PMID- 29619963
OWN - NLM
STAT- MEDLINE
DCOM- 20190320
LR  - 20190627
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 101
IP  - 1
DP  - 2018 May 1
TI  - National Cancer Institute Workshop on Proton Therapy for Children: Considerations
      Regarding Brainstem Injury.
PG  - 152-168
LID - S0360-3016(18)30051-8 [pii]
LID - 10.1016/j.ijrobp.2018.01.013 [doi]
AB  - PURPOSE: Proton therapy can allow for superior avoidance of normal tissues. A
      widespread consensus has been reached that proton therapy should be used for
      patients with curable pediatric brain tumor to avoid critical central nervous
      system structures. Brainstem necrosis is a potentially devastating, but rare,
      complication of radiation. Recent reports of brainstem necrosis after proton
      therapy have raised concerns over the potential biological differences among
      radiation modalities. We have summarized findings from the National Cancer
      Institute Workshop on Proton Therapy for Children convened in May 2016 to examine
      brainstem injury. METHODS AND MATERIALS: Twenty-seven physicians, physicists, and
      researchers from 17 institutions with expertise met to discuss this issue. The
      definition of brainstem injury, imaging of this entity, clinical experience with 
      photons and photons, and potential biological differences among these radiation
      modalities were thoroughly discussed and reviewed. The 3 largest US pediatric
      proton therapy centers collectively summarized the incidence of symptomatic
      brainstem injury and physics details (planning, dosimetry, delivery) for 671
      children with focal posterior fossa tumors treated with protons from 2006 to
      2016. RESULTS: The average rate of symptomatic brainstem toxicity from the 3
      largest US pediatric proton centers was 2.38%. The actuarial rate of grade >/=2
      brainstem toxicity was successfully reduced from 12.7% to 0% at 1 center after
      adopting modified radiation guidelines. Guidelines for treatment planning and
      current consensus brainstem constraints for proton therapy are presented. The
      current knowledge regarding linear energy transfer (LET) and its relationship to 
      relative biological effectiveness (RBE) are defined. We review the current state 
      of LET-based planning. CONCLUSIONS: Brainstem injury is a rare complication of
      radiation therapy for both photons and protons. Substantial dosimetric data have 
      been collected for brainstem injury after proton therapy, and established
      guidelines to allow for safe delivery of proton radiation have been defined.
      Increased capability exists to incorporate LET optimization; however, further
      research is needed to fully explore the capabilities of LET- and RBE-based
      planning.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Haas-Kogan, Daphne
AU  - Haas-Kogan D
AD  - Department of Radiation Oncology, Harvard Medical School and Brigham and Women's 
      Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston,
      Massachusetts.
FAU - Indelicato, Daniel
AU  - Indelicato D
AD  - Department of Radiation Oncology, University of Florida, Jacksonville, Florida.
FAU - Paganetti, Harald
AU  - Paganetti H
AD  - Department of Radiation Oncology, Harvard Medical School and Massachusetts
      General Hospital, Boston, Massachusetts.
FAU - Esiashvili, Natia
AU  - Esiashvili N
AD  - Department of Radiation Oncology, Winship Cancer Institute, Emory University,
      Atlanta, Georgia.
FAU - Mahajan, Anita
AU  - Mahajan A
AD  - Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas;
      Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
FAU - Yock, Torunn
AU  - Yock T
AD  - Department of Radiation Oncology, Harvard Medical School and Massachusetts
      General Hospital, Boston, Massachusetts.
FAU - Flampouri, Stella
AU  - Flampouri S
AD  - Department of Radiation Oncology, University of Florida, Jacksonville, Florida.
FAU - MacDonald, Shannon
AU  - MacDonald S
AD  - Department of Radiation Oncology, Harvard Medical School and Massachusetts
      General Hospital, Boston, Massachusetts.
FAU - Fouladi, Maryam
AU  - Fouladi M
AD  - Department of Pediatrics, Cincinnati Children's Hospital Medical Center,
      Cincinnati, Ohio.
FAU - Stephen, Kry
AU  - Stephen K
AD  - Department of Radiation Physics, University of Texas MD Anderson Cancer Center,
      Houston, Texas.
FAU - Kalapurakal, John
AU  - Kalapurakal J
AD  - Department of Radiation Oncology, Feinberg School of Medicine, Northwestern
      University, Chicago, Illinois.
FAU - Terezakis, Stephanie
AU  - Terezakis S
AD  - Department of Radiation Oncology, Johns Hopkins Medical Institute, Baltimore,
      Maryland.
FAU - Kooy, Hanne
AU  - Kooy H
AD  - Department of Radiation Oncology, Harvard Medical School and Massachusetts
      General Hospital, Boston, Massachusetts.
