Research advances in proton therapy for pediatric cancer
Wen Xiaoxiao,Shi Haiou,An Zheng
Department of Technical Support,Beijing Proton Medical Center (Wen XX,Shi HO),Department of Medical Engineering,China-Japan Friendship Hospital (An Z),Beijing 100029,China
Abstract： Pediatric cancer is one of the leading causes of death in children around the world. Although radiotherapy is an important means of treatment for pediatric cancer, it causes acute or chronic adverse events that may affect patients’ survival time and quality of life. As a novel and advanced radiation technique, proton therapy allows for precise dose delivery in target volume, significantly reducing the irradiation to surrounding tissues and organs. Studies have shown that proton therapy is well tolerated in the treatment of pediatric cancer, and it achieves good tumor control;proton therapy is superior to traditional radiotherapy in improving quality of life, protecting intelligence, and reducing the risk of secondary cancer. This article reviews the research advances in the application of proton therapy in the treatment of pediatric cancer.
Wen Xiaoxiao,Shi Haiou,An Zheng. Research advances in proton therapy for pediatric cancer[J]. Chinese Journal of Radiation Oncology, 2017, 26(6): 698-701.
[1] World health organization. GLOBOCAN 2012:estimated cancer incidence,mortality and prevalence worldwide in 2012[R].Lyon:International Agency for Research on Cancer,2014. [2] Zheng R,Peng X,Zeng H,et al. Incidence,mortality and survival of childhood cancer in China during 2000-2010 period:a population-based study[J].Cancer Lett,2015,363(2):176-180.DOI:10.1016/j.canlet.2015.04.021. [3] Heron M,Hoyert DL,Murphy SL,et al. Deaths:final data for 2006[J].Natl Vital Stat Rep,2009,57(14):1-134. [4] Winther JF,Kenborg L,Byrne J,et al. Childhood cancer survivor cohorts in Europe[J].Acta Oncologica,2015,54(5):655-668.DOI:10.3109/0284186X.2015.1008648. [5] Armstrong GT,Stovall M,Robison LL.Long-term effects of radiation exposure among adult survivors of childhood cancer:results from the childhood cancer survivor study[J].Radiation research,2010,174(6b):840-850.DOI:10.1667/RR1903.1. [6] Delaney TF,Kooy HM.Proton and charged particle radiotherapy[M].Philadelphia:Wolters Kluwer Health Philadelphia,2007. [7] Cotter SE,Mcbride SM,Yock TI.Proton radiotherapy for solid tumors of childhood[J].Technol Cancer Res Treat,2012,11(3):267-278.DOI:10.7785/tcrt.2012.500295. [8] Particle Therapy Co-Operative Group. Particle therapy patient statistics (per end of 2015)[EB/OL][2016-12-01].https://www.ptcog.ch/archive/patient_statistics/Patientstatistics-updateDec2015.pdf. [9] Ladra MM,Szymonifka JD,Mahajan A,et al. Preliminary results of a phase Ⅱ trial of proton radiotherapy for pediatric rhabdomyosarcoma[J].J Clin Oncol,2014,32(33):3762-7370.DOI:10.1200/JCO.2014.56.1548. [10] Merks JHM,De Salvo GL,Bergeron C,et al. Parameningeal rhabdomyosarcoma in pediatric age:results of a pooled analysis from North American and European cooperative groups[J].Ann Oncol,2014,25(1):231-236.DOI:10.1093/annonc/mdt426. [11] Donaldson SS,Meza J,Breneman JC,et al. Results from the IRS-IV randomized trial of hyperfractionated radiotherapy in children with rhabdomyosarcoma—a report from the IRSG[J].Int J Radiat Oncol Biol Phys,2001,51(3):718-728.DOI:10.1016/S0360-3016(01)01709-6. [12] Leiser D,Calaminus G,Malyapa R,et al. Tumour control and Quality of Life in children with rhabdomyosarcoma treated with pencil beam scanning proton therapy[J].Radiother Oncol,2016,120(1):163-168.DOI:10.1016/j.radonc.2016.05.013. [13] Weber DC,Ares C,Albertini F,et al. Pencil beam scanning proton therapy for pediatric