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Int J Radiat Oncol Biol Phys. 2019 Jan 23. pii: S0360-3016(19)30162-2. doi: 10.1016/j.ijrobp.2019.01.078. [Epub ahead of print]

Outcomes Following Proton Therapy for Pediatric Low-Grade Glioma.

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Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL. Electronic address:
Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL.
Department of Nemours Children's Health System, Jacksonville, FL, USA.
Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL.



Dosimetric studies show that proton therapy can reduce the low/intermediate radiation dose to uninvolved tissue in children with low-grade glioma (LGG). For this reason, LGG is the 4th most common pediatric tumor treated with proton therapy, yet clinical outcome data on efficacy and toxicity are limited.


We reviewed the medical records of 174 children (≤21 years old) with non-metastatic LGG enrolled on a prospective protocol and treated with proton therapy between 2007 and 2017 to assess clinical outcomes and toxicity, and analyze patient, tumor, and treatment-related variables.


Median age was 10.2 years (range, 2-21). Fifty-eight percent of tumors were WHO grade I; 30% WHO grade II; 12% were diagnosed on imaging characteristics alone. The most common histology was pilocytic astrocytoma (47%). The most common tumor subsites were diencephalon/optic pathway (52%), caudal brainstem (17%), and cerebellum (13%). Forty-two percent received chemotherapy before radiotherapy. The median follow-up was 4.4 years. The 5-year actuarial rates of local control, progression-free survival, and overall survival were 85% (95% CI 78-90%), 84% (95% CI 77-89%), and 92% (95% CI 85-95%). On univariate analysis, brainstem/spinal cord tumor location (62% vs. 90% elsewhere) and dose <54 GyRBE (67% vs. 91% for 54 GyRBE) were associated with inferior local control (p <0.01 for both). Twenty-two patients (12.6%) experienced acute nausea or vomiting requiring ondansetron; 2 patients (1.1%) required corticosteroids. Serious toxicities (4% of patients) included brainstem necrosis requiring corticosteroids (n=2), symptomatic vasculopathy (n=2), radiation retinopathy (n=1), epilepsy (n=1), and death from radiation-induced high-grade glioma (n =1). Thirty-nine patients (22%) developed new-onset central hormone deficiency. Pseudoprogression was observed in 32.1%.


Compared to modern photon series, proton therapy reduces the radiation dose to developing brain tissue, diminishing acute toxicities without compromising disease control.


brain; low-grade glioma; optic pathway glioma; outcomes; proton therapy; radiation therapy

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