title: First experiences in treatment of low-grade glioma grade I and II with proton therapy.
abstract: BACKGROUND
  To retrospectively assess feasibility and toxicity of proton therapy in patients with low-grade glioma (WHO °I/II).
  
  
  METHODS
  Proton beam therapy only administered in 19 patients (median age 29 years; 9 female, 10 male) for low-grade glioma between 2010 and 2011 was reviewed. In 6 cases proton therapy was performed due to tumor progression after biopsy, in 8 cases each due to tumor progression after (partial-) resection, and in 5 cases due to tumor progression after chemotherapy. Median total dose applied was 54 GyE (range, 48,6-54 GyE) in single fractions of median 1.8 GyE. Median clinical target volume was 99 cc (range, 6-463 cc) and treated using median 2 beams (range, 1-2).
  
  
  RESULTS
  Proton therapy was finished as planned in all cases. At end of proton therapy, 13 patients showed focal alopecia, 6 patients reported mild fatigue, one patient with temporal tumor localization concentration deficits and speech errors and one more patient deficits in short-term memory. Four patients did not report any side effects. During follow-up, one patient presented with pseudo-progression showing worsening of general condition and brain edema 1-2 months after last irradiation and restitution after 6 months. In the present MR imaging (median follow-up 5 months; range 0-22 months) 12 patients had stable disease, 2 (1) patients partial (complete) remission, one more patient pseudo-progression (differential diagnosis: tumor progression) 4 weeks after irradiation without having had further follow-up imaging so far, and one patient tumor progression approximately 9 months after irradiation.
  
  
  CONCLUSIONS
  Regarding early side effects, mild alopecia was the predominant finding. The rate of alopecia seems to be due to large treatment volumes as well as the anatomical locations of the target volumes and might be avoided by using multiple beams and the gantry in the future. Further evaluations including neuropsychological testing are in preparation.
authors.affiliation: Department of Radiation Oncology, University of Heidelberg, INF 400, Heidelberg, 69120, Germany. henrik.hauswald@med.uni-heidelberg.de
authors.forename: Henrik
authors.initials: H
authors.lastname: Hauswald
authors.forename: Stefan
authors.initials: S
authors.lastname: Rieken
authors.forename: Swantje
authors.initials: S
authors.lastname: Ecker
authors.forename: Kerstin A
authors.initials: KA
authors.lastname: Kessel
authors.forename: Klaus
authors.initials: K
authors.lastname: Herfarth
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
mesh_terms: D000293:Adolescent; D000328:Adult; D000505:Alopecia / Q000209:etiology; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018450:Disease Progression; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D061766:Proton Therapy / Q000009:adverse effects; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult