title: Clinical results of proton beam therapy for advanced neuroblastoma.
abstract: OBJECTIVE
  To evaluate the efficacy of proton beam therapy (PBT) for pediatric patients with advanced neuroblastoma.
  
  
  METHODS
  PBT was conducted at 21 sites in 14 patients with neuroblastoma from 1984 to 2010. Most patients were difficult to treat with photon radiotherapy. Two and 6 patients were classified into stages 3 and 4, respectively, and 6 patients had recurrent disease. Seven of the 8 patients who received PBT as the initial treatment were classified as the high risk group. Twelve patients had gross residual disease before PBT and 2 had undergone intraoperative radiotherapy before PBT. Five patients received PBT for multiple sites, including remote metastases. Photon radiotherapy was used in combination with PBT for 3 patients. The PBT doses ranged from 19.8 to 45.5 GyE (median: 30.6 GyE).
  
  
  RESULTS
  Seven patients are alive with no evidence of disease, 1 is alive with disease progression, and 6 died due to the tumor. Recurrence in the treatment field was not observed and the 3-year locoregional control rate was 82%. Severe acute radiotoxicity was not observed, but 1 patient had narrowing of the aorta and asymptomatic vertebral compression fracture at 28 years after PBT, and hair loss was prolonged in one patient.
  
  
  CONCLUSIONS
  PBT may be a better alternative to photon radiotherapy for children with advanced neuroblastoma, and may be conducted safely for patients with neuroblastoma that is difficult to manage using photon beams.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Oshiro
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizumoto
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Okumura
authors.forename: Shinji
authors.initials: S
authors.lastname: Sugahara
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukushima
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Tomohei
authors.initials: T
authors.lastname: Nakao
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Haruo
authors.initials: H
authors.lastname: Ohkawa
authors.forename: Michio
authors.initials: M
authors.lastname: Kaneko
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sakurai
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009447:Neuroblastoma / Q000532:radiotherapy*; D061766:Proton Therapy / Q000009:adverse effects; D012189:Retrospective Studies; D016896:Treatment Outcome