Quality of life in pediatric patients treated with adjuvant proton radiation for craniopharyngiomas.

Background: Pediatric craniopharyngiomas are curable tumors. Significant morbidity is reported from the tumor itself as well as treatments (surgery and radiotherapy (RT)), which adversely affects health-related quality of life (HRQoL) outcomes, which we reported and correlated with other health outcomes.

Methods: HRQoL data was collected from a prospective cohort of proton treated patients with craniopharyngiomas (≤ 22 years at the time of RT).

Self-Reported Health Status Survey Creation and Distribution Outcomes in a Large Cohort of Pediatric Oncology Patients Treated with Proton Radiation Therapy.

Purpose: Most pediatric patients receiving radiation therapy at Massachusetts General Hospital are referred from outside institutions and later return to their original care providers. As quaternary care centers, proton therapy centers face unique challenges in tracking patient follow-up, yet obtaining longitudinal data is crucial for assessing radiation therapy outcomes. We implemented an annual direct-to-patient survey to improve follow-up data collection.

Long-term Outcomes Following Proton-based Radiation Therapy for Pediatric Chordomas and Chondrosarcomas of the Mobile Spine and the Sacrum.

Purpose: To report the first cohort of children with spinal and sacrococcygeal chordomas (CH) and chondrosarcomas (CHS) treated with proton-based radiation therapy (PRT).

Materials And Methods: Between 1989 and 2019, 52 pediatric patients ≤22 years old with spinal CH (n = 43) or CHS (n = 9) were treated with PRT at a single institution. The primary tumor originated in the C-spine (n = 37, 71%), T-spine (n = 6, 12%), L-spine (n = 7, 14%), or sacrum (n = 2, 3%).

Hypofractionated Palliative Radiotherapy for Relapsed and Refractory High-Risk Neuroblastoma.

While palliative radiotherapy (RT) is frequently used in the management of relapsed/refractory high-risk neuroblastoma (HR-NBL); outcomes after palliative hypofractionated RT (hypo-RT) remain poorly characterized. : We conducted a multi-institutional retrospective study of 38 patients who were diagnosed with HR-NBL between 1997 and 2021 and received palliative RT. Conventional RT (conv-RT) and hypo-RT were defined as palliative treatment courses using dose ≤2 or >2 Gy per fraction, respectively.

Treatment Approach for Metastatic Intracranial Germinoma: A Multi-Institutional Experience.

Background: Germinoma is the most common intracranial germ cell tumor (IGCT) in children and young adults. Treatment with 24 Gy craniospinal irradiation (CSI) with boost to 40 Gy alone results in excellent survival, irrespective of disease stage. For localized germinoma, recent studies have demonstrated the efficacy of pre-irradiation induction chemotherapy in decreasing the field and dose of radiation therapy (RT) needed for cure.

Radiotherapy and surgery: can this combination be further optimized for patients with metastatic spine disease?

This narrative review provides a comprehensive overview of the current status, recent advancements, and future directions in the management of metastatic spine disease using both radiotherapy and surgery. Emphasis has been put on the integrated use of radiotherapy and surgery, incorporating recent developments such as separation surgery, active dose sparing of the surgical field, and the implementation of carbon fiber-reinforced polymer implants. Future studies should explore the effects of minimizing the time between radiotherapy and surgery and investigate the potential of vertebral re-ossification after radiotherapy to obviate the need for stabilization surgery.

Phase 2 trial of veliparib, local irradiation, and temozolomide in patients with newly diagnosed high-grade glioma: a Children's Oncology Group study.

Background: The outcome for pediatric patients with high-grade glioma (HGG) remains poor. Veliparib, a potent oral poly(adenosine diphosphate-ribose) polymerase (PARP) 1/2 inhibitor, enhances the activity of radiotherapy and DNA-damaging chemotherapy.

Methods: We conducted a single-arm, non-randomized phase 2 clinical trial to determine whether treatment with veliparib and radiotherapy, followed by veliparib and temozolomide, improves progression-free survival in pediatric patients with newly diagnosed HGG without H3 K27M or BRAF mutations, compared to patient-level data from historical cohorts with closely matching clinical and molecular features.

