New CHOP Study Shows Benefit of Proton Beam Therapy in Pediatric Head and Neck Cancers

James Radke | OCTOBER 23, 2017 | Rare Disease Report | See Original Article Here

Today in the journal Pediatric Blood Cancer, researchers from the University of Pennsylvania and the Children’s Hospital of Philadelphia (CHOP) published results from a study looking at the safety and efficacy of proton beam therapy to treat children with head and neck cancer.

Pediatric cancers in general are considered rare cancers, and head and neck malignancies account for approximately 12% of all pediatric cancers. Tumors such as neuroblastoma, thyroid cancer, and soft tissue sarcomas are usually treated with a combination chemotherapy, radiation, and surgery. The side effects of using radiation therapy can be very problematic in children and can include loss of appetite, difficulty swallowing, and/or mucositis. Regarding the latter adverse event, mucositis are ulcers that develop in the gastrointestinal tract and can occur in about half the patients, as documented in those with rhabdomyosarcoma receiving radiation therapy.

Since proton beam therapy is focused only on the area near the tumor, its use can greatly reduce the systemic side effects that are so troublesome for children getting more traditional radiation therapy.

In the study, 69 children with nonhematologic malignancies of the head and neck were treated with proton beam therapy. Thirty-five children had rhabdomyosarcoma, 10 had Ewing sarcoma, and the remaining 24 children had an array of head and neck malignancies.

The Grade 3 level adverse events reported were anorexia (22%), dysphagia (7%), and oral mucositis (4%). One-year overall survival was 93%.

In a news release, lead author Jennifer Vogel, MD, a resident in Radiation Oncology at the University of Pennsylvania noted that the severity of muscositis was related to the radiation dose given. Vogel said, “Different disease sites required different dosage levels, and we specifically found the severity of muscositis was associated with higher doses of radiation,” Vogel said.

The reduction in mucositis in children can greatly impact their quality of life not only during treatment but also for years to come.

Christine Hill-Kayser, MD, chief of the Pediatric Radiation Oncology Service at University of Pennsylvania and an attending physician at CHOP said,  “These concerns are especially important to address in pediatric patients, since they’re still developing and may need to deal with any adverse effects for the rest of their lives. This study shows that protons may be an important tool in improving quality of life both during treatment and for years after for these young patients.”

Hill-Kayser added, “This study shows this treatment is safe and offers practice guidelines for delivering head and neck proton therapy in the pediatric population.”

Reference
Vogel J, Both S, Kirk M, et al. Proton therapy for pediatric head and neck malignancies. Pediatr Blood Cancer. Published online Oct 23, 2017. https://doi.org/10.1002/pbc.26858

Image courtesy Wikimedia Commons.