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Updated: Sep 14, 2025
Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
Comparative proton and photon treatment plans in children treated for neuroblastoma
Anna Embring1, Ingrid Kristensen2, Martin P Nilsson3
1Department of Oncology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden. anna.embring@ki.se.
Insights
Proton therapy significantly reduced radiation dose to organs at risk in children with neuroblastoma compared to photon therapy. Further studies are needed to confirm if this leads to better clinical outcomes.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Medical Physics
Background:
- Neuroblastoma is the most common pediatric extracranial solid tumor.
- Radiotherapy is a key component in treating high-risk neuroblastoma patients.
- Understanding radiation dose distribution is crucial for minimizing treatment toxicity.
Purpose of the Study:
- To compare radiation doses to organs at risk (OAR) between proton and photon therapy plans for pediatric neuroblastoma.
- To analyze and report treatment-related side effects in children receiving radiotherapy for neuroblastoma.
Main Methods:
- Retrospective analysis of 30 children treated for abdominal neuroblastoma with comparative proton and photon plans.
- Identification of patients through the Swedish national registry (RADTOX).
- Comparison of doses to OAR and assessment of acute and late side effects.
Main Results:
- Proton therapy demonstrated significantly lower low-dose radiation spread (Body V5Gy, V10Gy) compared to photon therapy (p < 0.001).
- Mean doses to the bowel bag, kidneys, liver, pancreas, and spleen were significantly lower with proton plans.
- Acute side effects (grade ≥2) were observed in 40% of patients, and late side effects in 13%, with hematological and upper GI issues being most common.
Conclusions:
- Proton therapy offers reduced OAR doses and less low-dose exposure in pediatric neuroblastoma treatment.
- The clinical benefit of proton therapy requires further investigation in prospective studies.
Background And Purpose:
Neuroblastoma is the most common extracranial solid tumour in children. Radiotherapy is commonly part of the multimodal treatment for high-risk patients. The aim of this study is to analyse doses to organs at risk (OAR) in comparative proton and photon treatment plans for children treated for neuroblastoma and report side effects. Patient/material and methods: All children in Sweden treated with curative intent radiotherapy for abdominal neuroblastoma in 2017-2024 with comparative proton and photon treatment plans were retrospectively identified through a national registry (RADTOX), where data on side effects were collected. Doses to OAR were compared in each patient's proton and photon treatment plans.
Results:
A total of 30 children with a median age of 45 months (range 11-150) were included. The low-dose spread was significantly lower in the proton compared to the photon treatment plans measured as Body V5Gy and V10Gy (p < 0.001). Furthermore, the mean doses to the bowel bag, kidneys, liver, pancreas, and spleen were significantly lower in the proton plans. The median follow-up was 14 months (1-61), and the 2-year overall survival was 75.3%. While acute radiotherapy related grade ≥ 2 side effects were experienced by 12 patients (40%), late side effects were experienced by 7 patients (13%). The most common side effects were haematological and from the upper gastrointestinal tract.
Interpretation:
In selected cases, proton treatment can offer lower doses to OAR and less low-dose exposure compared to photon treatment in children treated for abdominal neuroblastoma. Whether this translates into a clinical benefit is currently unclear and should be evaluated in future studies.
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