Complications after proton radiotherapy in children, focusing on severe late complications. A complete Swedish cohort 2008–2019

Abstract

Background

Proton radiotherapy (RT) is an attractive tool to deliver local therapy with minimal dose to uninvolved tissue, however, not suitable for all patients. The aim was to explore complications, especially severe late complications (grades 3–4), following proton RT delivered to a complete Swedish cohort of paediatric patients aged <18 years treated 2008–2019.

Material and Methods

Data was downloaded from a national registry. Complications with a possible causation with RT are reported. Proton treatments until July 2015 was performed with a fixed horizontal 172 MeV beam (The Svedberg Laboratory (TSL), Uppsala) in a sitting position and thereafter with gantry-based pencil-beam scanning technique (Skandion Clinic, Uppsala) in a supine position.

Results

219 courses of proton RT (77 at TSL and 142 at Skandion) were delivered to 212 patients (mean age 9.2 years) with various tumour types (CNS tumours 58%, sarcomas 26%, germ cell tumours 7%). Twenty-five patients had severe acute complications (skin, mucous membrane, pharynx/oesophagus, larynx, upper gastrointestinal canal, lower gastrointestinal canal, eyes, ears). Fifteen patients had severe late complications; with increased proportion over time: 4% at 1-year follow-up (FU), 5% at 3-year, 11% at 5-year. Organs affected were skin (1 patient), subcutaneous tissue (4), salivary glands (1), upper GI (1), bone (7), joints (2), CNS (2), PNS (1), eyes (1) and ears (5). Twenty-one of the 28 patients with 10-year FU had at least one late complication grades 1–4 and fourteen of them had more than one (2–5 each).

Conclusion

The most important result of our study is the relatively low proportion of severe late complications, comparable with other proton studies on various tumours. Furthermore, the numbers of late complications are lower than our own data set on a mixed population of photon and proton treated paediatric patients, assuring the safety of using proton therapy also in the clinical practice.

Keywords:

• Proton radiotherapy
• children
• adolescents
• complications
• late effects

Ethics statement

The study was approved by The Swedish Ethical Review Authority (Dnr 2021-01284) in accordance with the Declaration of Helsinki.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Raw data is available from the corresponding author on request.

Additional information

Funding

This study was fully supported by the Swedish Childhood Cancer Foundation (TJ2018-0010, PL2018-0004, TJ2021-0020, PL2022-0001).