Pediatric cancers

Proton for Pediatric cancer

Brain tumors, e.g., Medulloblastoma, Atypical teratoid rhabdoid tumor (ATRT), supratentorial primitive neuroectodermal tumor (S-PNET), Germ cell tumor, Ependymoma, Glioma

  • Focal irradiation
      • Total of 25-33 fractions, 1 fraction daily
      • Potential benefit of proton beam therapy:
        • Reduce dose to normal brain parenchyma
          • Reduce risk/severity of cognitive function deterioration, decline of IQ
          • Reduce risk of second brain tumor
        • Reduce dose to hearing organ
          • Reduce risk/severity of hearing loss
        • Reduce dose to pituitary gland, hypothalamus
          • Reduce risk/severity of hormonal deficiency
  • Craniospinal irradiation followed by tumor bed boost
      • Total of 25-33 fractions, 1 fraction daily
      • Potential benefit of proton beam therapy
        • Reduce dose to oral cavity/pharynx
          • Reduce risk/severity of mucositis, pharyngitis
        • Reduce dose to thyroid gland
          • Reduce risk/severity of thyroidal deficiency
        • Reduce dose to heart
          • Reduce risk/severity of heart disease, pericarditis
        • Reduce dose to lung
          • Reduce risk/severity of pneumonitis, pulmonary fibrosis
        • Reduce dose to esophagus
          • Reduce risk/severity of esophagitis
        • Reduce dose to stomach
          •  Reduce risk/severity nausea/vomiting
        • Reduce dose to kidneys
          • Reduce risk/severity of kidney injury
        • Reduce dose to liver
          • Reduce risk/severity of liver injury
        • Reduce dose to bowel
          • Reduce risk/severity of abdominal discomfort
          • Reduce risk/severity of intestinal fibrosis
        • Reduce dose to bone marrow
          • Reduce risk/severity of anemia, leukopenia, thrombocytopenia
        • Reduce dose to nonspecific organs
          • Reduce risk of second primary cancer

Extracranial tumor, e.g., rhabdomyosarcoma, Ewing sarcoma, osteosarcoma, neuroblastoma, germ cell tumor

  • Total of 20-31 fractions, 1 fraction daily
    • Potential benefit of proton beam therapy
      • Depend on the location of tumor
      • The dose of proton beam that exposes to adjacent organs is probably less than the dose from photon (x-ray) beam e.g.
        • Reduce dose to salivary gland
          • Reduce risk/severity of xerostomia
        • Reduce dose to oral cavity/pharynx
          • Reduce risk/severity of mucositis, pharyngitis
        • Reduce dose to thyroid gland
          • Reduce risk/severity of thyroidal deficiency
        • Reduce dose to heart
          • Reduce risk/severity of heart disease, pericarditis
        • Reduce dose to lungs
          • Reduce risk/severity of pneumonitis, pulmonary fibrosis
        • Reduce dose to esophagus
          • Reduce risk/severity of esophagitis
        • Reduce dose to stomach
          • Reduce risk/severity nausea/vomiting
        • Reduce dose to kidneys
          • Reduce risk/severity of kidney injury
        • Reduce dose to liver
          • Reduce risk/severity of liver injury
        • Reduce dose to bowel
          • Reduce risk/severity of abdominal discomfort
          • Reduce risk/severity of intestinal fibrosis
        •  Reduce dose to bone marrow
          • Reduce risk/severity of anemia, leukopenia, thrombocytopenia
        •  Reduce dose to skeletal
          • Reduce risk/severity of short stature, limb shortening
          • Reduce risk/severity of skeletal fracture
        • Reduce dose to nonspecific organs
          • Reduce risk of second primary cancer

 

**Note: Patients and their families should discuss and be informed about the potential risk/benefit of proton and photon beam therapy before making decision. The detail of treatment might be different in each patient.