Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India
PURPOSEProton beam therapy (PBT) has been a preferred modality in pediatric malignancies requiring radiotherapy. We report our preliminary experience of treating consecutive patients younger than 25 years with image-guided pencil beam scanning PBT from the first and only center on the Indian subcont...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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American Society of Clinical Oncology
2020-11-01
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| Series: | JCO Global Oncology |
| Online Access: | https://ascopubs.org/doi/10.1200/GO.20.00319 |
| _version_ | 1818759773777035264 |
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| author | Srinivas Chilukuri Nagarjuna Burela Ramya Uppuluri D. Indumathi Sapna Nangia Pankaj Kumar Panda Dayananda Sharma Shamurailatpam Revathi Raj Thirumalai Raja Rakesh Jalali |
| author_facet | Srinivas Chilukuri Nagarjuna Burela Ramya Uppuluri D. Indumathi Sapna Nangia Pankaj Kumar Panda Dayananda Sharma Shamurailatpam Revathi Raj Thirumalai Raja Rakesh Jalali |
| author_sort | Srinivas Chilukuri |
| collection | DOAJ |
| description | PURPOSEProton beam therapy (PBT) has been a preferred modality in pediatric malignancies requiring radiotherapy. We report our preliminary experience of treating consecutive patients younger than 25 years with image-guided pencil beam scanning PBT from the first and only center on the Indian subcontinent.METHODSPatients were selected for PBT on the basis of a multidisciplinary tumor board decision. Patient demographic data, as well as tumor and treatment-related characteristics of the cohort, were captured. Patient and treatment-related factors and their association with acute toxicities were analyzed using univariable and multivariable analyses.RESULTSForty-seven patients (27 with CNS and 20 with non-CNS tumors) with a median age of 9 years (range, 2-25 years) were evaluated. Most common diagnoses were ependymoma, rhabdomyosarcoma, and glioma. Seventy-seven percent of patients traveled more than 500 km, and 70% of them lived in metropolitan cities. Forty-nine percent of patients had recurrent disease at presentation, and 15% had received a previous course of radiation. The median dose delivered was 54.8 cobalt gray equivalents (range, 40.0-70.4 cobalt gray equivalents) to a median clinical target volume of 175 mL (range, 18.7-3,083.0 mL), with 34% of patients requiring concurrent chemotherapy (CCT). Acute grade 2 and grade 3 dermatitis, mucositis, and hematologic toxicity was noted in 45% and 2%, 34% and 0%, and 38% and 30% of patients, respectively. Grade 2 fatigue was noted in 26% of patients. On multivariable analysis, for CNS tumors, both CCT and craniospinal irradiation were independently associated with ≥ 2 grade hematologic toxicity, whereas among non-CNS tumors, a clinical target volume > 150 mL was associated with ≥ 2 grade fatigue, head and neck irradiation was associated with ≥ 2 grade mucositis, and CCT was associated with grade ≥ 2 hematologic toxicity.CONCLUSIONThis study demonstrates safe implementation of a PBT program for children and young adults on the Indian subcontinent. Image-guided pencil beam scanning PBT in judiciously selected patients is feasible and can be delivered with acceptable acute toxicities. |
| first_indexed | 2024-12-18T06:48:03Z |
| format | Article |
| id | doaj.art-25985cfc9495460ca427eed610a543bc |
| institution | Directory Open Access Journal |
| issn | 2687-8941 |
| language | English |
| last_indexed | 2024-12-18T06:48:03Z |
| publishDate | 2020-11-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | JCO Global Oncology |
| spelling | doaj.art-25985cfc9495460ca427eed610a543bc2022-12-21T21:17:25ZengAmerican Society of Clinical OncologyJCO Global Oncology2687-89412020-11-0161736174510.1200/GO.20.00319Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in IndiaSrinivas Chilukuri0Nagarjuna Burela1Ramya Uppuluri2D. Indumathi3Sapna Nangia4Pankaj Kumar Panda5Dayananda Sharma Shamurailatpam6Revathi Raj7Thirumalai Raja8Rakesh Jalali9Apollo Proton Cancer Centre, Chennai, IndiaApollo Proton Cancer Centre, Chennai, IndiaApollo Proton Cancer Centre, Chennai, IndiaApollo Proton Cancer Centre, Chennai, IndiaApollo Proton Cancer Centre, Chennai, IndiaApollo Proton Cancer Centre, Chennai, IndiaApollo Proton Cancer Centre, Chennai, IndiaApollo Specialty Hospital, Chennai, IndiaApollo Proton Cancer Centre, Chennai, IndiaApollo Proton Cancer Centre, Chennai, IndiaPURPOSEProton beam therapy (PBT) has been a preferred modality in pediatric malignancies requiring radiotherapy. We report our preliminary experience of treating consecutive patients younger than 25 years with image-guided pencil beam scanning PBT from the first and only center on the Indian subcontinent.METHODSPatients were selected for PBT on the basis of a multidisciplinary tumor board decision. Patient demographic data, as well as tumor and treatment-related characteristics of the cohort, were captured. Patient and treatment-related factors and their association with acute toxicities were analyzed using univariable and multivariable analyses.RESULTSForty-seven patients (27 with CNS and 20 with non-CNS tumors) with a median age of 9 years (range, 2-25 years) were evaluated. Most common diagnoses were ependymoma, rhabdomyosarcoma, and glioma. Seventy-seven percent of patients traveled more than 500 km, and 70% of them lived in metropolitan cities. Forty-nine percent of patients had recurrent disease at presentation, and 15% had received a previous course of radiation. The median dose delivered was 54.8 cobalt gray equivalents (range, 40.0-70.4 cobalt gray equivalents) to a median clinical target volume of 175 mL (range, 18.7-3,083.0 mL), with 34% of patients requiring concurrent chemotherapy (CCT). Acute grade 2 and grade 3 dermatitis, mucositis, and hematologic toxicity was noted in 45% and 2%, 34% and 0%, and 38% and 30% of patients, respectively. Grade 2 fatigue was noted in 26% of patients. On multivariable analysis, for CNS tumors, both CCT and craniospinal irradiation were independently associated with ≥ 2 grade hematologic toxicity, whereas among non-CNS tumors, a clinical target volume > 150 mL was associated with ≥ 2 grade fatigue, head and neck irradiation was associated with ≥ 2 grade mucositis, and CCT was associated with grade ≥ 2 hematologic toxicity.CONCLUSIONThis study demonstrates safe implementation of a PBT program for children and young adults on the Indian subcontinent. Image-guided pencil beam scanning PBT in judiciously selected patients is feasible and can be delivered with acceptable acute toxicities.https://ascopubs.org/doi/10.1200/GO.20.00319 |
| spellingShingle | Srinivas Chilukuri Nagarjuna Burela Ramya Uppuluri D. Indumathi Sapna Nangia Pankaj Kumar Panda Dayananda Sharma Shamurailatpam Revathi Raj Thirumalai Raja Rakesh Jalali Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India JCO Global Oncology |
| title | Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India |
| title_full | Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India |
| title_fullStr | Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India |
| title_full_unstemmed | Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India |
| title_short | Preliminary Experience of Treating Children and Young Adults With Image-Guided Proton Beam Therapy in India |
| title_sort | preliminary experience of treating children and young adults with image guided proton beam therapy in india |
| url | https://ascopubs.org/doi/10.1200/GO.20.00319 |
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