Proton-Based Radiation Therapy for Skull Base Chondrosarcomas in Children and Adolescents: 40-Year Experience From the Massachusetts General Hospital.

Purpose: The literature on skull base chondrosarcoma (CHS) is scarce. We report outcomes for pediatric and young patients ≤22 years with base of skull CHSs treated with proton-based radiation therapy (PBRT).

Methods And Materials: We retrospectively reviewed all patients treated with PBRT between 1981 and 2023.

PTCOG international survey of practice patterns and trends in utilization of proton therapy for breast cancer.

Purpose/objectives: The indications, techniques, and extent to which proton beam therapy (PBT) is employed for breast cancer are unknown. We seek to determine PBT utilization for breast cancer.

Materials/methods: The Particle Therapy Co-Operative Group (PTCOG) Breast Subcommittee developed an IRB-approved 29-question survey and sent it to breast cancer radiation oncologists at all active PBT centers worldwide in June 2023.

Patterns of recurrence after radiotherapy for high-risk neuroblastoma: Implications for radiation dose and field.

Background: Prognosis for patients with high-risk neuroblastoma (HR-NBL) is guarded despite aggressive therapy, and few studies have characterized outcomes after radiotherapy in relation to radiation treatment fields.

Methods: Multi-institutional retrospective cohort of 293 patients with HR-NBL who received autologous stem cell transplant (ASCT) and EBRT between 1997-2021. LRR was defined as recurrence at the primary site or within one nodal echelon beyond disease present at diagnosis.

Validation of Patient-Reported Outcomes in Patients With Nonmetastatic Breast Cancer Receiving Comprehensive Nodal Irradiation in the RadComp Trial.

Purpose: Our purpose was to evaluate the measurement properties of patient-reported outcome (PRO) measures used in the ongoing RadComp pragmatic randomized clinical trial (PRCT).

Methods And Materials: The deidentified and blinded data set included 774 English-speaking female participants who completed their 6-month posttreatment assessment. Eleven PRO measures were evaluated, including the Trial Outcome Index from the Functional Assessment of Cancer Therapy-Breast (FACT-B), Satisfaction with Breast Cosmetic Outcomes, the BREAST-Q, and selected Patient-Reported Outcomes Measurement Information System (PROMIS) measures.

Chondrosarcoma of the Mobile Spine: An Update on Patients Treated at a Single Institution.

Study Design: Retrospective study.

Objective: The objective of this study was to report the clinical data for patients treated with mobile spine chondrosarcoma.

Summary Of Background Data: Chondrosarcoma of the mobile spine is a rare and challenging entity.

Unraveling molecular advancements in chordoma tumorigenesis and treatment response: a review of scientific discoveries and clinical implications.

Chordomas are tumors thought to originate from notochordal remnants that occur in midline structures from the cloves of the skull base to the sacrum. In adults, the most common location is the sacrum, followed by the clivus and then mobile spine, while in children a clival origin is most common. Most chordomas are slow growing.

The Use of Proton and Carbon Ion Radiation Therapy for Sarcomas.

The unique physical and biological characteristics of proton and carbon ions allow for improved sparing of normal tissues, decreased integral dose to the body, and increased biological effect through high linear energy transfer. These properties are particularly useful for sarcomas given their histology, wide array of locations, and age of diagnosis. This review summarizes the literature and describes the clinical situations in which these heavy particles have advantages for treating sarcomas.

Phantosmia during proton radiation and differences in frequency of phantosmia rates based on proton craniospinal irradiation technique for pediatric brain tumor patients.

Background: Unusual olfactory perception, often referred to as "phantosmia" or "cacosmia" has been reported during brain radiotherapy (RT), but is infrequent and does not typically interfere with the ability to deliver treatment. We seek to determine the rate of phantosmia for patients treated with proton craniospinal irradiation (CSI) and identify any potential clinical or treatment-related associations.