parameningeal rhabdomyosarcomas:clinical outcome of patients treated at the paul scherrer institute[J].Pediatr Blood Cancer,2016,63(10):1731-1736.DOI:10.1002/pbc.25864. [14] Michalski JM,Meza J,Breneman JC,et al. Influence of radiation therapy parameters on outcome in children treated with radiation therapy for localized parameningeal rhabdomyosarcoma in intergroup rhabdomyosarcoma study group trials Ⅱ through Ⅳ[J].Int J Radiat Oncol Biol Phys,2004,59(4):1027-1038.DOI:10.1016/j.ijrobp.2004.02.064. [15] Eaton BR,Esiashvili N,Kim S,et al. Clinical Outcomes Among Children With Standard-Risk Medulloblastoma Treated With Proton and Photon Radiation Therapy:A Comparison of Disease Control and Overall Survival[J].Int J Radiat Oncol Biol Phys,2016,94(1):133-138.DOI:10.1016/j.ijrobp.2015.09.014. [16] Yock TI,Yeap BY,Ebb DH,et al. Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma:a phase 2 single-arm study[J].Lancet Oncol,2016,17(3):287-298.DOI:10.1016/S1470-2045(15)00167-9. [17] Gajjar A,Chintagumpala M,Ashley D,et al. Risk-adapted craniospinal radiotherapy followed by high-dose chemotherapy and stem-cell rescue in children with newly diagnosed medulloblastoma (St Jude Medulloblastoma-96):long-term results from a prospective,multicentre trial[J].Lancet Oncol,2006,7(10):813-820.DOI:10.1016/S1470-2045(06)70867-1. [18] Packer RJ,Gajjar A,Vezina G,et al. Phase Ⅲ study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma[J].J Clin Oncol,2006,24(25):4202-4208.DOI:10.1200/JCO.2006.06.4980. [19] Burger PC,Yu IT,Tihan T,et al. Atypical teratoid/rhabdoid tumor of the central nervous system:a highly malignant tumor of infancy and childhood frequently mistaken for medulloblastoma:a Pediatric Oncology Group study[J].Am J Surg Pathol,1998,22(9):1083-1092.DOI:10.1097/00000478-199809000-00007. [20] Ginn KF,Gajjar A.Atypical teratoid rhabdoid tumor:current therapy and future directions.[J].Front Oncol,2012,2(2):114.DOI:10.3389/fonc.2012.00114. [21] Hilden JM,Meerbaum S,Burger P,et al. Central nervous system atypical teratoid/rhabdoid tumor:results of therapy in children enrolled in a registry[J].J Clin Oncol,2004,22(14):2877-2884.DOI:10.1200/JCO.2004.07.073. [22] Mcgovern SL,Okcu MF,Munsell MF,et al. Outcomes and acute toxicities of proton therapy for pediatric atypical teratoid/rhabdoid tumor of the central nervous system[J].Int J Radiat Oncol Biol Phys,2014,90(5):1143-1152.DOI:10.1016/j.ijrobp.2014.08.354. [23] Chi SN,Zimmerman MA,Yao X,et al. Intensive multimodality treatment for children with newly diagnosed CNS atypical teratoid rhabdoid tumor[J].J Clin Oncol,2009,27(3):385-389.DOI:10.1200/JCO.2008.18.7724. [24] Pai Panandiker AS,Merchant TE,Beltran C,et al. Sequencing of local therapy affects the pattern of treatment failure and survival in children with atypical teratoid rhabdoid tumors of the central nervous system[J].Int J Radiat Oncol Biol Phys,2012,82(5):1756-1763.DOI:10.1016/j.ijrobp.2011.02.059. [25] De Amorim-Bernstein K,Sethi R,Trofimov A,et al. Early clinical outcomes using proton radiation for children with central nervous system atypical teratoid rhabdoid tumors[J].Int J Radiat Oncol Biol Phys,2013,86(1):114-120.DOI:10.1016/j.ijrobp.2012.12.004. [26] Weber DC,Ares C,Malyapa R,et al. Tumor control and QoL outcomes of very young children with atypical teratoid/rhabdoid tumor treated with focal only chemo-radiation therapy using pencil beam scanning proton therapy[J].J Neurooncol,2015,121(2):389-397.DOI:10.1007/s11060-014-1648-2. [27] Yock TI,Bhat S,Szymonifka J,et al. Quality of life outcomes in proton and photon treated pediatric brain tumor survivors[J].Radiother Oncol,2014,113(1):89-94.DOI:10.1016/j.radonc.2014.08.017. [28] Kahalley