Embring Anna, Kristensen Ingrid, Nilsson Martin P, Engellau Jacob, Blomstrand Malin, Fröjd Charlotta, Agrup Måns, Flejmer Anna, Svärd Anna-Maja, Asklid Anna
Department of Oncology, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund, Sweden; Department of Oncology, Clinical Sciences, Lund University, Lund, Sweden.
Acta Oncol. 2025 Jul 23;64:939-945. doi: 10.2340/1651-226X.2025.43865.
Neuroblastoma is the most common extracranial solid tumour in children. Radiotherapy is commonly part of the multimodal treatment for high-risk patients. The aim of this study is to analyse doses to organs at risk (OAR) in comparative proton and photon treatment plans for children treated for neuroblastoma and report side effects. Patient/material and methods: All children in Sweden treated with curative intent radiotherapy for abdominal neuroblastoma in 2017-2024 with comparative proton and photon treatment plans were retrospectively identified through a national registry (RADTOX), where data on side effects were collected. Doses to OAR were compared in each patient's proton and photon treatment plans.
A total of 30 children with a median age of 45 months (range 11-150) were included. The low-dose spread was significantly lower in the proton compared to the photon treatment plans measured as Body V5Gy and V10Gy (p < 0.001). Furthermore, the mean doses to the bowel bag, kidneys, liver, pancreas, and spleen were significantly lower in the proton plans. The median follow-up was 14 months (1-61), and the 2-year overall survival was 75.3%. While acute radiotherapy related grade ≥ 2 side effects were experienced by 12 patients (40%), late side effects were experienced by 7 patients (13%). The most common side effects were haematological and from the upper gastrointestinal tract.
In selected cases, proton treatment can offer lower doses to OAR and less low-dose exposure compared to photon treatment in children treated for abdominal neuroblastoma. Whether this translates into a clinical benefit is currently unclear and should be evaluated in future studies.
神经母细胞瘤是儿童最常见的颅外实体瘤。放射治疗通常是高危患者多模式治疗的一部分。本研究的目的是分析接受神经母细胞瘤治疗的儿童在质子治疗和光子治疗对比计划中危及器官（OAR）的剂量，并报告副作用。患者/材料与方法：通过国家登记处（RADTOX）对2017 - 2024年在瑞典接受腹部神经母细胞瘤根治性放疗且有质子治疗和光子治疗对比计划的所有儿童进行回顾性识别，在该登记处收集副作用数据。比较每位患者质子治疗和光子治疗计划中OAR的剂量。
共纳入30名儿童，中位年龄45个月（范围11 - 150个月）。以体部V5Gy和V10Gy衡量，质子治疗计划中的低剂量分布显著低于光子治疗计划（p < 0.001）。此外，质子治疗计划中肠袋、肾脏、肝脏、胰腺和脾脏的平均剂量显著更低。中位随访时间为14个月（1 - 61个月），2年总生存率为75.3%。12名患者（40%）出现了≥2级急性放疗相关副作用，7名患者（13%）出现了晚期副作用。最常见的副作用是血液学方面的以及上消化道的副作用。
在特定病例中，对于接受腹部神经母细胞瘤治疗的儿童，与光子治疗相比，质子治疗可使OAR接受更低的剂量且低剂量暴露更少。目前尚不清楚这是否会转化为临床益处，应在未来研究中进行评估。
