Why are not ALL Paediatric Patients Treated With Protons? A Complete National Cohort From Sweden 2016-2019

• Published in: Pediatric blood & cancer Vol. 67; no. S4; p. S79
• Main Authors: Martinsson, U., Svärd, A-M, Kadkhoda, Z. Taheri, Embring, A., Frykholm, G., Agrup, M., Cange, H. Haugen, Fröjd, C., Blomstrand, M., Engellau, J., Kristensen, I.
• Format: Journal Article
• Language: English
• Published: 2020
• ISSN: 1545-5009; 1545-5017
• DOI: 10.1002/pbc.28742

Background and Aims: A proton therapy (PT) facility – Skandion clinic- opened in Uppsala in august 2015. It was stated that all children inSweden, benefitting from PT, ought to be sent there. PT plans are prepared at six university-based radiotherapy (RT) centres and assessedby a national board. There are no additional costs for the families compared to other radiotherapy (RT) options, not even for travel and lodging. Methods: Since 2008 all children receiving RT with any modality areregistered in the Swedish Radtox registry. Inclusion is populationbased, prospective and complete. Radiation oncologists from the sixcentres performing paediatric RT retrospectively reviewed patientswho had not received PT. Results: 354 treatments were given, 252 (71%) were not PT. Thereasons for choosing conventional RT were dismal prognosis in 66patients, uncertainty due to internal movement and lack of motioncontrol technique at the PT centre in 63 patients, and lack of dosimetric advantage for protons in 47 patients. Infrequent reasons were lackof set up for CSI or very superficial treatment in the beginning [n=11],variations of air in the field [n=6], not robust treatment plan for otherreasons (mainly metal in the field) [n=6], gamma-knife/other stereotactic treatment [n= 5], brachytherapy [n=4], TBI [n=31], acute RT startnecessary [n=10], and social reasons [n=3]. Conclusions: Even though proton therapy, due to less side effects,has been advocated to be the best treatment modality for children, this might not always be the case. Sometimes conventional RTmay be advantageous, despite the increased exit-dose, due to thewider penumbra of PT. Social needs and palliative situations may bemore important than an optimal dose-distribution. However, technical improvement of PT by application of gating and treatment planningsystems (TPS) handling dose-deposition uncertainties should make themodality available for a wider range of paediatric patients.