Wed. Mar 3rd, 2021

When you If the child has brain cancer or another aggressive tumor, you are focusing on the immediate present. Which course of treatment – surgery, chemotherapy or what combination Radiation – Will your child survive? But with most children long live Diagnosing their cancer, it is also important to consider how they now treat May affect them later, Even as adults.

One option some parents may face is whether to seek a new type of radiation called proton beam therapy instead of traditional X-ray radiation to possibly minimize harmful side effects in their developing child. Proton beam therapy is considered by some experts to be a major advancement in cancer therapy. Others, however, hesitate to get caught up in early propaganda without more long-term evidence. Nevertheless, people are traveling far and wide so that their children can receive proton therapy from the centers where it is offered.

Four leading Radiation oncologist Explained to US News what parents should understand about proton therapy and its potential benefits:

Reduced side effects from cancer treatment are a major goal.(Courtesy of Mayo Clinic)

Proton beam therapy is a form of radiation that can reduce late side effects compared to conventional X-ray radiation. Lack of pinpoint beam and exit dose – which is radiation-free because the conventional X-ray beam extends beyond the tumor and exits the other side through the body – gives rise to healthy, normal tissue in developing areas such as the brain, heart Gives and lungs.

Childhood brain cancer is considered to be one of the most evidence-based uses for proton therapy. This can reduce late effects such as hearing loss or the ability to perform well in school. However, at least for now, proton therapy does not provide a greater possibility of treatment than conventional X-ray radiation.

The brain is the most common area for developing cancerous tumors in children, requiring radiation treatment, Drs. Torun Yock, director of pediatric radiation oncology, said Massachusetts General Hospital And an Associate Professor at Harvard Medical School.

“Because the pediatric brain is still growing and evolving, if you radiate the brain during this process, it will not continue to grow and develop as it normally would,” she says Huh. “And it slows down the pace of development over time, which appears as droplets in neurocognitive testing.”

Yock says that a young child is more capable of development. “A 2-year-old is very different from a 15-year-old in terms of brain development, so the adverse consequences are much greater in a 2-year-old.”

Obviously, there is an advantage to not irradiating healthy brain tissue, she says. For example, children may be prevented from loss or loss of vision or hearing by avoiding brain vision and hearing centers.

Proton beam therapy allows doctors to deliver the same dose as with conventional radiation, while reducing the dose – and complications – to normal, healthy tissue, Dr. Sameer Keolle, medical director of the proton beam therapy program Mayo Clinic in Arizona. This allows for higher doses to be used than conventional X-ray radiation (also called photon radiation) to treat resistant tumors, while still protecting with tissue.

With conventional radiation to the brain, radiation is disintegrated. Dr. “This collateral radiation exposes large amounts of brain to low amounts of radiation,” says Thomas Merchant. St. Jude Children’s Research Hospital In Memphis, Tennessee. He said that even low amounts of radiation can be harmful.

Large-scale proton beam technology behind the scenes.(Courtesy of Mayo Clinic)

In November 2015, the new St. Jude Red Frog Events Proton Therapy Center – the world’s only proton-therapy center dedicated solely to children’s treatment – began treating children with invasive cancers, including brain tumors and Hodgkin lymphoma. .

“Children have some brain tumors where we have to treat the entire brain and spine,” says Merchant. “If we give proton therapy, we don’t have the radiation emitting in the chest and abdomen that you have when you treat someone with conventional radiation.” It can reduce long-term side effects in the heart and lungs.

With the latest form of proton therapy, called pencil-beam scanning – which corresponds to or shapes the highest-dose radiation to a targeted tumor – it is possible to reduce the “margin” area around the tumor exposed to radiation. , The businessman says. The method, which is used by St. Jude, may ultimately have the potential to reduce the risk of secondary cancer.

Dr. Anita Mahajan, a professor and head of pediatric radiation oncology MD Anderson Cancer Center of University of TexasSays, when she describes proton therapy to parents, she insists on that proton therapy is Radiation.

