Proton therapy in paediatric oncology: an Irish perspective

Area of Science:

• Paediatric Oncology
• Radiation Oncology
• Medical Physics

Background:

• Proton therapy (PT) offers potential advantages over conventional photon radiotherapy, particularly for paediatric oncology, due to reduced treatment side effects.
• Ireland lacks domestic PT facilities, necessitating international referrals for eligible children.

Purpose of the Study:

• To describe the characteristics and outcomes of Irish children referred for proton therapy abroad.
• To evaluate the broader clinical case for proton therapy in paediatric cancer treatment.

Main Methods:

• Retrospective review of paediatric patients referred for PT before October 2015.
• Data collection included demographics, diagnosis, referral timelines, PT-related adverse events, patient outcomes, and treatment costs.
• Literature review on the efficacy and evidence base of proton therapy.

Main Results:

• Seventeen Irish children were referred for PT, with the highest number in the 0-4 year age group.
• The median age at diagnosis was 4.8 years, and the average cost per child was €37,312.
• Two patients experienced disease relapse, and four reported PT-related adverse effects.

Conclusions:

• The evidence supporting proton therapy's superiority over conventional treatments remains limited, despite widespread global use.
• Randomized controlled trials are debated due to clinical equipoise, yet higher-level evidence is called for, especially considering reported toxicities.
• Long-term evaluation and clinical trials are anticipated to support the use of PT in paediatric patients.