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Delivery of Re-irradiation and Complex Palliative Radiotherapy Using Proton Therapy in Pediatric Cancer Patients
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  • Eva Berlin,
  • Rachel Eisenberg,
  • Christine Hill-Kayser,
  • Robert Lustig,
  • Goldie Kurtz,
  • Elizabeth Cummings,
  • Michael LaRiviere
Eva Berlin
University of Pennsylvania Department of Radiation Oncology
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Rachel Eisenberg
Albany Medical Center Hospital
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Christine Hill-Kayser
University of Pennsylvania Department of Radiation Oncology
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Robert Lustig
University of Pennsylvania Department of Radiation Oncology
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Goldie Kurtz
University of Pennsylvania Department of Radiation Oncology
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Elizabeth Cummings
University of Pennsylvania Department of Radiation Oncology
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Michael LaRiviere
University of Pennsylvania Department of Radiation Oncology

Corresponding Author:[email protected]

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Abstract

Background: Characterize indications for pediatric palliative-intent proton radiation therapy (PIPRT). Procedure: We retrospectively reviewed patients ≤21 years 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 reirradiation (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: 18 patients underwent PIPRT between 2014-2020. 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) (4 adjacent, 11 direct), craniospinal irradiation (4), reduction of dose to normal tissues (3). 16 experienced grade (G) 1-2 toxicity; 2 G3. There were no reports of radionecrosis. Median PFS was 5.3 months (95% 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.
02 May 2023Submitted to Pediatric Blood & Cancer
02 May 2023Submission Checks Completed
02 May 2023Assigned to Editor
02 May 2023Review(s) Completed, Editorial Evaluation Pending
02 May 2023Reviewer(s) Assigned
25 May 2023Editorial Decision: Revise Minor
30 Aug 2023Assigned to Editor
30 Aug 2023Submission Checks Completed
30 Aug 20231st Revision Received
30 Aug 2023Review(s) Completed, Editorial Evaluation Pending
30 Aug 2023Reviewer(s) Assigned
18 Sep 2023Editorial Decision: Revise Minor
25 Sep 20232nd Revision Received
25 Sep 2023Submission Checks Completed
25 Sep 2023Assigned to Editor
25 Sep 2023Review(s) Completed, Editorial Evaluation Pending
25 Sep 2023Editorial Decision: Accept