• A review on proton therapy advantages in treatment of pediatric cancer
  • Aida Karami,1,* Marziyeh Tahmasbi,2
    1. Department of Radiologic Technology, Faculty of Paramedicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
    2. Department of Radiology Technology, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran


  • Introduction: Cancer is the second cause of death in children under the age of 15. The majority of pediatric oncology concepts includes curative aims and long-term survival besides minimizing treatment-related side effects to improve quality of life. Radiotherapy (RT) is important in children because immature childhood tissues exacerbate destructive radiation effects on growth, intelligence quality and endocrine system. Particle therapy due to its exclusive physical features is recommended for pediatric radiation therapy which involves carbon ion therapy (CIRT) and proton therapy (PT). Therefore, the aim of this review was to evaluate the proton therapy in treatment of pediatric cancer.
  • Methods: The present review article was performed by searching “Pubmed” and “google scholar” by different combinations of terms “particle therapy” and “pediatric cancer” and “proton therapy” and “carbon ion therapy”. 28 articles were obtained. After removing the reiterative and reviewing abstracts, 12 articles were selected and reviewed full text.
  • Results: Particle therapy is less dependent on presence of oxygen in cancerous cell, thus could be effective on hypoxic tumors. Due to high local dose in the target place (Bragg-peak), minimal low integral dose in other depths, particle therapy is significantly superior to conventional radiotherapy with photons, so results in sparing uninvolved tissues, decreasing acute and late radiation related sequels and eventually reducing the incidence of secondary malignancy which is one of the critical concerns of pediatrics radiation therapy; As studies had shown that radiotherapy increases probability of incidence of secondary sarcoma in children with hereditary retinoblastoma. Proton therapy has been done in various modes such as pencil beam, scattering and uniform beam, on children with tumors of CNS(ependymoma, neuroblastoma, germ cell tumors, medulloblastoma), eye, soft tissue and bone sarcomas of head and neck and paraspinal or pelvic regions. PT provides higher tumor dose distribution, lower toxicities and shorter treatment times (hypo-fractionation). Meanwhile, in PT the expected sever toxicities from other RT modalities are rare; fewer mild side effects are related to the size and location of the lesion and almost disappear during the first six months or remain at a very low level. Grade IV acute toxicity reaction (bone marrow) might be revealed in patients received chemotherapy concurrently. Leading patient’s complications probably are hair loss in patients with superficial lesions, dermatitis, dizziness, headache, mucositis and hearing loss. Except in specific cases, e.g. osteosarcoma, the main pediatric treatments are with protons. Substantial to know that in whole-brain RT for metastatic cancers or for acute leukemia, PT has no more priority than photons. Also, the procedure is accomplished under general anesthesia (for all children preferably) due to children difficulties to remain immobile.
  • Conclusion: Although, PT could be expensive, however; it may lead to economic benefits by less irradiation, salvage surgery and palliative chemotherapy. Particle therapy is a considerable method used for radio-resistant and deep located tumors and the ones with adjacency to sensitive organs such as osteosarcoma due to its greater biological effectiveness. To assess the long-term potential of particle therapy in pediatric patients needs much longer pursue in the future.
  • Keywords: Particle therapy, Proton therapy, Pediatric cancer