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The Current State of Radiotherapy for Pediatric Brain Tumors: An Overview of Post-Radiotherapy Neurocognitive Decline and Outcomes. J Pers Med 2022; 12:jpm12071050. [PMID: 35887547 PMCID: PMC9315742 DOI: 10.3390/jpm12071050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Tumors of the central nervous system are the most common solid malignancies diagnosed in children. While common, they are also found to have some of the lowest survival rates of all malignancies. Treatment of childhood brain tumors often consists of operative gross total resection with adjuvant chemotherapy or radiotherapy. The current body of literature is largely inconclusive regarding the overall benefit of adjuvant chemo- or radiotherapy. However, it is known that both are associated with conditions that lower the quality of life in children who undergo those treatments. Chemotherapy is often associated with nausea, emesis, significant fatigue, immunosuppression, and alopecia. While radiotherapy can be effective for achieving local control, it is associated with late effects such as endocrine dysfunction, secondary malignancy, and neurocognitive decline. Advancements in radiotherapy grant both an increase in lifetime survival and an increased lifetime for survivors to contend with these late effects. In this review, the authors examined all the published literature, analyzing the results of clinical trials, case series, and technical notes on patients undergoing radiotherapy for the treatment of tumors of the central nervous system with a focus on neurocognitive decline and survival outcomes.
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Nakao T, Fukushima H, Fukushima T, Suzuki R, Hosaka S, Yamaki Y, Kobayashi C, Iwabuchi A, Imagawa K, Sakai A, Shinkai T, Masumoto K, Sakashita S, Masumoto T, Mizumoto M, Sumazaki R, Sakurai H. Interinstitutional patient transfers between rapid chemotherapy cycles were feasible to utilize proton beam therapy for pediatric Ewing sarcoma family of tumors. Rep Pract Oncol Radiother 2018; 23:442-450. [PMID: 30197580 DOI: 10.1016/j.rpor.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 06/04/2018] [Accepted: 08/11/2018] [Indexed: 12/18/2022] Open
Abstract
Aim To assess the feasibility of transferring to the University of Tsukuba Hospital for proton beam therapy (PBT) during intensive chemotherapy in children with Ewing sarcoma family of tumors (ESFT) who had been diagnosed and started their first-line treatment at prefectural or regional centers for pediatric oncology. Background The treatment of ESFT relies on a multidisciplinary approach using intensive neoadjuvant and adjuvant chemotherapies with surgery and radiotherapy. Multi-agent chemotherapy comprising vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide (VDC-IE) is widely used for ESFT, and the interval between each course is very important for maintaining the intensity and effect of chemotherapy. Materials and methods Clinical information of patients who received PBT and VDC-IE between April 2009 and May 2016 was collected retrospectively. The intervals between each course of VDC-IE and adverse events were assessed. Results Fifteen patients were evaluated. No delays in the intervals of chemotherapy due to transfer were observed. There were no adverse events caused during/just after transfer and no increases in adverse events. The estimated 4-year overall and event-free survival rates were 94.6% and 84.8%, respectively. Discussion Although the results of efficacy are preliminary, survival rates were comparable with past studies. More experience and follow-up are required to further assess the efficacy of PBT for patients with ESFT. Conclusion Multidisciplinary therapy for children with ESFT involving transfer to our hospital for PBT during VDC-IE was feasible without treatment delay or an increase in adverse events.