LS,Ris MD,Grosshans DR,et al. Comparing intelligence quotient change after treatment with proton versus photon radiation therapy for pediatric brain tumors[J].J Clin Oncol,2016,34(10):1043-1049.DOI:10.1200/JCO.2015.62.1383. [29] Greenberger BA,Pulsifer MB,Ebb DH,et al. Clinical outcomes and late endocrine,neurocognitive,and visual profiles of proton radiation for pediatric low-grade gliomas[J].Int J Radiat Oncol Biol Phys,2014,89(5):1060-1068.DOI:10.1016/j.ijrobp.2014.04.053. [30] Macdonald SM,Sethi R,Lavally B,et al. Proton radiotherapy for pediatric central nervous system ependymoma:clinical outcomes for 70 patients[J].Neuro Oncol,2013,15(11):1552-1559.DOI:10.1093/neuonc/not121. [31] Fuji H,Schneider U,Ishida Y,et al. Assessment of organ dose reduction and secondary cancer risk associated with the use of proton beam therapy and intensity modulated radiation therapy in treatment of neuroblastomas[J].Radiat Oncol,2013,8:255.DOI:10.1186/1748-717X-8-255. [32] Zhang R,Howell RM,Taddei PJ,et al. A comparative study on the risks of radiogenic second cancers and cardiac mortality in a set of pediatric medulloblastoma patients treated with photon or proton craniospinal irradiation[J].Radiother Oncol,2014,113(1):84-88.DOI:10.1016/j.radonc.2014.07.003. [33] Macdonald SM,Safai S,Trofimov A,et al. Proton radiotherapy for childhood ependymoma:initial clinical outcomes and dose comparisons[J].Int J Radiat Oncol Biol Phys,2008,71(4):979-986.DOI:10.1016/j.ijrobp.2007.11.065. [34] Mu X,Bjork-Eriksson T,Nill S,et al. Does electron and proton therapy reduce the risk of radiation induced cancer after spinal irradiation for childhood medulloblastoma? A comparative treatment planning study[J].Acta Oncol,2005,44(6):554-562.DOI:10.1080/02841860500218819. [35] Brodin NP,Munck AF,Rosenschold P,et al. Radiobiological risk estimates of adverse events and secondary cancer for proton and photon radiation therapy of pediatric medulloblastoma[J].Acta Oncol,2011,50(6):806-816.DOI:10.3109/0284186X.2011.582514. [36] Cotter SE,Herrup DA,Friedmann A,et al. Proton radiotherapy for pediatric bladder/prostate rhabdomyosarcoma:clinical outcomes and dosimetry compared to intensity-modulated radiation therapy[J].Int J Radiat Oncol Biol Phys,2011,81(5):1367-1373.DOI:10.1016/j.ijrobp.2010.07.1989. [37] Lin R,Hug EB,Schaefer RA,et al. Conformal proton radiation therapy of the posterior fossa:a study comparing protons with three-dimensional planned photons in limiting dose to auditory structures[J].Int J Radiat Oncol Biol Phys,2000,48(4):1219-1226.DOI:10.1016/S0360-3016(00)00741-0. [38] St Clair WH,Adams JA,Bues M,et al. Advantage of protons compared to conventional X-ray or IMRT in the treatment of a pediatric patient with medulloblastoma[J].Int J Radiat Oncol Biol Phys,2004,58(3):727-734.DOI:10.1016/S0360-3016(03)01574-8. [39] Hillbrand M,Georg D,Gadner H,et al. Abdominal cancer during early childhood:a dosimetric comparison of proton beams to standard and advanced photon radiotherapy[J].Radiother Oncol,2008,89(2):141-149.DOI:10.1016/j.radonc.2008.06.012. [40] Taddei PJ,Mirkovic D,Fontenot JD,et al. Stray radiation dose and second cancer risk for a pediatric patient receiving craniospinal irradiation with proton beams[J].Phys Med Biol,2009,54(8):2259-2275.DOI:10.1088/0031-9155/54/8/001. [41] Geng C,Moteabbed M,Xie Y,et al. Assessing the radiation-induced second cancer risk in proton therapy for pediatric brain tumors:the impact of employing a patient-specific aperture in pencil beam scanning[J].Phys Med Biol,2016,61(1):12-22.DOI:10.1088/0031-9155/61/1/12.
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