The biggest difference, she points out, is that the sub-atomic particle, the proton, stops where the oncologist requires it. “It has to go in, but we can stop it from coming out.”

The ability to avoid other organs is important. “For example, if we are treating a young child for pelvic rhabdomyosarcoma [a muscle and connective tissue cancer]”One of the things we might be able to do is to avoid growth plates,” says Mahajan.

Future Fertility is a factor In cancer treatment plans. In cases involving radiation around the pelvic region, it is sometimes possible to avoid ovulation in a young girl or testes in a boy.

‘Spaceship hamster wheel’

A proton is a positively charged atomic particle. In proton therapy, a powerful machine called a particle accelerator accelerates the proton to reach a higher energy level. The technology is large-scale – three stories high and weighing more than 100 tons – requiring special housing within a treatment facility to house the equipment and deliver the proton beam. A rotating device called a gantry releases protons to the tumor from different angles. You can do this Take a quick virtual tour Proton Beam Therapy at Mayo Clinic in Arizona.

Treatment room at St. Jude Red Frog Events Proton Therapy Center.(Courtesy of St. Jude Children’s Research Hospital / Peter Barta)

In the treatment room, patients are positioned on a table or on a special chair. A CT or MRI scan is taken before each treatment to ensure accurate positioning. Some children require unconsciousness to sleep through treatment, while others who remain still may remain awake.

Patients may need dead-end devices for every proton-beam treatment to keep them in the proper, precise position. With brain cancer, patients usually wear a custom-fitted mask to maintain their condition.

Parents can take the children to the treatment room and see them before treatment begins, Mahajan says. a Child Life Specialist Is part of the team to help children and families cope with the entire patient experience.

While the treatment itself is painless, side effects can include skin problems such as swelling, dryness, blister or peeling – similar to conventional radiation. Fatigue, nausea and vomiting are side effects as well and are due to other treatments patients are receiving, like chemotherapy.

Meg McClinn of Riverside, Connecticut, recalls introducing her son to proton beam therapy three years ago when he was treated at Mass General for a type of brain tumor called medulloblastoma. He and fellow patients named the device a “spaceship hamster wheel”.

Young people take the healing process into difficult situations, says Keol. “Children are tough,” he says. “Sometimes they are a lot tougher than adults. Being bigger and bigger, they have a great attitude.”

23 are Operating Proton Beam Center in USAccording to the National Association for Proton Therapy, it is unevenly distributed throughout the country. Only a part exists in the context of a pediatric focused cancer program. According to a rough estimate by Yoke, 500 to 600 pediatric patients receive proton radiation therapy every year.

With a typical treatment course lasting six weeks, families face disruption to travel children’s Hospital With a proton therapy center, to stay and make arrangements for other children at home.

Proton therapy costs about twice as much as conventional X-ray radiation. The average cost for a complete course of proton radiation treatment is estimated at $ 40,000.

Creating a new proton center is a huge investment. “If you just look at the upfront costs, it will be three to four times more expensive than photons,” says Yock. “It is absolutely profound in terms of the need and quality assurance of people and equipment and engineers and physicists. A good team is required to run it safely with good quality control.”

Yoke co-authored a study published in the journal Cancer in December 2015 that compared the cost-effectiveness of proton radiation therapy versus conventional radiation in children with medulloblastoma. The study, which used the model to measure long-term side effects and associated costs in treatment, work-force participation, and quality of life, found that proton therapy was effective.

As Mahajan states, “If we can prevent some neuro-cognitive deficits, endocrine issues, developmental issues, skeletal deformity, they are going to help make that child more productive in society and less on the road to therapy.” Intervention is required. ”

Insurance usually covers the cost of proton therapy when a cancer is considered curable, Yock says: “Ninety-eighty percent of the time, we succeed in arguing for a pediatric patient to be treated, “She says.

“We do not recommend taking radiation lightly,” says the trader. Patients are carefully evaluated to determine the course of treatment. “It is very important for the parents and the child to know what they are doing,” he said. “One thing we do is compare treatment plans using protons or conventional or photon radiation, and select the best plan. And in most cases, the proton plan looks better.”

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