title: Proton therapy for pediatric cranial tumors: preliminary report on treatment and disease-related morbidities.
abstract: OBJECTIVE
  Accelerated protons were used in an attempt to limit treatment-related morbidity in children with tumors in or near the developing brain, by reducing the integral dose to adjacent normal tissues.
  
  
  METHODS
  Children treated with protons at Loma Linda University Medical Center between August 1991 and December 1994 were analyzed retrospectively. Twenty-eight children, aged 1 to 18 years, were identified as at risk for brain injury from treatment. Medical records, physical examinations, and correspondence with patients, their parents, and referring physicians were analyzed. The investigators tabulated post-treatment changes in pre-treatment signs and symptoms and made judgments as to whether improvement, no change, or worsening related to disease or treatment had supervened. Magnetic resonance images were correlated with clinical findings and radiographic impressions were tabulated.
  
  
  RESULTS
  Follow-up ranged from 7 to 49 months (median 25 months). Four instances of treatment-related morbidity were identified. Forty-one instances of site-specific, disease-related morbidity were identified: 15 improved or resolved and 26 remained unchanged after treatment. Four patients had radiographic evidence of local failure. Three of these patients, including two with high-grade glioma, have died.
  
  
  CONCLUSIONS
  Early treatment-related morbidity associated with proton therapy is low. Tumor progression remains a problem when treating certain histologies such as high-grade glioma. Escalating the dose delivered to target volumes may benefit children with tumors associated with poor rates of local control. Long-term follow-up, including neurocognitive testing, is in progress to assess integral-dose effects on cognitive, behavioral and developmental outcomes in children with cranial tumors.
authors.affiliation: Department of Radiation Medicine, Loma Linda University Medical Center, CA 92354, USA.
authors.forename: B
authors.initials: B
authors.lastname: McAllister
authors.forename: J O
authors.initials: JO
authors.lastname: Archambeau
authors.forename: M C
authors.initials: MC
authors.lastname: Nguyen
authors.forename: J D
authors.initials: JD
authors.lastname: Slater
authors.forename: L
authors.initials: L
authors.lastname: Loredo
authors.forename: R
authors.initials: R
authors.lastname: Schulte
authors.forename: O
authors.initials: O
authors.lastname: Alvarez
authors.forename: A A
authors.initials: AA
authors.lastname: Bedros
authors.forename: T
authors.initials: T
authors.lastname: Kaleita
authors.forename: M
authors.initials: M
authors.lastname: Moyers
authors.forename: D
authors.initials: D
authors.lastname: Miller
authors.forename: J M
authors.initials: JM
authors.lastname: Slater
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009017:Morbidity; D010911:Pituitary Neoplasms / Q000150:complications / Q000532:radiotherapy; D061766:Proton Therapy; D011522:Protons / Q000009:adverse effects; D011879:Radiotherapy Dosage; D011881:Radiotherapy, Computer-Assisted; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology
chemical_list: D011522:Protons