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. 2024 Mar 8;6(1):vdae034.
doi: 10.1093/noajnl/vdae034. eCollection 2024 Jan-Dec.

Proton versus photon craniospinal irradiation for adult medulloblastoma: A dosimetric, toxicity, and exploratory cost analysis

William G Breen  1 , Connie S Geno  1 , Mark R Waddle  1 , Jing Qian  1 , William S Harmsen  2 , Terry C Burns  3 , Ugur T Sener  4 , Michael W Ruff  4 , Bryan J Neth  4 , Joon H Uhm  4 , David M Routman  1 , Elizabeth Yan  1 , Jon J Kruse  1 , Nadia N Laack  1 , Paul D Brown  1 , Anita Mahajan  1
Affiliations

Proton versus photon craniospinal irradiation for adult medulloblastoma: A dosimetric, toxicity, and exploratory cost analysis

William G Breen et al. Neurooncol Adv. .

Abstract

Background: This study aimed to determine whether proton craniospinal irradiation (CSI) decreased the dose to normal tissue and resulted in less toxicity than photon CSI for adult patients.

Methods: This single-institution retrospective analyzed differences in radiation doses, acute toxicity, and cost between proton and CSI for adult medulloblastoma patients.

Results: Of 39 total patients, 20 were treated with photon CSI prior to 2015, and 19 were treated with proton CSI thereafter. Median age was 28 years (range 18-66). The molecular subtype was most commonly sonic hedgehog (68%). Patients most commonly received 36 Gy CSI in 20 fractions with a boost to 54-55.8 Gy (92%). Proton CSI delivered significantly lower mean doses to cochleae, lacrimal glands, lens, parotid glands, pharyngeal constrictors, esophagus, lungs, liver, and skin (all P < .001). Patients receiving proton CSI had significantly lower rates of acute dysphagia of any grade (5% versus 35%, P = .044) and decreased median weight loss during radiation (+1.0 versus -2.8 kg, P = .011). Weight loss was associated with acute hospitalization (P = .009). Median follow-up was 2.9 and 12.9 years for proton and photon patients, respectively, limiting late toxicity and outcome comparisons. At the last follow-up, 5 photon patients had died (2 of progressive disease, 3 without recurrence ages 41-63) and 21% had experienced major cardiovascular events. At 10 years, 89% were alive and 82% were recurrence free.

Conclusions: This study demonstrates dosimetric improvements with proton CSI, potentially leading to decreased acute toxicity including dysphagia and weight loss during treatment.

Keywords: brain tumors; healthcare costs; medulloblastoma; proton therapy; radiotherapy.

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Conflict of interest statement

None of the authors reported conflicts of interest.

Figures

Figure 1.
Figure 1.
Comparison of radiation dose between patients receiving proton CSI (left) and photon CSI (right), demonstrating increased dose spill anteriorly into the esophagus, thorax, abdomen, and pelvis with photon CSI.
See this image and copyright information in PMC

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References

    1. Smoll NR, Drummond KJ.. The incidence of medulloblastomas and primitive neurectodermal tumours in adults and children. J Clin Neurosci. 2012;19(11):1541–1544. - PubMed
    1. Greuter L, Guzman R, Soleman J.. Typical pediatric brain tumors occurring in adults-differences in management and outcome. Biomedicines. 2021;9(4):356. - PMC - PubMed
    1. Beier D, Proescholdt M, Reinert C, et al. . Multicenter pilot study of radiochemotherapy as first-line treatment for adults with medulloblastoma (NOA-07). Neuro Oncol. 2018;20(3):400–410. - PMC - PubMed
    1. Franceschi E, Seidel C, Sahm F, Pajtler KW, Hau P.. How we treat medulloblastoma in adults. Esmo Open. 2021;6(4):100327. - PMC - PubMed
    1. Hau P, Frappaz D, Hovey E, et al. . Development of randomized trials in adults with medulloblastoma-the example of EORTC 1634-BTG/NOA-23. Cancers. 2021;13(14):3451. - PMC - PubMed

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