FAU - Grosshans, David
AU  - Grosshans D
AD  - Department of Radiation Physics, University of Texas MD Anderson Cancer Center,
      Houston, Texas.
FAU - Makrigiorgos, Mike
AU  - Makrigiorgos M
AD  - Department of Radiation Oncology, Harvard Medical School and Dana-Farber Cancer
      Institute, Boston, Massachusetts.
FAU - Mishra, Kavita
AU  - Mishra K
AD  - Department of Radiation Oncology, University of California, San Francisco, San
      Francisco, California.
FAU - Poussaint, Tina Young
AU  - Poussaint TY
AD  - Department of Radiology, Harvard Medical School and Dana-Farber Cancer Institute,
      Boston Children's Hospital, Boston, Massachusetts.
FAU - Cohen, Kenneth
AU  - Cohen K
AD  - Department of Pediatrics, Johns Hopkins Medical Institute, Baltimore, Maryland.
FAU - Fitzgerald, Thomas
AU  - Fitzgerald T
AD  - Department of Radiation Oncology, UMass Memorial Medical Center, Worcester,
      Massachusetts.
FAU - Gondi, Vinai
AU  - Gondi V
AD  - Northwestern Medicine Chicago Proton Center, Chicago, Illinois.
FAU - Liu, Arthur
AU  - Liu A
AD  - Department of Radiation Oncology, University of Colorado School of Medicine,
      Aurora, Colorado.
FAU - Michalski, Jeff
AU  - Michalski J
AD  - Department of Radiation Oncology, Washington University School of Medicine, St.
      Louis, Missouri.
FAU - Mirkovic, Dragan
AU  - Mirkovic D
AD  - Department of Radiation Physics, University of Texas MD Anderson Cancer Center,
      Houston, Texas.
FAU - Mohan, Radhe
AU  - Mohan R
AD  - Department of Radiation Physics, University of Texas MD Anderson Cancer Center,
      Houston, Texas.
FAU - Perkins, Stephanie
AU  - Perkins S
AD  - Department of Radiation Oncology, Washington University School of Medicine, St.
      Louis, Missouri.
FAU - Wong, Kenneth
AU  - Wong K
AD  - Children's Hospital of Angeles and University of Southern California Keck School 
      of Medicine, Los Angles, California.
FAU - Vikram, Bhadrasain
AU  - Vikram B
AD  - Radiation Research Program, National Cancer Institute, National Institutes of
      Health, Rockville, Maryland.
FAU - Buchsbaum, Jeff
AU  - Buchsbaum J
AD  - Radiation Research Program, National Cancer Institute, National Institutes of
      Health, Rockville, Maryland.
FAU - Kun, Larry
AU  - Kun L
AD  - Department of Radiation Oncology, University of Texas Southwestern Medical
      School, Dallas, Texas. Electronic address: larry.kun@utsouthwestern.edu.
LA  - eng
GR  - R01 CA172067/CA/NCI NIH HHS/United States
GR  - R01 NS091620/NS/NINDS NIH HHS/United States
GR  - U10 CA180833/CA/NCI NIH HHS/United States
PT  - Consensus Development Conference, NIH
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Review
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Brain Stem/diagnostic imaging/*pathology/*radiation effects
MH  - Cancer Care Facilities/statistics & numerical data
MH  - Child
MH  - Florida
MH  - Humans
MH  - Infratentorial Neoplasms/diagnostic imaging/pathology/*radiotherapy
MH  - Linear Energy Transfer
MH  - Massachusetts
MH  - National Cancer Institute (U.S.)
MH  - Necrosis/diagnostic imaging/epidemiology/etiology/prevention & control
MH  - Photons/adverse effects
MH  - Practice Guidelines as Topic
MH  - Proton Therapy/*adverse effects/methods/standards
MH  - Radiation Injuries/diagnostic imaging/*epidemiology/prevention & control
MH  - Radiotherapy, Intensity-Modulated
MH  - Relative Biological Effectiveness
MH  - Texas
MH  - Uncertainty
MH  - United States
PMC - PMC5903576
MID - NIHMS945652
EDAT- 2018/04/06 06:00
MHDA- 2019/03/21 06:00
CRDT- 2018/04/06 06:00
PHST- 2017/10/31 00:00 [received]
PHST- 2017/12/21 00:00 [revised]
PHST- 2018/01/01 00:00 [accepted]
PHST- 2018/04/06 06:00 [entrez]
PHST- 2018/04/06 06:00 [pubmed]
PHST- 2019/03/21 06:00 [medline]
AID - S0360-3016(18)30051-8 [pii]
AID - 10.1016/j.ijrobp.2018.01.013 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2018 May 1;101(1):152-168. doi:
      10.1016/j.ijrobp.2018.01.013.