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Study Backs Proton Therapy In High-Risk Kids

August 19, 2013
Written by: , Filed in: Abdominal Imaging, Chest Radiology, Pediatric Radiology
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As big health systems rush to build extremely expensive proton beam therapy centers, skeptics have pointed to a lack of evidence, so far, demonstrating that proton therapy works better than conventional radiation therapy. Now, at least one new study indicates that it does.

On the other hand, the study also found that in some cases, more-conventional intensity-modulated X-ray therapy (IMXT) worked better.

The study involved children with a high-risk form of neuroblastoma, the most common solid tumor of early childhood. It strikes the peripheral nervous system, usually appearing in the chest or abdomen. Christine Hill-Kayser, MD, leader of the study and lead author of an article about it in Pediatric Blood & Cancer, explained the virtues of proton therapy:

Protons are heavier than the particles in X-rays and have more stopping power. They deposit 90 percent of their energy precisely at the tumor site, with nearly zero radiation away from the tumor. That protects healthy organs—which, as growing tissues, are especially vulnerable to radiation damage in young children.

Dr. Hill-Kayser is a radiation oncologist at the Cancer Center of The Children’s Hospital of Philadelphia. She was quoted in a hospital news release. The article appears in the October issue of Pediatric Blood & Cancer after having been published online in June.

The study involved 13 children with a median age of 3. Each had responded well to chemotherapy followed by surgery, more chemotherapy, bone marrow transplant, and, in some cases, immunotherapy. Radiation therapy was the final step, meant to destroy lingering cancer cells with minimal toxicity to healthy tissue.

The study team determined that 11 of the children should receive proton therapy but that IMXT would be better for the other two. All 13 patients came through without cancer recurrence or acute organ toxicity. The researchers determined that proton therapy reduced radiation dosage to most, although not all, healthy areas of the body compared to X-ray therapies.

Dr. Hill-Kayser stressed that radiation treatment must be meticulously customized for each patient. “To better assess the use of proton therapy against high-risk neuroblastoma,” she said, “we’ll need to study larger numbers of patients and do long-term follow-up. However, this represents a great start.”

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