Risk of brainstem necrosis in pediatric patients with central nervous system malignancies after pencil beam scanning proton therapy

Authors

  • J. Vogel Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
  • A. Grewal Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  • S. O’Reilly Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  • R. Lustig Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  • G. Kurtz Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
  • J. E. Minturn Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • A. C. Shah Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • A. J. Waanders Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • J. B. Belasco Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • K. A. Cole Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • M. J. Fisher Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • P. C. Phillips Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • N. J. Balamuth Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • P. B. Storm Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
  • C. E. Hill-Kayser Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

DOI:

https://doi.org/10.1080/0284186X.2019.1659996

Abstract

Background: Radiation therapy (RT) plays an important role in management of pediatric central nervous system (CNS) malignancies. Centers are increasingly utilizing pencil beam scanning proton therapy (PBS-PT). However, the risk of brainstem necrosis has not yet been reported. In this study, we evaluate the rate of brainstem necrosis in pediatric patients with CNS malignancies treated with PBS-PT.

Material and methods: Pediatric patients with non-hematologic CNS malignancies treated with PBS-PT who received dose to the brainstem were included. All procedures were approved by the institutional review board. Brainstem necrosis was defined as symptomatic toxicity. The actuarial rate was analyzed by the Kaplan Meier method.

Results: One hundred and sixty-six consecutive patients were reviewed. Median age was 10 years (range 0.5–21 years). Four patients (2.4%) had prior radiation. Median maximum brainstem dose in the treated course was 55.4 Gy[RBE] (range 0.15–61.4 Gy[RBE]). In patients with prior RT, cumulative median maximum brainstem dose was 98.0 Gy [RBE] (range 17.0–111.0 Gy [RBE]). Median follow up was 19.6 months (range, 2.0–63.0). One patient who had previously been treated with twice-daily radiation therapy and intrathecal (IT) methotrexate experienced brainstem necrosis. The actuarial incidence of brainstem necrosis was 0.7% at 24 months (95% CI 0.1–5.1%).

Conclusion: The rate of symptomatic brainstem necrosis was extremely low after treatment with PBS-PT in this study. Further work to clarify clinical and dosimetric parameters associated with risk of brainstem necrosis after PBS-PT is needed.

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Published

2019-12-02

How to Cite

Vogel, J., Grewal, A., O’Reilly, S., Lustig, R., Kurtz, G., Minturn, J. E., … Hill-Kayser, C. E. (2019). Risk of brainstem necrosis in pediatric patients with central nervous system malignancies after pencil beam scanning proton therapy. Acta Oncologica, 58(12), 1752–1756. https://doi.org/10.1080/0284186X.2019.1659996

Issue

Vol. 58 No. 12 (2019): Acta Oncologica

Section

Articles