGCT treated with PT. METHODS Between 2007 and 2016, 14 children (median age 11, range, 5-19 years) with nonmetastatic NGGCT were treated with PT after induction chemotherapy. Most (8/14) were mixed germ cell. Five of 14 patients had complete resection of their primary tumor before radiation. Off study, eight patients received 36 Gy (RBE [relative biological effectiveness]) craniospinal irradiation (CSI). On study, two patients received 30.6 Gy (RBE) whole-ventricle irradiation and four received focal radiation alone. All patients received a total dose of 54 Gy (RBE) to the tumor/tumor bed. RESULTS At a median follow-up of 2.8 years, all patients were alive with no local recurrences. Three-year progression-free survival was 86%. Both metastatic recurrences occurred in patients treated with focal radiation alone; one with an immature teratoma developed an isolated spinal recurrence 5 months after treatment. Another with a mixed germ cell tumor developed a multifocal ventricular and shunt tract recurrence 7 months after treatment. Serious toxicity was minimal, including cataracts and hormone deficiency, and limited to children who received CSI. CONCLUSION Early outcomes in children treated for NGGCT suggest the high conformality of PT does not compromise disease control and yields low toxicity. This pattern of failure data adds to growing evidence suggesting chemotherapy followed by focal radiotherapy alone is inadequate in controlling localized NGGCT.
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Affiliation(s)
- Meriem Mokhtech
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Ronny L Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Eric S Sandler
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Ronica Nanda
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Natalie Logie
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Philipp R Aldana
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
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Abstract
Proton Beam Therapy is one of the key elements in a major improvement in access to advanced radiotherapy in the UK. An overseas programme has treated significant numbers of children and young adults and skull base tumours since 2008. A major government investment has resulted in building two proton centres in England sited in academic major cancer centres. A weak evidence base for most adult indications means that the NHS will use clinical trials and studies to explore the future role of Protons.
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Affiliation(s)
- A Crellin
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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36
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Giordanengo S, Manganaro L, Vignati A. Review of technologies and procedures of clinical dosimetry for scanned ion beam radiotherapy. Phys Med 2017; 43:79-99. [DOI: 10.1016/j.ejmp.2017.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 09/23/2017] [Accepted: 10/18/2017] [Indexed: 12/17/2022] Open
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37
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Peyrl A, Frischer J, Hainfellner JA, Preusser M, Dieckmann K, Marosi C. Brain tumors - other treatment modalities. HANDBOOK OF CLINICAL NEUROLOGY 2017; 145:547-560. [PMID: 28987193 DOI: 10.1016/b978-0-12-802395-2.00034-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Management of tumors of the central nervous system is challenging for clinicians for various reasons, including complex diagnostic procedures, limited penetration of drugs into brain tissue, and the prerequisite to preserve brain function in any case of therapeutic intervention. Therapeutic success is dependent on the efforts, skills, and cooperation of involved specialists and disciplines. Knowledge and ability to apply adequate therapeutic modalities in an interdisciplinary approach in due time are crucial, necessitating coordination of diagnostic procedures and therapeutic interventions by means of multidisciplinary brain tumor boards. In this chapter we present in brief the essential current standards and future perspectives for therapy modalities that complement surgery of brain tumors.
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Affiliation(s)
- Andreas Peyrl
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Josa Frischer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Johannes A Hainfellner
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Institute of Neurology, Medical University of Vienna, Vienna, Austria.
| | - Matthias Preusser
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Comprehensive Cancer Center - Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria; Department of Medicine I, Medical University of Vienna, Vienna, Austria
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