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Key Words
- DFS, disease-free survival
- EFS, event-free survival
- ESFT, Ewing sarcoma family of tumors
- Ewing sarcoma family of tumors (ESFT)
- Multi-institutional
- Multidisciplinary therapy
- OS, overall survival
- PBT, proton beam therapy
- Pediatric
- Proton beam therapy (PBT)
- UTH, University of Tsukuba Hospital
- VDC-IE, vincristine, doxorubicin, cyclophosphamide, ifosfamide and etoposide
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Affiliation(s)
- Tomohei Nakao
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki 305-8576, Japan.,Department of Pediatrics, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Hiroko Fukushima
- Department of Child Health, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takashi Fukushima
- Department of Child Health, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Ryoko Suzuki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Sho Hosaka
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Yuni Yamaki
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Chie Kobayashi
- Department of Child Health, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Atsushi Iwabuchi
- Department of Child Health, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kazuo Imagawa
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Aiko Sakai
- Department of Pediatrics, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki 305-8576, Japan
| | - Toko Shinkai
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kouji Masumoto
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Shingo Sakashita
- Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tomohiko Masumoto
- Department of Radiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Ryo Sumazaki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Fukushima H, Fukushima T, Suzuki R, Iwabuchi A, Hidaka K, Shinkai T, Masumoto K, Muroi A, Yamamoto T, Nakao T, Oshiro Y, Mizumoto M, Sakurai H, Sumazaki R. Comorbidity and quality of life in childhood cancer survivors treated with proton beam therapy. Pediatr Int 2017; 59:1039-1045. [PMID: 28503890 DOI: 10.1111/ped.13323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/05/2017] [Accepted: 05/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The rate of childhood cancer survival has recently reached >80%. Various adverse events among childhood cancer survivors (CCS) have been reported. Proton beams are able to avoid unnecessary irradiation to normal/vital organs. We conducted a quality of life (QOL) study for CCS who were treated with proton beam therapy (PBT). METHODS We included those patients treated with PBT to the brain, head, or neck and who were ≤15 years old at the University of Tsukuba Hospital between 1983 and 2011. Clinical information was collected from medical records. Questionnaires including the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales (which assess health-related quality of life) were sent to the families/patients. RESULTS Sixty patients were included. Median age at treatment was 6.2 years. The number of patients with status alive/dead/unknown was 32/24/4. Median follow-up period was 63.0 months (range, 48-340 months) for survivors. Questionnaires were sent to 25 families/patients and 19 were returned. PedsQL was assessed for 17 patients. Eleven of 32 living patients had at least one comorbidity grade 3/4. Average QOL score was above that for Japanese schoolchildren and adolescents. There was no correlation with comorbidity, and only longer time from treatment was correlated with a higher PedsQL score (P = 0.006). CONCLUSION CCS who were treated with multimodal treatment using PBT had a higher QOL score. Higher score was related to longer time since treatment, regardless of comorbidity.
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Affiliation(s)
- Hiroko Fukushima
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takashi Fukushima
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryoko Suzuki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Atsushi Iwabuchi
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kyoko Hidaka
- Department of Clinical Psychology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Toko Shinkai
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kouji Masumoto
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomohei Nakao
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryo Sumazaki
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Takizawa D, Oshiro Y, Mizumoto M, Fukushima H, Fukushima T, Sakurai H. Proton beam therapy for a patient with large rhabdomyosarcoma of the body trunk. Ital J Pediatr 2015; 41:90. [PMID: 26573272 PMCID: PMC4647646 DOI: 10.1186/s13052-015-0200-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/08/2015] [Indexed: 12/12/2022] Open
Abstract
Background We present the clinical course of a pediatric patient with large rhabdomyosarcoma of the body trunk who received proton beam therapy (PBT). Case presentation A 1-year-old girl was diagnosed with stage IV alveolar rhabdomyosarcoma in 2008. A large tumor was located in the central diaphragm and had infiltrated the liver and pericardium with peritoneal dissemination. Chemotherapy was immediately started with six courses of vincristine, actinomycin-D and cyclophosphamide (VAC) firstly, and secondly followed by 2 courses of ifosfamide, carboplatin and etoposide (ICE), but a large tumor of 15 cm in size remained. The tumor was inoperable because of its location, and photon radiotherapy could not be performed due to limited liver tolerance. The patient was referred to our hospital and received PBT at a dose of 54 GyE in 30 fractions in June 2009. The tumor quickly responded and 95 % of volume reduction was achieved at the end of PBT. However, marginal recurrence in the caudal part of the irradiated field, where we reduced the proton dose because of the presence of the intestine, was detected in August 2010. The recurrent tumor size was less than 1 cm. Chemotherapy with VAC followed by topotecan and carboplatin (TC) was again tried, but the tumor size was stable. Repeated PBT was not possible because of limited intestinal tolerance; therefore, intraoperative radiotherapy was conducted with 20 Gy of electron beams in April 2011. The tumor was subsequently well controlled, but secondary myelodysplastic syndrome developed and the patient died of hemophagocytic syndrome after umbilical cord blood transplantation in May 2012. Conclusion PBT was performed safely and effectively for a 1-year-old girl with alveolar rhabdomyosarcoma with liver and cardiac invasion that was resistant to surgery and chemotherapy. This case illustrates that PBT can be useful in cases that are difficult to treat with conventional radiotherapy.
