title: Proton therapy in pediatric skull base and cervical canal low-grade bone malignancies.
abstract: OBJECTIVE
  To evaluate outcomes and tolerance of high-dose photon and proton therapy in the management of skull base and cervical canal primary bony malignancies in children.
  
  
  METHODS
  Thirty children were treated postoperatively with high-dose photon-proton (29 patients) or protons-only (1 patient) radiotherapy. Twenty-six patients had chordomas (CH), 3 had low-grade chondrosarcomas (CS), and 1 had an aggressive chondroma (AC). The mean age was 12.8 years. At the time of radiation, all but 1 patient had a gross residue. The anatomic sites affected were skull base (n = 16), cervical canal (n = 1), or both (n = 13). Mean total dose was 68.4 cobalt Gray equivalents, conventionally fractionated.
  
  
  RESULTS
  With a mean follow-up of 26.5 months, 5 of 30 children failed locally: 5 of 5 lesions were CH, 5 of 5 patients had experienced pain at presentation (p = 0.03), and 4 of 5 had cervical extension (p = 0.07). The 5-year overall survival/progression-free survival rates for CS and CH were 100%/100% and 81%/77%, respectively. Side effects were scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. Acute toxicity ranged between 0 and 2. Late toxicity of radiotherapy was severe in 1 patient (Grade 3 auditory) and minor or mild in the rest of the population (7 patients with Grade 2 pituitary dysfunction).
  
  
  CONCLUSIONS
  High-dose combined fractionated photon-proton therapy is well tolerated in children and allows excellent local control with minimal long-term toxicity.
authors.affiliation: Centre de Protonthérapie de l'Institut Curie à Orsay, Campus Universitaire, Orsay, France. jean-louis.habrand@curie.net
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Habrand
authors.forename: Ralf
authors.initials: R
authors.lastname: Schneider
authors.forename: Claire
authors.initials: C
authors.lastname: Alapetite
authors.forename: Loic
authors.initials: L
authors.lastname: Feuvret
authors.forename: Slavo
authors.initials: S
authors.lastname: Petras
authors.forename: Jean
authors.initials: J
authors.lastname: Datchary
authors.forename: Jacques
authors.initials: J
authors.lastname: Grill
authors.forename: Georges
authors.initials: G
authors.lastname: Noel
authors.forename: Sylvie
authors.initials: S
authors.lastname: Helfre
authors.forename: Regis
authors.initials: R
authors.lastname: Ferrand
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bolle
authors.forename: Christian
authors.initials: C
authors.lastname: Sainte-Rose
mesh_terms: D000293:Adolescent; D002574:Cervical Vertebrae / Q000528:radiation effects*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000379:methods; D061766:Proton Therapy; D019292:Skull Base Neoplasms / Q000532:radiotherapy*; D013125:Spinal Neoplasms / Q000532:radiotherapy*; D016896:Treatment Outcome; D011522:Protons
chemical_list: D011522:Protons