Abstract
Radiation therapy represents an important approach in the therapeutic management of children and adolescents with malignant tumors and its application with modern techniques – including Proton Beam Therapy (PBT) – is of great interest. In particular, potential radiation-induced injuries and secondary malignancies – also associated to the prolonged life expectancy of patients – are still questions of concern that increase the debate on the usefulness of PBT in pediatric treatments. This paper presents a literary review of current applications of PBT in non-Central Nervous System pediatric tumors (such as retinoblastoma, Hodgkin Lymphoma, Wilms tumor, bone and soft tissues sarcomas). We specifically reported clinical results achieved with PBT and dosimetric comparisons between PBT and the most common photon-therapy techniques. The analysis emphasizes that PBT minimizes radiation doses to healthy growing organs, suggesting for reduced risks of late side-effects and radiation-induced secondary malignancies. Extended follow up and confirms by prospective clinical trials should support the effectiveness and long-term tolerance of PBT in the considered setting.
Highlights
Irradiation of primary or post-operative tumor site represents a fundamental part of the standard therapies for cancer due to the capability of X-rays to damage tumor cells DNA and induce tumor cells death [1]
It is well known that the use of RT in children and adolescents is challenging [2] because of the increased risk of late toxicities and secondary malignant neoplasms (SMNs) which are related to the higher radiation sensitivity and the increased cell-turnover of developing tissues [2]
RB is a radiosensitive tumor, the use of RT could increase the risks of radiationinduced SMNs [12, 49], which is greater in children with hereditary RB gene mutation [12, 17, 50]
Summary
Irradiation of primary or post-operative tumor site represents a fundamental part of the standard therapies for cancer due to the capability of X-rays to damage tumor cells DNA and induce tumor cells death [1]. Proton Beam Therapy (PBT) is a modality of charged particle therapy which provides excellent dosedistributions and an increased dose-sparing of normal tissues due to the absence of an exit-dose and an entrance-dose which is much lower than the target dose [1, 4]. These physical characteristics and the aforementionated dosimetric advantages suggest that PBT could be proposed as an alternative approach to conventional photon RT for the therapeutic management of malignant diseases [5, 6]. The question of PBT effectiveness and safety in comparison to modern high-conformal photon techniques is still debated [11, 12] due to the lack of long-term clinical data
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