title: Proton beam craniospinal irradiation reduces acute toxicity for adults with medulloblastoma.
abstract: OBJECTIVE
  Efficacy and acute toxicity of proton craniospinal irradiation (p-CSI) were compared with conventional photon CSI (x-CSI) for adults with medulloblastoma.
  
  
  METHODS
  Forty adult medulloblastoma patients treated with x-CSI (n=21) or p-CSI (n=19) at the University of Texas MD Anderson Cancer Center from 2003 to 2011 were retrospectively reviewed. Median CSI and total doses were 30.6 and 54 Gy, respectively. The median follow-up was 57 months (range 4-103) for x-CSI patients and 26 months (range 11-63) for p-CSI.
  
  
  RESULTS
  p-CSI patients lost less weight than x-CSI patients (1.2% vs 5.8%; P=.004), and less p-CSI patients had >5% weight loss compared with x-CSI (16% vs 64%; P=.004). p-CSI patients experienced less grade 2 nausea and vomiting compared with x-CSI (26% vs 71%; P=.004). Patients treated with x-CSI were more likely to have medical management of esophagitis than p-CSI patients (57% vs 5%, P<.001). p-CSI patients had a smaller reduction in peripheral white blood cells, hemoglobin, and platelets compared with x-CSI (white blood cells 46% vs 55%, P=.04; hemoglobin 88% vs 97%, P=.009; platelets 48% vs 65%, P=.05). Mean vertebral doses were significantly associated with reductions in blood counts.
  
  
  CONCLUSIONS
  This report is the first analysis of clinical outcomes for adult medulloblastoma patients treated with p-CSI. Patients treated with p-CSI experienced less treatment-related morbidity including fewer acute gastrointestinal and hematologic toxicities.
authors: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors: Aaron P
authors: AP
authors: Brown
authors: Christian L
authors: CL
authors: Barney
authors: David R
authors: DR
authors: Grosshans
authors: Mary Frances
authors: MF
authors: McAleer
authors: John F
authors: JF
authors: de Groot
authors: Vinay K
authors: VK
authors: Puduvalli
authors: Susan L
authors: SL
authors: Tucker
authors: Cody N
authors: CN
authors: Crawford
authors: Meena
authors: M
authors: Khan
authors: Soumen
authors: S
authors: Khatua
authors: Mark R
authors: MR
authors: Gilbert
authors: Paul D
authors: PD
authors: Brown
authors: Anita
authors: A
authors: Mahajan
mesh_terms: D000293:Adolescent; D000328:Adult; D002528:Cerebellar Neoplasms / Q000097:blood / Q000532:radiotherapy*; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods*; D004941:Esophagitis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000097:blood / Q000532:radiotherapy*; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D017785:Photons / Q000009:adverse effects / Q000627:therapeutic use; D061766:Proton Therapy / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012189:Retrospective Studies; D013131:Spine / Q000528:radiation effects; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology; D015431:Weight Loss; D055815:Young Adult