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Updated: Jul 15, 2025
Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
Delivery of re-irradiation and complex palliative radiotherapy using proton therapy in pediatric cancer patients
Eva Berlin1,2, Rachel Eisenberg3, Christine Hill-Kayser1,2
1Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Pediatric palliative-intent proton radiation therapy (PIPRT) is most commonly used for re-irradiation to achieve durable tumor control. This study found PIPRT to be safe, with no high-grade toxicities observed in young patients.
Area of Science:
- Oncology
- Radiation Oncology
- Pediatric Oncology
Background:
- Pediatric palliative-intent proton radiation therapy (PIPRT) is a specialized treatment approach.
- Characterizing indications for PIPRT is crucial for optimizing its use in non-curative settings.
Purpose of the Study:
- To characterize the indications for pediatric palliative-intent proton radiation therapy (PIPRT).
- To evaluate the safety and efficacy of PIPRT in pediatric patients.
Main Methods:
- Retrospective review of patients aged 21 years and younger who received PIPRT.
- Defined PIPRT as radiotherapy for symptom improvement or durable local control in a non-curative setting.
- Assessed acute toxicity and survival outcomes (PFS, OS) using Kaplan-Meier analysis.
Main Results:
- Eighteen patients received PIPRT between 2014-2020, with a median age of 10 years.
- Common indications included re-irradiation (15 patients) for durable tumor control and palliative symptom management.
- Most patients experienced grade 1-2 toxicity; no radionecrosis or high-grade toxicity was reported.
Conclusions:
- Re-irradiation for durable tumor control is the primary indication for PIPRT in pediatric patients.
- PIPRT demonstrates a favorable safety profile with low toxicity in this cohort.
Background:
The intent of this study is to characterize indications for pediatric palliative-intent proton radiation therapy (PIPRT).
Procedure:
We retrospectively reviewed patients 21 years and younger who received PIPRT. We defined PIPRT as radiotherapy (RT) aimed to improve cancer-related symptoms/provide durable local control in the non-curative setting. Mixed proton/photon plans were included. Adjacent re-irradiation (reRT) was defined as a reRT volume within the incidental dose cloud of a prior RT target, whereas direct reRT was defined as in-field overlap with prior RT target. Acute toxicity during RT until first inspection visit was graded according to the Common Terminology Criteria for Adverse Events. The Kaplan-Meier method, measured from last PIPRT fraction, was used to assess progression-free survival (PFS) and overall survival (OS).
Results:
Eighteen patients underwent PIPRT between 2014 and 2020. Median age at treatment start was 10 years [2-21]. Median follow-up was 8.2 months [0-48]. Treatment sites included: brain/spine [10], abdomen/pelvis [3], thorax [3], and head/neck [2]. Indications for palliation included: durable tumor control [18], neurologic symptoms [4], pain [3], airway compromise [2], and great vessel compression [1]. Indications for protons included: reRT [15] (three adjacent, 12 direct), craniospinal irradiation [4], reduction of dose to normal tissues [3]. Sixteen experienced grade (G) 1-2 toxicity; two G3. There were no reports of radionecrosis. Median PFS was 5.3 months [95% confidence interval (CI): 2.7-16.3]. Median OS was 8.3 months [95% CI: 5.5-26.3].
Conclusions:
The most common indication for PIPRT was reRT to provide durable tumor control. PIPRT appears to be safe, with no cases of high-grade toxicity.
