Proton Beam Therapy for Childhood Malignancies: Status Report

Abstract

Proton beam therapy (PT) offers improved sparing of normal tissue, thus potentially reducing the risk for treatment related late sequelae and induction of secondary cancer. In addition, it can be an instrument for intensification of local therapy (“dose escalation”) for disease currently not sufficiently controlled. Up to now, more than 70 000 patients have been treated with PT worldwide. In particular, tumors of the ocular fundus, the base of skull and prostate were targeted. In recent years an increasing number of children got treated, predominantly when suffering from sarcomas or brain tumors. In Europe, treatment was applied so far mainly in Switzerland (PSI) or France (Orsay). However, availability of particle therapy is about to increase considerably within the next years. The German Working Group of paediatric radiation oncology APRO=Arbeitsgemeinschaft für Pädiatrische Radioonkologie) is currently trying to embed PT in the multidisciplinary concepts of the GPOH, and PT experts are appointed for each relevant study. In addition, prospective documentation of the applied PT is to be performed according to the RISK protocol. Still, it is mandatory to reach out for the integration of PT into our cooperative network and the multidisciplinary trials. Best practice solutions have to be established in order to provide high quality and transparency of any applied particle therapy.

Zusammenfassung

Die Protonentherapie (PT) zeichnet sich durch eine verbesserte Schonung des gesunden Gewebes aus. Dadurch kann potenziell das Risiko von Nebenwirkungen und der Induktion von Zweittumoren gesenkt werden. Ebenso kann die PT als Instrument zur lokalen Therapieintensivierung genutzt werden („Dosiseskalation”) für die Fälle, in denen die lokalen Tumorkontrollraten bislang unbefriedigend sind. Mittlerweile wird die PT weltweit seit über 50 Jahren klinisch eingesetzt mit mehr als 70 000 behandelten Patienten. Im Fokus der Partikeltherapie standen bislang vor allem Tumoren des Augenhintergrundes, Schädelbasistumoren und Prostatakarzinome. Seit einigen Jahren werden zunehmend aber auch Kinder mit PT behandelt. Dabei handelt es sich in erster Linie um Patienten mit Knochen- oder Weichteiltumoren sowie Hirntumoren. Die Therapie erfolgte in Europa bisher überwiegend am Paul Scherrer Institut in der Schweiz oder in Frankreich/Orsay, die Verfügbarkeit wird aber in den nächsten Jahren deutlich ansteigen. Die APRO (Arbeitsgemeinschaft für Pädiatrische Radioonkologie) versucht aktuell, die PT in die multidisziplinären Konzepte der GPOH zu integrieren und Experten in den Studien zu positionieren. Eine Dokumentation der durchgeführten Therapie nach RISK ist dabei ebenfalls vorgesehen, um die essenziellen Belange der Qualitätssicherung und Transparenz zu lösen.

Key words

children - cancer - proton beam therapy - irradiation

Schlüsselwörter

Kinder - Tumor - Protonentherapie - Bestrahlung

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