Highlights
- •Cancers of the central nervous system are the most common solid tumours in children.
- •Proton therapy provides survival and tumour control comparable to photon therapy.
- •Reported median follow-up times were up to 5 years. Limited studies reported longer follow-up results.
- •For stronger evidence, it is highly desired for future studies to improve current reporting.
- •Reporting should include the follow-up time, clearly indicating toxicity criteria used in their evaluation and identifying the risk group.
Abstract
Clinical implementation of proton therapy demonstrated its potential to overcome some
limitations of the more traditional, photon-based radiotherapy, due to physical and
radiobiological advantages of protons. However, questions concerning the long-term
effects of protons on paediatric patients need outcome analysis of the reported literature
in order to be answered. The current paper has analysed the available clinical trials
and comparative studies (protons vs photons) for paediatric cancers of the central
nervous system (CNS) analysing the reported outcomes and follow-up times in order
to evaluate the safety of proton therapy for this patient group.
Based on the literature analysis, proton therapy for treatment of paediatric cancers
of the CNS was found to provide survival and tumour control outcomes comparable, and
frequently superior, to photon therapy. Furthermore, the use of protons was shown
to decrease the incidence of severe acute and late toxicities, including reduced severity
of endocrine, neurological, IQ and QoL deficits. Most commonly, the reported median
follow-up time was up to 5 years. Only a few studies reported promising, longer follow-up
results. Considering that these patients are likely to survive many of the malignancies
reported on, the incidence of long term sequellae impacting growth, development and
quality of life into adulthood, should be viewed longitudinally for completeness.
The evidence surrounding proton therapy in paediatric tumour management supports its
effectiveness and potential benefits in reducing the incidence of late-onset toxicities
and second malignancies. For stronger evidence, it is highly desired for future studies
to improve current reporting by (1) highlighting the paediatric patient cohort’s outcome
(in mixed patient groups), (2) reporting the follow-up time, (3) clearly indicating
the toxicity criteria used in their evaluation, and (4) identifying the risk group.
With this suggested clarity of future reporting, meaningful data to support treatment
choice may then be available.
Keywords
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Article info
Publication history
Published online: January 28, 2019
Accepted:
January 9,
2019
Received in revised form:
December 31,
2018
Received:
November 6,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
