Demographic profile and early clinical experience of treating children
and young adults with image guided proton beam therapy in India
Abstract
Background: We report demographic profile and our initial experience of
treating children and young adults with image guided pencil beam
scanning proton beam therapy (PBS-PBT) at our centre. Material and
methods: All patients younger than 25 years, consecutively treated with
PBT based on a multi-disciplinary tumor board decision were analyzed.
Patients were treated under daily on-board kilovoltage x-ray and/or cone
beam CT scan guidance. The demographic profile, treatment
characteristics and the acute toxicities were reported. Patient and
treatment related factors and their association with acute toxicities
were analyzed using univariate and multivariate analysis. Results:
Forty-seven patients {27 with central nervous system(CNS) and 20 with
non-CNS tumors} with a median age of 9 years were evaluated. Most
common diagnoses were ependymoma, rhabdomyosarcoma and glioma. Median
dose delivered was 54.8CGE(40-70.4) to a median clinical target volume
of 175cc (18.7-3083cc) with 34% requiring concurrent chemotherapy(CCT).
Acute grade-2 and 3 dermatitis, mucositis, and hematological toxicity
was noted in 45% and 2%; 34% and 0%; 38% and 30%; respectively.
Grade-2 fatigue was noted in 26%. On univariate analysis, CCT(p=0.009)
and cranio-spinal irradiation(p<0.001) were associated with
grade-2 or more hematological toxicity in patients with CNS tumors.
Among non-CNS tumors, clinical target volume more than 150cc was
associated with grade-2 or more fatigue(p=0.017). Conclusions: The
demographic pattern of patients treated with PBT at this new and only
centre in the region was similar to previously published literature.
Image guided PBS-PBT resulted in acceptable acute toxicities both among
children with CNS and non-CNS tumors.