Treatment of pediatric patients and young adults with particle therapy at the Heidelberg Ion Therapy Center (HIT): establishment of workflow and initial clinical data

Stephanie E Combs,Angelika Hoess,Swantje Ecker,Jürgen Debus,Alexandra Jensen,Oliver Jäkel,Klaus Herfarth,Kerstin A Kessel,Claudia Blattmann,Olaf Witt,Eike Martin,Susanne Oertel,Andreas E Kulozik

doi:10.1186/1748-717x-7-170

Abstract

BackgroundTo report on establishment of workflow and clinical results of particle therapy at the Heidelberg Ion Therapy Center.Materials and methodsWe treated 36 pediatric patients (aged 21 or younger) with particle therapy at HIT. Median age was 12 years (range 2-21 years), five patients (14%) were younger than 5 years of age. Indications included pilocytic astrocytoma, parameningeal and orbital rhabdomyosarcoma, skull base and cervical chordoma, osteosarcoma and adenoid-cystic carcinoma (ACC), as well as one patient with an angiofibroma of the nasopharynx. For the treatment of small children, an anesthesia unit at HIT was established in cooperation with the Department of Anesthesiology.ResultsTreatment concepts depended on tumor type, staging, age of the patient, as well as availability of specific study protocols. In all patients, particle radiotherapy was well tolerated and no interruptions due to toxicity had to be undertaken. During follow-up, only mild toxicites were observed. Only one patient died of tumor progression: Carbon ion radiotherapy was performed as an individual treatment approach in a child with a skull base recurrence of the previously irradiated rhabdomyosarcoma. Besides this patient, tumor recurrence was observed in two additional patients.ConclusionClinical protocols have been generated to evaluate the real potential of particle therapy, also with respect to carbon ions in distinct pediatric patient populations. The strong cooperation between the pediatric department and the department of radiation oncology enable an interdisciplinary treatment and stream-lined workflow and acceptance of the treatment for the patients and their parents.

Highlights

In pediatric oncology, most treatment concepts in the 21st century are of curative intent, aiming at long-term overall survival
One patient died of tumor progression: Carbon ion radiotherapy was performed as an individual treatment approach in a child with a skull base recurrence of the previously irradiated rhabdomyosarcoma
Clinical protocols have been generated to evaluate the real potential of particle therapy, with respect to carbon ions in distinct pediatric patient populations

Summary

Introduction

Most treatment concepts in the 21st century are of curative intent, aiming at long-term overall survival. With respect to radiotherapy, sparing of normal dose and potentially reducing side effects is the use of particle therapy, due to the physical properties of ion beams [1,2]). The distinct physical characteristics of a particle beams potentially offer clinical benefit especially in pediatric oncology: In the entry channel of the beam almost no energy is deposited, while a high local dose deposition, the Bragg Peak, can be guided by energy-variation of the beam, into the defined target volume. Comparative analyses with photon treatment have shown that reduction of integral dose may lead to a significant decrease in side effects, especially with respect to secondary malignancies in pediatric patients treated with proton radiotherapy [13]. Until now no real long-term data, especially no randomized comparisons of high-end photons and protons are available.

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Results

Conclusion