Abstract
Proton therapy (PRT) is associated with reduced integral dose to normal brain tissue. While preliminary data is evolving on the efficacy of PRT for CNS tumors, little is known regarding which CNS patients are treated with PRT. We hypothesized that a large proportion of brain patients treated with PRT are young (pediatrics: <=18 years, young adults: 19-40 years) given the longer life expectancy over which they are at risk for CNS toxicity. We utilized the Proton Collaborative Group (PCG) registry, which prospectively follows patients across 8 academic and community PRT centers in the United States. Patients with spine tumors were excluded. The relative proportion of various histological classifications were evaluated by age group. Between 2009 and 2017, 1295 patients with diagnosis of a primary brain tumor were treated with PRT. Median age at PRT was 30.7 years (range, 0.73-92.2) with relatively equal sex distribution (52.5% male, 47.4% female). Most patients were pediatric (37.8%) or young adult (22.2%) and received PRT at initial diagnosis (67.3%) rather than at recurrence (32%). The frequency of tumor types treated varied by age group. Pediatric patients received PRT most frequently for embryonal tumors (28.2%), astrocytic tumors (19.8%), and ependymal tumors (19.4%). Among young adults, astrocytic tumors (27.4%), oligodendroglial/mixed gliomas (17.4%), and embryonal tumors (12.2%) were most frequently treated. Last, among adults >40 years, meningeal tumors (35.8%) were most commonly treated with PRT, followed by astrocytic tumors (27.1%) and oligodendroglial/mixed gliomas (11.4%). Primary brain tumor patients treated with PRT are young, with the majority treated for relatively favorable tumor types. This likely reflects the selection of patients that may derive the greatest benefit from reduction in brain dose. Additional studies including comparison of tumor types among CNS patients treated with photons are warranted.
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