TY - JOUR
T1 - Imaging changes with or without neurological symptoms after proton therapy in pediatric posterior fossa tumors; initial experience of the Dutch national cohort
AU - Rutgers, Jikke J
AU - Maduro, John H
AU - van Rossum, Peter S N
AU - Lequin, Maarten H
AU - van der Weide, Hiske L
AU - Hoeben, Bianca A W
AU - van der Heide, Astrid
AU - Plasschaert, Sabine L A
AU - Bregman, Abel
AU - Matysiak, Witold P
AU - Seravalli, Enrica
AU - Langendijk, Johannes A
AU - Hoving, Eelco W
AU - Janssens, Geert O
N1 - Copyright © 2025. Published by Elsevier Inc.
PY - 2025/8/31
Y1 - 2025/8/31
N2 - BACKGROUND AND PURPOSE: The incidence of proton therapy (PT)-related imaging changes in the central nervous system, and associated symptoms, varies widely in literature. The aim of this study was to assess imaging changes after implementation of intensity-modulated pencil beam scanning in a national cohort of pediatric posterior fossa (PF) tumors.MATERIALS AND METHODS: All pediatric PF tumor patients treated in the XXX with PT between 06-2018 and 12-2022 were analyzed. Patients receiving re-irradiation or a combination with photon therapy were excluded. Imaging changes were defined as new contrast enhancement on T1-weighted images or abnormal signal on T2-weighted imaging in the brain parenchyma or spinal cord, outside of the tumor bed and within the irradiated area. Associated symptoms were graded according to CTCAE v5.0.RESULTS: Seventy-seven PF patients (median age 7.0 years) were analyzed. Median follow-up was 25 months and prescribed dose 54 GyE (range 49.6 - 59.4 GyE). At 12 months post-PT, a cumulative incidence rate of 33% contrast enhancement and 47% T2-weighted imaging changes was observed. Of all patients, 15% experienced any neurological symptoms related to these imaging changes, grade ≥2 symptoms were observed in 9%. The imaging changes were predominantly transient. Younger children, especially those <5 years, had a significantly higher risk of developing imaging changes (HR 8.64 [95%CI 3.60-20.74]) and symptoms (HR 6.97 [95%CI 1.80-26.99]). Prescribed dose ≥59.4 GyE and higher cerebellar D0.1cc and D10% were associated with an increased risk of imaging changes and associated symptoms.CONCLUSION: The initial experience of PT for pediatric PF tumors in XXX demonstrates post-PT contrast enhancement with associated symptoms in 15% of the patients, and an increased risk in patients <5 years old and patients with a prescribed dose ≥59.4 GyE.
AB - BACKGROUND AND PURPOSE: The incidence of proton therapy (PT)-related imaging changes in the central nervous system, and associated symptoms, varies widely in literature. The aim of this study was to assess imaging changes after implementation of intensity-modulated pencil beam scanning in a national cohort of pediatric posterior fossa (PF) tumors.MATERIALS AND METHODS: All pediatric PF tumor patients treated in the XXX with PT between 06-2018 and 12-2022 were analyzed. Patients receiving re-irradiation or a combination with photon therapy were excluded. Imaging changes were defined as new contrast enhancement on T1-weighted images or abnormal signal on T2-weighted imaging in the brain parenchyma or spinal cord, outside of the tumor bed and within the irradiated area. Associated symptoms were graded according to CTCAE v5.0.RESULTS: Seventy-seven PF patients (median age 7.0 years) were analyzed. Median follow-up was 25 months and prescribed dose 54 GyE (range 49.6 - 59.4 GyE). At 12 months post-PT, a cumulative incidence rate of 33% contrast enhancement and 47% T2-weighted imaging changes was observed. Of all patients, 15% experienced any neurological symptoms related to these imaging changes, grade ≥2 symptoms were observed in 9%. The imaging changes were predominantly transient. Younger children, especially those <5 years, had a significantly higher risk of developing imaging changes (HR 8.64 [95%CI 3.60-20.74]) and symptoms (HR 6.97 [95%CI 1.80-26.99]). Prescribed dose ≥59.4 GyE and higher cerebellar D0.1cc and D10% were associated with an increased risk of imaging changes and associated symptoms.CONCLUSION: The initial experience of PT for pediatric PF tumors in XXX demonstrates post-PT contrast enhancement with associated symptoms in 15% of the patients, and an increased risk in patients <5 years old and patients with a prescribed dose ≥59.4 GyE.
U2 - 10.1016/j.ijrobp.2025.08.046
DO - 10.1016/j.ijrobp.2025.08.046
M3 - Article
C2 - 40897265
SN - 0360-3016
JO - International Journal of Radiation Oncology, Biology, Physics
JF - International Journal of Radiation Oncology, Biology, Physics
ER -