ArticleNeuro-oncology2022
Quantifying the risk and dosimetric variables of symptomatic brainstem injury after proton beam radiation in pediatric brain tumors.
Article in Neuro-oncology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 30 citations in OpenAlex.
- Proton Radiation Therapy: A Systematic Review of Treatment-Related Side Effects and Toxicities.International journal of molecular sciences · 2024Pooled it
- Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis.Frontiers in oncology · 2022Pooled it
- East Asian multi-centre study on clinical long-term outcomes of postoperative proton beam therapy for localised paediatric intracranial ependymoma.Clinical and translational radiation oncology · 2026Article
- Article
- Emerging Outcome Trends From Proton Therapy for Pediatric CNS Tumors: A Systematic Review.International journal of particle therapy · 2026Review
- Patient-reported outcomes in oropharyngeal cancer: comparing two cohorts with different treatment protocols.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Proton-Based Re-Irradiation of Locally Recurrent Pediatric Brain Tumors in Close Proximity to the Brainstem.International journal of particle therapy · 2026Article
- Cancer Neuroscience: Linking Neuronal Plasticity with Brain Tumor Growth and Resistance.Biology · 2026Review
- Three-year insights from a proton therapy centre: Evolving strategies in ependymoma treatment planning.Technical innovations & patient support in radiation oncology · 2025Article
- Pediatric CNS Radiation Oncology: Recent Developments and Novel Techniques.Current oncology (Toronto, Ont.) · 2025Review
- Brainstem Toxicity Following Proton Beam Radiation Therapy in Pediatric Brain Tumors: A Systematic Review and Meta-Analysis.Cancers · 2024Review
- Variations in linear energy transfer distributions within a European proton therapy planning comparison of paediatric posterior fossa tumours.Physics and imaging in radiation oncology · 2024Article
- The Role of Reirradiation in Childhood Progressive Diffuse Intrinsic Pontine Glioma (DIPG): An Ongoing Challenge beyond Radiobiology.Brain sciences · 2023Article
- Neurocognition and mean radiotherapy dose to vulnerable brain structures: new organs at risk?Radiation oncology (London, England) · 2023Article
- Critical Appraisal of Proton Therapy for Patients with Central Nervous System (CNS) Malignancies.Current treatment options in oncology · 2023Review
- Linear energy transfer-inclusive models of brainstem necrosis following proton therapy of paediatric ependymoma.Physics and imaging in radiation oncology · 2023Article
- Neurotoxicity from Old and New Radiation Treatments for Brain Tumors.International journal of molecular sciences · 2023Review
- Radiotherapy for Diffuse Intrinsic Pontine Glioma: Insufficient but Indispensable.Brain tumor research and treatment · 2023Review
- Radiotherapy for Atypical Teratoid/Rhabdoid Tumor (ATRT) on the Pediatric Proton/Photon Consortium Registry (PPCR).Journal of neuro-oncology · 2023Article
- Current Molecular and Clinical Landscape of ATRT - The Link to Future Therapies.Cancer management and research · 2023Review
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Authors and funding
10 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundBrainstem toxicity after radiation therapy (RT) is a devastating complication and a particular concern with proton radiation (PBT). We investigated the incidence and clinical correlates of brainstem injury in pediatric brain tumors treated with PBT.
methodsAll patients <21 years with brain tumors treated with PBT at our institution from 2007-2019, with a brainstem Dmean >30 Gy and/or Dmax >50.4 Gy were included. Symptomatic brainstem injury (SBI) was defined as any new or progressive cranial neuropathy, ataxia, and/or motor weakness with corresponding radiographic abnormality within brainstem.
resultsA total of 595 patients were reviewed and 468 (medulloblastoma = 200, gliomas = 114, ependymoma = 87, ATRT = 43) met our inclusion criteria. Median age at RT was 6.3 years and median prescribed RT dose was 54Gy [RBE]. Fifteen patients (3.2%) developed SBI, at a median of 4 months after RT. Grades 2, 3, 4, and 5 brainstem injuries were seen in 7, 5, 1, and 2 patients respectively. Asymptomatic radiographic changes were seen in 51 patients (10.9%). SBI was significantly higher in patients with age ≤3 years, female gender, ATRT histology, patients receiving high-dose chemotherapy with stem cell rescue, and those not receiving craniospinal irradiation. Patients with SBI had a significantly higher V50-52. In 2014, our institution started using strict brainstem dose constraints (Dmax ≤57 Gy, Dmean ≤52.4 Gy, and V54≤10%). There was a trend towards decrease in SBI from 4.4% (2007-2013) to 1.5% (2014-2019) (P = .089) without affecting survival.
conclusionOur results suggest a low risk of SBI after PBT for pediatric brain tumors, comparable to photon therapy. A lower risk was seen after adopting strict brainstem dose constraints.
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