Methods: We performed a retrospective review of 127 pediatric patients treated with CSI, followed by a boost to the brain for primary brain tumors in a single institution between 2016 and 2021.

Genetic architecture of the acute and persistent immune cell response after radiation exposure.

Hematologic toxicity is a common side effect of multimodal cancer therapy. Nearly all animal studies investigating the causes of radiotherapy-induced hematologic toxicity use inbred strains with limited genetic diversity and do not reflect the diverse responses observed in humans. We used the population-based Collaborative Cross (CC) mouse resource to investigate the genetic architecture of the acute and persistent immune response after radiation exposure by measuring 22 immune parameters in 1,720 CC mice representing 35 strains.

Multi-institutional Characterization of Outcomes for Pediatric and Young Adult Patients With High-Risk Myxopapillary Ependymoma After Radiation Therapy.

Purpose: Myxopapillary ependymoma (MPE) is a rare, typically slow-growing subtype of spinal ependymomas. There are no standard guidelines for radiotherapy and long-term outcomes after radiation, particularly patterns of relapse, for pediatric and young adult (YA) patients with MPE remain under-characterized.

Methods And Materials: This is an Institutional Review Board-approved multi-institutional retrospective cohort study of 60 pediatric and YA patients diagnosed with MPE and received radiotherapy between 2000-2020.

Toward Systematic Assessment and Improvement of Radiation Therapy Plan Quality of Cooperative Group Trial Submissions: A Report From the Children's Oncology Group.

Purpose: This study evaluates the quality of plans used for the treatment of patients in the Children's Oncology Group study ACNS1123. Plan quality is quantified based on a scoring system specific to the protocol. In this way, the distribution of plan quality scores is determined that can be used to identify plan quality issues for this study and for future plan quality improvement.

Surgery and proton radiation therapy for pediatric base of skull chordomas: Long-term clinical outcomes for 204 patients.

Background: Data on clinical outcomes for base of skull (BOS) chordomas in the pediatric population is limited. We report patient outcomes after surgery and proton radiotherapy (PRT).

Methods: Pediatric patients with BOS chordomas were treated with PRT or combined proton/photon approach (proton-based; for most, 80% proton/20% photon) at the Massachusetts General Hospital from 1981 to 2021.

Prognostic Significance of Percentage and Size of Dedifferentiation in Dedifferentiated Chondrosarcoma.

Dedifferentiated chondrosarcoma is rare, aggressive, and microscopically bimorphic. How pathologic features such as the amounts of dedifferentiation affect prognosis remains unclear. We evaluated the percentages and sizes of dedifferentiation in a consecutive institutional series of dedifferentiated chondrosarcomas from 1999 to 2021.

Late Radiation-Induced Carotid Artery Stenosis and Stroke in Pediatric Patient Treated With Proton Radiation Therapy for Skull-Base Chordoma.

Radiation vasculopathy is a well-recognized late complication of radiation therapy. We present a case of a stroke 29 years after high-dose proton radiation therapy for skull-base chordoma due to occlusion of bilateral internal carotid arteries.

Patterns of failure in pediatric medulloblastoma and implications for hippocampal sparing.

Background: Hippocampal avoidance (HA) has been shown to preserve cognitive function in adult patients with cancer treated with whole-brain radiation therapy for brain metastases. However, the feasibility of HA in pediatric patients with brain tumors has not been explored because of concerns of increased risk of relapse in the peri-hippocampal region. Our aim was to determine patterns of recurrence and incidence of peri-hippocampal relapse in pediatric patients with medulloblastoma (MB).

Effects of Proton Craniospinal Radiation on Vertebral Body Growth Retardation in Children.

Purpose: It is of great interest to physicians and patients/patients' families to be able to predict the amount of growth decrement after craniospinal irradiation (CSI). Little data exist on the effect of proton CSI. Our aim was to determine the effect of proton CSI on vertebral body (VB) growth retardation, and to identify factors associated with growth delay.