Treatment of pediatric patients and young adults with particle therapy at the Heidelberg Ion Therapy Center (HIT): establishment of workflow and initial clinical data.
BACKGROUND
To report on establishment of workflow and clinical results of particle therapy at the Heidelberg Ion Therapy Center.


METHODS
We treated 36 pediatric patients (aged 21 or younger) with particle therapy at HIT. Median age was 12 years (range 2-21 years), five patients (14%) were younger than 5 years of age. Indications included pilocytic astrocytoma, parameningeal and orbital rhabdomyosarcoma, skull base and cervical chordoma, osteosarcoma and adenoid-cystic carcinoma (ACC), as well as one patient with an angiofibroma of the nasopharynx. For the treatment of small children, an anesthesia unit at HIT was established in cooperation with the Department of Anesthesiology.


RESULTS
Treatment concepts depended on tumor type, staging, age of the patient, as well as availability of specific study protocols. In all patients, particle radiotherapy was well tolerated and no interruptions due to toxicity had to be undertaken. During follow-up, only mild toxicites were observed. Only one patient died of tumor progression: Carbon ion radiotherapy was performed as an individual treatment approach in a child with a skull base recurrence of the previously irradiated rhabdomyosarcoma. Besides this patient, tumor recurrence was observed in two additional patients.


CONCLUSIONS
Clinical protocols have been generated to evaluate the real potential of particle therapy, also with respect to carbon ions in distinct pediatric patient populations. The strong cooperation between the pediatric department and the department of radiation oncology enable an interdisciplinary treatment and stream-lined workflow and acceptance of the treatment for the patients and their parents.
Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany. stephanie.combs@med.uni-heidelberg.de
Stephanie E
SE
Combs
Kerstin A
KA
Kessel
Klaus
K
Herfarth
Alexandra
A
Jensen
Susanne
S
Oertel
Claudia
C
Blattmann
Swantje
S
Ecker
Angelika
A
Hoess
Eike
E
Martin
Olaf
O
Witt
Oliver
O
Jäkel
Andreas E
AE
Kulozik
Jürgen
J
Debus
D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000706:statistics & numerical data; D001254:Astrocytoma / Q000532:radiotherapy*; D001932:Brain Neoplasms / Q000532:radiotherapy*; D002244:Carbon / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002813:Chondrosarcoma / Q000532:radiotherapy*; D005260:Female; D005858:Germany; D006801:Humans; D007477:Ions / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D056888:Patient Positioning; D010372:Pediatrics / Q000379:methods*; D010865:Pilot Projects; D061766:Proton Therapy; D011522:Protons / Q000009:adverse effects; D019292:Skull Base Neoplasms / Q000532:radiotherapy*; D057188:Workflow; D055815:Young Adult
D007477:Ions; D011522:Protons; D002244:Carbon