Treatment tolerance of particle therapy in pediatric patients

Figures & data

Table I. Patients’ characteristic of 83 children and young adults treated with proton and carbon ion irradiation.

Histology	N (%)
Primary brain tumors	28 (34%)
Pilocytic astrocytoma	n = 15
Astrocytoma (WHO II-III)	n = 4
Glioblastoma	n = 3
Others (ATRT, PNET, medulloblatoma, atypical menigeoma)	n = 4
Neurocytoma/ pituaray adenoma/craniopharyngeoma	3 (4%)
Chordoma/chondrosarcoma	12 (14%)
Skull base chordoma	n = 9
Skull base chordosarcoma	n = 3
Osteosarcoma	7 (8%)
Skull base	n = 3
Pelvic	n = 4
Rhabdomyosarcoma	14 (17%)
ACC	5 (6%)
Other sarcoma	4 (5%)
Angiofibroma/arteriovenous hemangioma	4 (5%)
Germ cell tumors	3 (4%)
Aggressive fibromatosis/desmoid tumor	3 (4%)
Gender
Male	49 (59%)
Female	34 (41%)
Treatment conceps
Protons	58 (70%)
Carbon ions	27 (33%)
Photons and proton boost	4 (31%)
Photons and carbon ion boost	9 (69%)

Table II. Radiation doses of the different tumors.

	IMRT (median dose; range)	Proton therapy (median dose; range)	Carbon ion therapy (median dose; range)
Brain tumors
Pilocytic astrocytoma		54 GyE (50.4–54.0 GyE)
Astrocytoma (WHO II–III)		54 GyE (45–55.8 GyE)
Glioblastoma	50 Gy	10 GyE (boost after IMRT)	18 GyE (boost after IMRT)
Glioblastoma (relapse)			39 GyE
ATRT		50.4 GyE
PNET		54 GyE
Medulloblastoma (relapse)		39.6 GyE
Atypical meningeoma			51 GyE
Neurocytoma/		59.4 GyE
Pituary adenoma		54 GyE
Craniopharyngeoma		50.4 GyE
Sarcoma/chordoma
Skull base chordoma		72 GyE	66 GyE (60.0–66.0 GyE)
Skull base chordosarcoma		70 GyE	60 GyE
Skull base osteosarcoma	42 Gy		24 GyE (boost after IMRT) 61.5 GyE (60.0–63.0 GyE)
Pelvic osteosarcoma	50 Gy (50–54 Gy)	54 GyE	18 GyE(18–24 GyE) (boost after IMRT or proton irradiation)
Rhabdomyosarcoma nasopharynx	41.6 Gy	9 GyE
Rhabdomyosarcoma		50.4 GyE (41.4–52.2 GyE)	45 GyE
ACC	50 Gy (50–56 Gy)	24 GyE (boost)	24 GyE (18–24 GyE) (boost)
Other sarcoma	56 Gy (54–58 Gy)	54 GyE	16 GyE (15–18 GyE) (boost after IMRT or proton irradiation)
Others
Angiofibroma		45 GyE
Arteriovenous hemangioma		20 GyE (SBRT)
Germ cell tumor		54 GyE
Germinoma	24 Gy (CSI)	16 GyE (boost); 24 GyE
Aggressive fibromatosis/Desmoid tumor		58 GyE (56–66 GyE)

Figure 1. Toxicity reaction after 2 months, 6 months and 1 year: nearly all side effects disappeared quickly.

Figure 2. Comparison of acute toxicity reaction after proton irradiation and carbon ion irradiation.

Table III. Comparison of acute side effects between particle and photon therapy in head- and neck rhabdomyosarcoma patients.

	Particle therapy (N = 13)	Photon therapy (N = 19)
Skin erythema	92%	42%
Mucositis	46%	42%
Nausea and vomiting	15%	11%
Conjunctivitis	38%	16%
Toxicity > 2°	15%	none