Insights on Proton Therapy for Pediatric Cancer Patients

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MahajanandChild.jpgThe 42nd Congress of the International Society of Pediatric Oncology (SIOP) is in full swing as close to 2,000 pediatric oncology experts have traveled from 92 countries to learn and share the latest research and experiences in the field.

Anita Mahajan, M.D., professor in MD Anderson's Department of Radiation Oncology, shared insights at the annual meeting from her experience treating pediatric patients at MD Anderson's Proton Therapy Center. She sat down with me after her talk to answer some questions.

Some quick facts:

  • Approximately 100 pediatric patients a year receive proton therapy at MD Anderson, making it one of the largest centers for pediatric proton treatment in the nation.

  • One-third of its pediatric patients are younger than 5 years old.

  • About 43% travel to MD Anderson from outside of Texas for proton therapy.

  • MD Anderson is one of only five proton centers in the United States that treats pediatric patients.

How do you decide which pediatric patients get proton therapy versus traditional radiation?

We use our medical judgment to evaluate whether proton therapy will be significantly more beneficial for the patient. For instance, if a patient has leukemia and needs total cranial radiation, then we wouldn't use proton therapy because the entire brain would be irradiated. However, for a young child with a brain tumor, we would most often use proton therapy to help spare the healthy tissue and areas essential to cognitive growth. Also, we believe proton is more beneficial for patients needing large doses of radiation because preliminary data shows that it can help reduce late effects. The potential benefits of proton therapy are greatest in younger children

What are MD Anderson's foremost strengths when it comes to treating pediatric patients with proton therapy?

MD Anderson is known for its excellent multidisciplinary support. Regardless of where patients come from, they not only benefit from our resources at the proton center, but they also have access to the specialists at the Children's Cancer Hospital. Within our team, we are sub-specialized. I focus primarily on pediatrics, someone else focuses primarily on lung tumors and so on. Because of that and the amount of patients we see, there are a huge number of resources I can access when planning a patient's course of treatment. Overall, I think our resources and the experience of our specialists, plus our emphasis on pediatrics at MD Anderson, are what set us apart.

What can we learn from other proton therapy centers?

We always strive to improve our techniques and can learn from other centers what works best for them and what experiences they have had. By exchanging information with other centers, we can all help minimize side effects from treatment and know what is normal versus something that needs additional attention. We're all in this together and want to keep improving the experience and outcomes for our patients.

What are some of the key messages you presented at SIOP?

We shared some preliminary results from our studies that indicate proton may have the benefits we have expected. It's still early, though, and we have to be careful and follow our patients in the long-term and collaborate with others to keep track of them. We need sufficient data to illustrate to insurance companies how the benefits of proton therapy most often will outweigh the costs in the long run. We also shared some results from a study that showed the potential to use lower dosages of proton therapy than with other forms of radiation, but we haven't started applying this in our treatment plans yet.

What does the future of proton therapy look like?

There's a strong momentum right now for proton therapy. It's largely accepted among physicians and the technology continues to improve, such as with the advancement of pencil beam or spot scanning proton therapy.

It's exciting and our program is really developing. Proton therapy isn't magic and can't help everyone, but it's very promising and there's a huge emphasis on pediatrics in Houston.

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