Proton Radiotherapy for Management of Medulloblastoma: A Systematic Review of Clinical Outcomes

Helical tomotherapy craniospinal irradiation in primary brain tumours: Toxicities and outcomes in a peadiatric and adult population

“…Proton therapy could be the ideal tool to reduce toxicity due to non-target doses, with a potential beneficial effect on preservation of cognitive function, specifically for boosts, which may in turn limit the diffuse dose received by supratentorial structures and thyroid [40] , [58] , [59] , [60] . Access to proton therapy was very limited at the time of the study, with only a few of our patients treated by proton for the boost irradiation to their primary tumour site.…”

Successful Implementation of Image-Guided Pencil-Beam Scanning Proton Therapy in Medulloblastomas

“…Survival and control outcomes have largely been reported as similar between proton and photon CSI. A recent large systematic review by Young et al comparing proton vs. photon CSI between more than 2000 medulloblastoma patients from 35 studies reported comparable OS (~85-87%), PFS, and patterns of failure for up to a 10-year follow-up period [34]. Infants younger than 3 years have been typically known to fare worse, with a 5-year survival of 30-50% only; however, this is partly also owing to the usual omission, postponing, or de-escalation of CSI due to their age [35,36].…”

“…The long-term toxicities, including neurocognitive, neuroendocrine, hearing and vision outcomes, fertility, growth, cataracts, to name a few, as well as secondary malignancies, if any, are being followed up during routine reviews and will be separately reported. Superior intellectual outcomes of significant magnitude including stable IQ and better working memory are reported in patients after proton CSI compared to photon CSI and merits strong consideration as a veto factor for preferring protons for CSI, given its long-term implications in employability, functioning, professional and social independence, and ultimately the quality of life, in a group that enjoys excellent long-term survival [34]. Although the hypothalamo-pituitary axis is irradiated as part of the target, and hence the incidence of most neuroendocrinopathies are comparable, a clinically significant reduction in both central and peripheral hypothyroidism is also reported in patients who received proton CSI vs. their photon-treated counterparts, possibly due to a relative resistance of TSH-producing pituitary cells as well as lesser dose to the thyroid gland itself.…”

The evolving role of reirradiation in the management of recurrent brain tumors

“…Preliminary data suggest that CSI as a component of reirradiation offers a statistically significant PFS benefit compared with focal reirradiation, although large series with long-term follow-up are needed to confirm its survival benefit. There is published evidence supporting the use of proton beam therapy for its potential ability of reducing late toxicity in patients receiving CSI [ 81 – 84 ]. In this regard, results of a prospective study of surgery and fractionated re-irradiation with photon or proton RT in patients for recurrent ependymoma are expected in 2028 (ClinicalTrials.gov, number NCT02125786).…”