Evolution of Proton Radiation Therapy Brainstem Constraints on the Pediatric Proton/Photon Consortium Registry.
| Autor: | Correia D; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Cantonal Hospital Aarau, Aarau, Aargau, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: dora.correia@ksa.ch., Indelicato DJ; Department of Radiation Oncology, University of Florida, Jacksonville, Florida., Paulino AC; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas., Ermoian R; Department of Radiation Oncology, University of Washington, Seattle, Washington., Mihalcik S; Northwestern Medicine Chicago Proton Center, Warrenville, Illinois., Perkins SM; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri., Hill-Kayser C; Department of Radiation Oncology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania., Mangona VS; Department of Radiation Oncology, Texas Center for Proton Therapy, Irving, Texas., Lee J; Department of Radiation Oncology, ProCure Proton Therapy Center, Franklin Township, New Jersey., Chang JH; Department of Radiation Oncology, The Oklahoma Proton Center and University of Oklahoma Health Science Center, Oklahoma City, Oklahoma., Laack NN; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota., Kwok Y; Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland., Perentesis J; Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Vatner R; Department of Radiation Oncology, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Dave R; Medical College of Georgia, Augusta University, Augusta, Georgia; Department of Pediatrics, Emory University, Atlanta, Georgia., Gallotto SL; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Lawell MP; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Bajaj BVM; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Allison KW; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Perry A; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts., Yock TI; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | Practical radiation oncology [Pract Radiat Oncol] 2024 Nov-Dec; Vol. 14 (6), pp. e507-e514. Date of Electronic Publication: 2024 Aug 10. |
| DOI: | 10.1016/j.prro.2024.05.013 |
| Abstrakt: | Purpose: Increasing concern that brainstem toxicity incidence after proton radiation therapy might be higher than with photons led to a 2014 University of Florida (UF) landmark paper identifying its risk factors and proposing more conservative dose constraints. We evaluated how practice patterns changed among the Pediatric Proton/Photon Consortium Registry (PPCR). Material and Methods: This prospective multicenter cohort study gathered data from patients under the age of 22 years enrolled on the PPCR, treated between 2002 and 2019 for primary posterior fossa brain tumors. After standardizing brainstem contours, we garnered dosimetry data and correlated those meeting the 2014 proton-specific brainstem constraint guidelines by treatment era, histology, and extent of surgical resection. Results: A total of 467 patients with evaluable proton radiation therapy plans were reviewed. Median age was 7.1 years (range: <1-21.9), 63.0% (n = 296) were men, 76.0% (n = 357) were White, and predominant histology was medulloblastoma (55.0%, n = 256), followed by ependymoma (27.0%, n = 125). Extent of resection was mainly gross total resection (GTR) (67.0%, n = 312), followed by subtotal resection (STR) or biopsy (20.0%, n = 92), and near total resection (NTR) (9.2%, n = 43). The UF brainstem constraint metrics most often exceeded were the goal D Conclusion: Since the publication of the UF guidelines, the pediatric proton community has implemented more conservative brainstem constraints in all patients except those with ependymoma, irrespective of residual disease after surgery. Future work will evaluate if this change in practice is associated with decreased rates of brainstem toxicity. Competing Interests: Disclosures Dora Correia has a leadership role as chair of the EORTC Young and Early-Career Investigator Radiation Oncology Scientific Council not conferring a conflict of interest. Daniel J. Indelicato has an honorarium for committee service at the NCI Central IRB. Nadia N. Laack receives NCI institutional and COG support for the ACCL2031 randomized trial. Stephanie M. Perkins is part of the board of the National Association of Proton Therapy, Proton Collaborative Group, and Mevion Medical Systems, Inc., receiving support and honoraria from the latter. Torunn I. Yock receives in-kind funding for the Pediatric Proton/Photon Consortium Registry (PPCR) from MIM Software, IBA, Protom, and Elekta. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
| Externí odkaz: |
|