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Affiliation(s)
- Daichi Takizawa
- Departments of Radiation Oncology1 and Child Health3, University of Tsukuba, Ibaraki, Japan. .,Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yoshiko Oshiro
- Departments of Radiation Oncology1 and Child Health3, University of Tsukuba, Ibaraki, Japan. .,Department of Radiation Oncology, Tsukuba Medical Center Hospital, Ibaraki, Japan.
| | - Masashi Mizumoto
- Departments of Radiation Oncology1 and Child Health3, University of Tsukuba, Ibaraki, Japan. .,Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Hiroko Fukushima
- Departments of Child Health, University of Tsukuba and Proton Medical Research Center, Ibaraki, Japan.
| | - Takashi Fukushima
- Departments of Child Health, University of Tsukuba and Proton Medical Research Center, Ibaraki, Japan.
| | - Hideyuki Sakurai
- Departments of Radiation Oncology1 and Child Health3, University of Tsukuba, Ibaraki, Japan. .,Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
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Mizumoto M, Oshiro Y, Takizawa D, Fukushima T, Fukushima H, Yamamoto T, Muroi A, Okumura T, Tsuboi K, Sakurai H. Proton beam therapy for pediatric ependymoma. Pediatr Int 2015; 57:567-71. [PMID: 25754294 DOI: 10.1111/ped.12624] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 12/12/2014] [Accepted: 01/08/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy of proton beam therapy for pediatric patients with ependymoma. METHODS Proton beam therapy was conducted for six patients (three boys and three girls; age, 2-6 years; median, 5 years) with ependymoma. The tumors were WHO grades 2 and 3 in two and four patients, respectively. All patients underwent surgery (subtotal and gross total resection in three patients each) and proton beam therapy at doses of 50.4-61.2 GyE (median, 56.7 GyE). The mean doses to normal brain tissue in proton beam therapy and photon radiotherapy were simulated using the same treatment planning computed tomography images. RESULTS All patients completed the planned irradiation. The follow-up period was 13-44 months (median, 24.5 months) from completion of proton beam therapy and all patients were alive at the end of this period. Local recurrence in the treatment field occurred in one patient at 4 months after proton beam therapy at 50.4 GyE. Alopecia and mild dermatitis occurred in all patients, but there was no severe toxicity. One patient had a once-off seizure after proton beam therapy and alopecia persisted in another patient for 31 months, but no patients had difficulty with daily life. The simulation showed that proton beam therapy reduces the dose to normal brain tissue by approximately half compared with photon radiotherapy. CONCLUSIONS Proton beam therapy for pediatric ependymoma is safe, does not have specific toxicities, and can reduce irradiation of normal brain tissue.
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Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, Tsukuba University, Tsukuba, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, Tsukuba University, Tsukuba, Japan.,Department of Radiation Oncology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Daichi Takizawa
- Department of Radiation Oncology, Tsukuba University, Tsukuba, Japan
| | | | | | | | - Ai Muroi
- Department of Neurosurgery, Tsukuba University, Tsukuba, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, Tsukuba University, Tsukuba, Japan
| | - Koji Tsuboi
- Department of Radiation Oncology, Tsukuba University, Tsukuba, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, Tsukuba University, Tsukuba, Japan
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Preparation of pediatric patients for treatment with proton beam therapy. Radiother Oncol 2015; 114:245-8. [DOI: 10.1016/j.radonc.2015.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 11/23/2022]
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Sugawara K, Mizumoto M, Numajiri H, Ohno T, Ohnishi K, Ishikawa H, Okumura T, Sakurai H. Proton beam therapy for a patient with a giant thymic carcinoid tumor and severe superior vena cava syndrome. Rare Tumors 2014; 6:5177. [PMID: 25002943 PMCID: PMC4083663 DOI: 10.4081/rt.2014.5177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 03/02/2014] [Accepted: 03/07/2014] [Indexed: 11/23/2022] Open
Abstract
Surgical resection is the first choice for treatment of a thymic carcinoid tumor and radiotherapy is often performed as adjuvant therapy. Here, we report a case of an unresectable and chemoresistant thymic carcinoid tumor that was treated successfully using standalone proton beam therapy (PBT). The patient was a 66-year-old woman in whom surgical resection of the tumor was impossible because of cardiac invasion. Therefore, chemotherapy was administered. However, the tumor grew to 15 cm in diameter and she developed severe superior vena cava (SVC) syndrome. She was referred to our hospital and received PBT at a dose of 74 GyE in 37 fractions. PBT was conducted without severe early toxicities. After PBT, the tumor mildly shrunk to 13 cm in diameter and SVC syndrome almost disappeared. Subsequently, the tumor has continued to decrease in size slowly over the last 2 years and late toxicities have not been observed. Our experience with this case suggests that PBT may be effective for an unresectable thymic carcinoid tumor.
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Affiliation(s)
- Kaori Sugawara
- Department of Radiation Oncology, University of Tsukuba , Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba , Ibaraki, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba , Ibaraki, Japan
| | - Toshiki Ohno
- Department of Radiation Oncology, University of Tsukuba , Ibaraki, Japan
| | - Kayoko Ohnishi
- Department of Radiation Oncology, University of Tsukuba , Ibaraki, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, University of Tsukuba , Ibaraki, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba , Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba , Ibaraki, Japan
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