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Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India
Srinivas Chilukuri1, Nagarjuna Burela1, Ramya Uppuluri1
1Apollo Proton Cancer Centre, Chennai, India.
Insights
Proton beam therapy (PBT) is safe for young patients in India. This study shows image-guided pencil beam scanning PBT can be delivered with acceptable side effects in pediatric cancer patients.
Area of Science:
- Oncology
- Radiation Oncology
- Pediatric Oncology
Background:
- Proton beam therapy (PBT) is a preferred radiotherapy method for pediatric cancers.
- The Indian subcontinent lacked a PBT center until recently.
Purpose of the Study:
- To report the preliminary experience of treating pediatric and young adult patients (<25 years) with image-guided pencil beam scanning PBT.
- To evaluate the feasibility and acute toxicities of PBT at the first center in the Indian subcontinent.
Main Methods:
- Consecutive patients younger than 25 years undergoing PBT were selected by a multidisciplinary tumor board.
- Demographic, tumor, and treatment data were collected.
- Associations between patient/treatment factors and acute toxicities were analyzed using univariable and multivariable methods.
Main Results:
- Forty-seven patients (27 CNS, 20 non-CNS tumors) with a median age of 9 years were treated.
- Common diagnoses included ependymoma, rhabdomyosarcoma, and glioma.
- Acute toxicities observed included dermatitis (45%), mucositis (34%), hematologic toxicity (38%), and fatigue (26%). Concurrent chemotherapy and craniospinal irradiation were associated with higher hematologic toxicity in CNS tumors.
Conclusions:
- The implementation of a PBT program for pediatric and young adult patients in the Indian subcontinent was demonstrated to be safe.
- Image-guided pencil beam scanning PBT is feasible and can be delivered with acceptable acute toxicities in carefully selected patients.
Purpose:
Proton beam therapy (PBT) has been a preferred modality in pediatric malignancies requiring radiotherapy. We report our preliminary experience of treating consecutive patients younger than 25 years with image-guided pencil beam scanning PBT from the first and only center on the Indian subcontinent.
Methods:
Patients were selected for PBT on the basis of a multidisciplinary tumor board decision. Patient demographic data, as well as tumor and treatment-related characteristics of the cohort, were captured. Patient and treatment-related factors and their association with acute toxicities were analyzed using univariable and multivariable analyses.
Results:
Forty-seven patients (27 with CNS and 20 with non-CNS tumors) with a median age of 9 years (range, 2-25 years) were evaluated. Most common diagnoses were ependymoma, rhabdomyosarcoma, and glioma. Seventy-seven percent of patients traveled more than 500 km, and 70% of them lived in metropolitan cities. Forty-nine percent of patients had recurrent disease at presentation, and 15% had received a previous course of radiation. The median dose delivered was 54.8 cobalt gray equivalents (range, 40.0-70.4 cobalt gray equivalents) to a median clinical target volume of 175 mL (range, 18.7-3,083.0 mL), with 34% of patients requiring concurrent chemotherapy (CCT). Acute grade 2 and grade 3 dermatitis, mucositis, and hematologic toxicity was noted in 45% and 2%, 34% and 0%, and 38% and 30% of patients, respectively. Grade 2 fatigue was noted in 26% of patients. On multivariable analysis, for CNS tumors, both CCT and craniospinal irradiation were independently associated with ≥ 2 grade hematologic toxicity, whereas among non-CNS tumors, a clinical target volume > 150 mL was associated with ≥ 2 grade fatigue, head and neck irradiation was associated with ≥ 2 grade mucositis, and CCT was associated with grade ≥ 2 hematologic toxicity.
Conclusion:
This study demonstrates safe implementation of a PBT program for children and young adults on the Indian subcontinent. Image-guided pencil beam scanning PBT in judiciously selected patients is feasible and can be delivered with acceptable acute toxicities.
