Outcomes and Acute Toxicities of Proton Therapy for Pediatric Atypical Teratoid/Rhabdoid Tumor of the Central Nervous System

Journal Article · Mon Dec 01 04:00:00 EST 2014 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2014.08.354· OSTI ID:22420507

Okcu, M. Fatih ^[1]; Munsell, Mark F. ^[2]; Kumbalasseriyil, Nancy; Grosshans, David R.; McAleer, Mary F. ^[3]; Chintagumpala, Murali ^[1]; Khatua, Soumen ^[4]; Mahajan, Anita ^[3]

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1. Texas Children's Hematology and Oncology Centers, Department of Pediatrics, Baylor College of Medicine, Houston, Texas (United States)
2. Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
3. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)
4. Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

Purpose: Atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system is a rare cancer primarily affecting children younger than 5 years old. Because patients are young and receive intensive chemotherapy, there is concern regarding late radiation toxicity, particularly as survival rates improve. Therefore, there is interest in using proton therapy to treat these tumors. This study was undertaken to investigate outcomes and acute toxicities associated with proton therapy for AT/RT. Methods and Materials: The records of 31 patients with AT/RT treated with proton radiation from October 2008 to August 2013 were reviewed. Demographics, treatment characteristics, and outcomes were recorded and analyzed. Results: Median age at diagnosis was 19 months (range, 4-55 months), with a median age at radiation start of 24 months (range, 6-62 months). Seventeen patients received local radiation with a median dose of 50.4 GyRBE (range, 9-54 GyRBE). Fourteen patients received craniospinal radiation; half received 24 GyRBE or less, and half received 30.6 GyRBE or more. For patients receiving craniospinal radiation, the median tumor dose was 54 GyRBE (range, 43.2-55.8 GyRBE). Twenty-seven patients (87%) completed the planned radiation. With median follow-up of 24 months for all patients (range, 3-53 months), median progression-free survival was 20.8 months and median overall survival was 34.3 months. Five patients (16%) developed clinical findings and imaging changes in the brainstem 1 to 4 months after radiation, consistent with radiation reaction; all cases resolved with steroids or bevacizumab. Conclusions: This is the largest report of children with AT/RT treated with proton therapy. Preliminary survival outcomes in this young pediatric population are encouraging compared to historic results, but further study is warranted.

• OSTI ID: 22420507
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 90; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
BIOMEDICAL RADIOGRAPHY
CENTRAL NERVOUS SYSTEM
CHEMOTHERAPY
CHILDREN
COMPARATIVE EVALUATIONS
DIAGNOSIS
NEOPLASMS
PATIENTS
PEDIATRICS
PROTON BEAMS
RADIATION DOSES
RADIOTHERAPY
REVIEWS
STEROIDS
TOXICITY