Chronological Analysis of Acute Hematological Outcomes after Proton and Photon Beam Craniospinal Irradiation in Pediatric Brain Tumors

Abstract

This study aimed to compare the early hematological dynamics and acute toxicities between proton beam craniospinal irradiation (PrCSI) and photon beam craniospinal irradiation (PhCSI) for pediatric brain tumors. Materials and MethodsWe retrospectively reviewed patients with pediatric brain tumors who received craniospinal irradiation (CSI). The average change in hemoglobin levels (ΔHbavg), absolute lymphocyte counts (ΔALCavg), and platelet counts (ΔPLTavg) from baseline values was evaluated and compared between the PrCSI and PhCSI groups at 1 and 2 weeks after the initiation of CSI, 1 week before and at the end of radiotherapy, and 3-4 weeks after the completion of radiotherapy using t test and mixed-model analysis. ResultsThe PrCSI and PhCSI groups consisted of 36 and 30 patients, respectively. There were no significant differences in ΔHbavg between the two groups at any timepoint. However, ΔALCavg and ΔPLTavg were significantly lower in the PhCSI group than in PrCSI group at every timepoint, demonstrating that PrCSI resulted in a significantly lower rate of decline and better recovery of absolute lymphocyte and platelet counts. The rate of grade 3 acute anemia was significantly lower in the PrCSI group than in in the PhCSI group. ConclusionPrCSI showed a lower rate of decline and better recovery of absolute lymphocyte and platelet counts than PhCSI in the CSI for pediatric brain tumors. Grade 3 acute anemia was significantly less frequent in the PrCSI group than in the PhCSI group. Further large-scale studies are warranted to confirm these results.

Long-term effects of local radiotherapy on growth and vertebral features in children with high-risk neuroblastoma

“…PBT as an RT modality was not significantly associated with height restriction. PBT has been preferred for pediatric patients with cancer because it has shown potential benefits, such as lower secondary malignancy [ 20 ] and better hematologic outcomes after RT [ 21 ]. PBT can spare the anterior part of the body when locally irradiated using posterior beams.…”

Long-term effects of local radiotherapy on growth and vertebral features in children with high-risk neuroblastoma

“…PBT as an RT modality was not signi cantly associated with height restriction. PBT has been preferred for pediatric patients with cancer because it has shown potential bene ts, such as lower secondary malignancy [19] and better hematologic outcomes after RT [20]. PBT can spare the anterior part of the body when locally irradiated using posterior beams.…”

Comparison of Craniospinal Irradiation Using Proton Beams According to Irradiation Method and Initial Experience Treating Pediatric Patients

“…Past studies have shown that hematologic toxicity was less prominent for PBT compared with photon RT during and for 4 weeks after CSI. 17 Yoo et al 25 reported that PBT resulted in a better recovery of the absolute lymphocyte and PLT counts than photon RT. We decided between using the WVB technique or the VBS technique based on the patient's age.…”