title: Proton beam therapy reduces the incidence of acute haematological and gastrointestinal toxicities associated with craniospinal irradiation in pediatric brain tumors.
abstract: BACKGROUND
  The benefits of proton beam craniospinal irradiation (PrBCSI) in children have been extensively reported in dosimetric studies. However, there is limited clinical evidence supporting the use of PrBCSI. We compared the acute toxicity of PrBCSI relative to that of conventional photon beam CSI (PhBCSI) in children with brain tumours.
  
  
  METHODS
  We prospectively evaluated the haematological and gastrointestinal toxicities in 30 patients who underwent PrBCSI between April 2008 and December 2012. As a reference group, we retrospectively evaluated the medical records of 13 patients who underwent PhBCSI between April 2003 and April 2012. The median follow-up time from starting CSI was 22 months (range 2-118 months). The mean irradiation dose was 32.1 Gy (range 23.4-39.6 Gy) and 29.4 CGE (cobalt grey equivalents; range 19.8-39.6), in the PrBCSI and PhBCSI groups, respectively (p = 0.236).
  
  
  RESULTS
  There was no craniospinal fluid space relapse after curative therapy in either group of patients. Thrombocytopenia was less severe in the PrBCSI group than in the PhBCSI group (p = 0.012). The recovery rates of leukocyte and platelet counts measured one month after treatment were significantly greater in the PrBCSI group than in the PhBCSI group (p = 0.003 and p = 0.010, respectively). Diarrhoea was reported by 23% of patients in the PhBCSI group versus none in the PrBCSI group (p = 0.023).
  
  
  CONCLUSIONS
  The incidence rates of thrombocytopenia and diarrhoea were lower in the PrBCSI group than in the PhBCSI group. One month after completing treatment, the recovery from leukopenia and thrombocytopenia was better in patients treated with PrBCSI than in those treated with PhBCSI.
authors.affiliation: Proton Therapy Center, Research Institute and Hospital, National Cancer Center , Seoul , Korea.
authors.forename: Sanghyuk
authors.initials: S
authors.lastname: Song
authors.forename: Hyeon Jin
authors.initials: HJ
authors.lastname: Park
authors.forename: Jong Hyung
authors.initials: JH
authors.lastname: Yoon
authors.forename: Dae Woong
authors.initials: DW
authors.lastname: Kim
authors.forename: Jeonghoon
authors.initials: J
authors.lastname: Park
authors.forename: Dongho
authors.initials: D
authors.lastname: Shin
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Shin
authors.forename: Hyoung Jin
authors.initials: HJ
authors.lastname: Kang
authors.forename: Seung-Ki
authors.initials: SK
authors.lastname: Kim
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Phi
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000097:blood / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D061888:Craniospinal Irradiation / Q000009:adverse effects* / Q000379:methods; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D007970:Leukopenia / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D010976:Platelet Count; D011446:Prospective Studies; D061766:Proton Therapy / Q000009:adverse effects* / Q000379:methods; D011879:Radiotherapy Dosage; D018709:Statistics, Nonparametric; D013921:Thrombocytopenia / Q000453:epidemiology / Q000209:etiology*; D013926:Thrombopoietin / Q000097:blood
chemical_list: D013926:Thrombopoietin