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Breen WG, Paulino AC, Hartsell WF, et al. Factors Associated With Acute Toxicity in Pediatric Patients Treated With Proton Radiation Therapy: A Report From the Pediatric Proton Consortium Registry. Pract Radiat Oncol. 2021;doi: 10.1016/j.prro.2021.10.011.
Breen, W. G., Paulino, A. C., Hartsell, W. F., Mangona, V. S., Perkins, S. M., Indelicato, D. J., Harmsen, W. S., Tranby, B. N., Bajaj, B. V. M., Gallotto, S. L., Yock, T. I., & Laack, N. N. (2021). Factors Associated With Acute Toxicity in Pediatric Patients Treated With Proton Radiation Therapy: A Report From the Pediatric Proton Consortium Registry. Practical radiation oncology, . https://doi.org/10.1016/j.prro.2021.10.011
Breen, William G, et al. "Factors Associated With Acute Toxicity in Pediatric Patients Treated With Proton Radiation Therapy: A Report From the Pediatric Proton Consortium Registry." Practical radiation oncology vol. (2021). doi: https://doi.org/10.1016/j.prro.2021.10.011
Breen WG, Paulino AC, Hartsell WF, Mangona VS, Perkins SM, Indelicato DJ, Harmsen WS, Tranby BN, Bajaj BVM, Gallotto SL, Yock TI, Laack NN. Factors Associated With Acute Toxicity in Pediatric Patients Treated With Proton Radiation Therapy: A Report From the Pediatric Proton Consortium Registry. Pract Radiat Oncol. 2021 Dec 17; doi: 10.1016/j.prro.2021.10.011. Epub 2021 Dec 17. PMID: 34929404.
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Pract Radiat Oncol. 2021 Dec 17; doi: 10.1016/j.prro.2021.10.011. Epub 2021 Dec 17.

Factors Associated With Acute Toxicity in Pediatric Patients Treated With Proton Radiation Therapy: A Report From the Pediatric Proton Consortium Registry.

Practical radiation oncology

William G Breen, Arnold C Paulino, William F Hartsell, Victor S Mangona, Stephanie M Perkins, Daniel J Indelicato, W Scott Harmsen, Brianna N Tranby, Benjamin V M Bajaj, Sara L Gallotto, Torunn I Yock, Nadia N Laack

Affiliations

  1. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
  2. Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
  3. Northwestern Medicine Chicago Proton Center, Warrenville, Illinois.
  4. Department of Radiation Oncology, Texas Center for Proton Therapy, Irving, Texas.
  5. Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
  6. Department of Radiation Oncology, University of Florida, Jacksonville, Florida.
  7. Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
  8. Massachusetts General Hospital, Boston, Massachusetts.
  9. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
  10. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. Electronic address: [email protected].

PMID: 34929404 DOI: 10.1016/j.prro.2021.10.011

Abstract

PURPOSE: Limited prospective information regarding acute toxicity in pediatric patients receiving proton therapy (PT) exists. In this study, Pediatric Proton Consortium Registry (PPCR) data was analyzed for factors associated with development of acute toxicity in children receiving passively scattered or pencil beam scanning PT.

METHODS AND MATERIALS: Pediatric patients treated with PT and enrolled on the PPCR from 2016 to 2017 at 7 institutions were included. Data were entered on presence versus absence of acute general, cardiac, endocrine, eye, gastrointestinal, genitourinary, hematologic, mouth, musculoskeletal, neurologic, psychological, respiratory, and skin toxicities before (baseline) and at the end of PT (acute). Associations between patient and treatment variables with development of acute toxicity were assessed with multivariable modeling.

RESULTS: Of 422 patients included, PT technique was passively scattered in 241 (57%), pencil beam scanning in 180 (43%), and missing in 1 (<1%) patient. Median age was 9.9 years. Daily anesthesia for treatment was used in 169 (40%). Treatments were categorized as craniospinal irradiation (CSI; n = 100, 24%), focal central nervous system PT (n = 157, 38%), or body PT (n = 158, 38%). Passively scattered PT was associated with increased risk of hematologic toxicity compared with pencil beam scanning PT (odds ratio [OR]: 3.03; 95% confidence interval [CI], 1.38-6.70; P = .006). There were no other differences toxicities between PT techniques. Uninsured patients had increased risk of GI (OR: 2.71; 95% CI, 1.12-6.58; P = .027) and hematologic toxicity (OR: 10.67; 95% CI, 2.68-42.46; P <.001). Patients receiving concurrent chemotherapy were more likely to experience skin (OR: 2.45; 95% CI, 1.23-4.88; P = .011), hematologic (OR: 2.87; 95% CI, 1.31-6.25; P = .008), GI (OR: 2.37; 95% CI, 1.33-4.21; P = .003), and mouth toxicities (OR: 2.03; 95% CI, 1.10-3.73; P = .024). Patients receiving 49 to 55 Gy were more likely to experience skin (OR: 2.18; 95% CI, 1.06-4.44; P = .033) toxicity than those receiving <49 Gy.

CONCLUSIONS: The PPCR registry highlights broad differences in acute toxicity rates in children receiving PT, and identifies opportunities for improvements in prevention, monitoring, and treatment of toxicities.

Copyright © 2021 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

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