PROTON THERAPY, IMRT OR VMAT FOR PEDIATRIC BRAIN TUMORS?

Currently, 80% of pediatric cancer patients are long-term survivors of this diagnosis, leading to a better appreciation of treatment-related late effects such as second cancers. Childhood and adolescence cancer survivors treated with radiation therapy are especially susceptible to second tumors with latency periods of a decade or longer, due to their longer life expectancy, smaller statures and highly radiosensitive tissues. Choosing the least toxic radiation modality is thus of utmost importance for pediatric patients.

The risk of radiation-induced second cancers was assessed in 4 different treatment modalities for a cohort of 6 pediatric patients with brain/head & neck tumors : passive scattering and pencil beam scanning proton therapy (PPT and PBS), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT).

It was shown that IMRT and VMAT led to higher risk of developing second malignancies compared to PPT and PBS for these patients. Obvious advantages of PT were demonstrated, and choosing proton over photon therapy for pediatric patients with brain tumors was proved to be highly beneficial when considering second malignancies.