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Gastrointestinal bleeding/ulcer among paediatric cancer patients after proton beam therapy
Hiroko Fukushima1,2, Masashi Mizumoto3, Ryoko Suzuki1,2
1Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan.
Insights
Proton beam therapy for paediatric cancer patients can cause gastrointestinal bleeding/ulcer, particularly in older children receiving specific chemotherapies. Careful monitoring is advised for upper gastrointestinal irradiation during intensive treatment.
Area of Science:
- Oncology
- Radiation Oncology
- Pediatric Gastroenterology
Background:
- Gastrointestinal (GI) bleeding and ulcer complications in pediatric cancer patients undergoing proton beam therapy (PBT) are not well-documented.
- Understanding these risks is crucial for optimizing treatment protocols and patient care.
Purpose of the Study:
- To investigate the incidence and characteristics of GI bleeding/ulcer in pediatric patients treated with PBT.
- To identify potential risk factors associated with these complications.
Main Methods:
- A cohort of 124 pediatric patients (age ≤15 years) with their GI tract in the irradiated field were analyzed.
- Patient demographics, PBT details, concurrent chemotherapy regimens, and occurrence of GI bleeding/ulcer were recorded.
Main Results:
- Four patients (3.2%) developed GI bleeding/ulcer, with no associated mortality.
- Affected patients were significantly older at the time of PBT (median age 14.1 years) compared to unaffected patients.
- Bleeding/ulcer sites were the stomach and duodenum, occurring during or early after PBT, often with specific chemotherapy regimens (vincristine-cyclophosphamide-ifosfamide-etoposide or vincristine-cyclophosphamide).
Conclusions:
- Older pediatric patients receiving PBT, especially with concurrent intensive chemotherapy, face an increased risk of upper GI bleeding/ulcer.
- These complications primarily affect the upper GI tract and tend to occur early in the treatment course.
- Further research is warranted to refine risk stratification and management strategies for GI toxicity in this population.
Background:
The details of gastrointestinal bleeding/ulcer in paediatric cancer patients treated with proton beam therapy have not been reported previously.
Methods:
Patients aged 15 years or younger at the time of proton beam therapy and whose gastrointestinal tract was included in the irradiated field participated.
Results:
A total of 124 patients participated in the study; their median age at irradiation was 5.4 years. Concurrent chemotherapies were vincristine-cyclophosphamide (16 patients), irinotecan-based treatment (16 patients), vincristine-cyclophosphamide-ifosfamide-etoposide (14 patients), other chemotherapy (27 patients) and no chemotherapy (51 patients). Gastrointestinal bleeding/ulcer occurred in four patients (3.2%), with no death due to the bleeding/ulcer. The sites of the gastrointestinal bleeding/ulcer were the stomach (two patients) and the duodenum (two patients). The ages of the four patients at PBT were 5.3, 13.8, 14.2 and 14.8 years, which were significantly older than those of patients without GI bleeding/ulcer (p = 0.017). The maximum irradiated doses to the GI tract in the four patients were 43.2, 45, 50.4 and 50.4 gray equivalent, respectively. The concomitant chemotherapy was vincristine-cyclophosphamide-ifosfamide-etoposide 3 and vincristine-cyclophosphamide 1. Weeks from proton beam therapy to bleeding/ulcer were 15, 20, 22 and 264.
Discussion And Conclusions:
Patients who developed gastrointestinal bleeding/ulcer were treated concurrently with vincristine-cyclophosphamide-ifosfamide-etoposide or vincristine-cyclophosphamide, and their ages were older than those of patients without gastrointestinal bleeding/ulcer. Bleeding occurred in the upper gastrointestinal tract in all the cases, and most cases occurred early and during chemotherapy. Upper gastrointestinal irradiation in older children undergoing intensive chemotherapy may increase the risk of developing gastrointestinal complications.
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