PMID- 30684665
OWN - NLM
STAT- In-Data-Review
LR  - 20190410
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 104
IP  - 1
DP  - 2019 May 1
TI  - Outcomes Following Proton Therapy for Pediatric Low-Grade Glioma.
PG  - 149-156
LID - S0360-3016(19)30162-2 [pii]
LID - 10.1016/j.ijrobp.2019.01.078 [doi]
AB  - PURPOSE: 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 fourth most common pediatric tumor
      treated with proton therapy, yet clinical outcome data on efficacy and toxicity
      are limited. METHODS AND MATERIALS: We reviewed the medical records of 174
      children (</=21 years old) with nonmetastatic LGG enrolled on a prospective
      protocol and treated with proton therapy between 2007 and 2017. We assessed
      clinical outcomes and toxicity and analyzed patient, tumor, and treatment-related
      variables. RESULTS: The median age was 10.2 years (range, 2-21). Fifty-eight
      percent of tumors were World Health Organization grade 1 and 30% were grade 2;
      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 (16%), and cerebellum (13%).
      Forty-two percent received chemotherapy before radiation therapy. 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% confidence interval
      [CI], 78%-90%), 84% (95% CI, 77%-89%), and 92% (95% CI, 85%-95%), respectively.
      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 < .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%. CONCLUSIONS:
      Compared with modern photon series, proton therapy reduces the radiation dose to 
      developing brain tissue, diminishing acute toxicities without compromising
      disease control.
CI  - Copyright (c) 2019 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Indelicato, Daniel J
AU  - Indelicato DJ
AD  - Department of Radiation Oncology, University of Florida College of Medicine,
      Jacksonville, Florida. Electronic address: dindelicato@floridaproton.org.
FAU - Rotondo, Ronny L
AU  - Rotondo RL
AD  - Department of Radiation Oncology, University of Florida College of Medicine,
      Jacksonville, Florida.
FAU - Uezono, Haruka
AU  - Uezono H
AD  - Department of Radiation Oncology, University of Florida College of Medicine,
      Jacksonville, Florida.
FAU - Sandler, Eric S
AU  - Sandler ES
AD  - Nemours Children's Health System, Jacksonville, Florida.
FAU - Aldana, Philipp R
AU  - Aldana PR
AD  - Department of Neurosurgery, University of Florida College of Medicine,
      Jacksonville, Florida.
FAU - Ranalli, Nathan J
AU  - Ranalli NJ
AD  - Department of Neurosurgery, University of Florida College of Medicine,
      Jacksonville, Florida.
FAU - Beier, Alexandra D
AU  - Beier AD
AD  - Department of Neurosurgery, University of Florida College of Medicine,
      Jacksonville, Florida.
FAU - Morris, Christopher G
AU  - Morris CG
AD  - Department of Radiation Oncology, University of Florida College of Medicine,
      Jacksonville, Florida.
FAU - Bradley, Julie A
AU  - Bradley JA
AD  - Department of Radiation Oncology, University of Florida College of Medicine,
      Jacksonville, Florida.
LA  - eng
PT  - Journal Article
DEP - 20190123
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
EDAT- 2019/01/27 06:00
MHDA- 2019/01/27 06:00
CRDT- 2019/01/27 06:00
PHST- 2018/11/26 00:00 [received]
PHST- 2019/01/10 00:00 [revised]
PHST- 2019/01/13 00:00 [accepted]
PHST- 2019/01/27 06:00 [pubmed]
PHST- 2019/01/27 06:00 [medline]
PHST- 2019/01/27 06:00 [entrez]
AID - S0360-3016(19)30162-2 [pii]
AID - 10.1016/j.ijrobp.2019.01.078 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2019 May 1;104(1):149-156. doi:
      10.1016/j.ijrobp.2019.01.078. Epub 2019 Jan 23.