Proposal for proton radiation therapy in childhood cancers from a referral institution five years after approval of insurance coverage in Japan

Abstract

【Introduction】Proton radiation therapy is a promising treatment to reduce irradiation-induced adverse effects. Increasing numbers of pediatric patients are being administered proton radiation therapy, and insurance coverage for this treatment was approved in Japan in April 2016. We report the clinical characteristics of patients treated with proton radiation therapy at our hospital and propose further improvements in patient recruitment from the viewpoint of referrals.

【Methods and Results】We investigated the cases of 17 patients who received proton radiation therapy at Saitama Children’s Medical Center between April 2016 and March 2021. This therapy was administered for the following primary diseases: brain tumors (seven patients), rhabdomyosarcomas (five patients), Ewing sarcoma family of tumors (ESFT) (four patients), and neuroblastoma (one patient). The interval between tumor diagnosis and irradiation as primary treatment was a median of four months (0–8 months). The prognoses were as follows: two patients died of the disease, two patients were alive with the disease, and 13 patients were alive without evidence of the disease. No patient showed grade 3/4 adverse events (based on the Common Terminology Criteria for Adverse Events) associated with proton radiation therapy except for one patient who showed grade 3 esophagitis.

【Discussion/Conclusion】Although patients showed tolerable adverse effects of proton radiation therapy during short-term follow-up, long-term follow-up with close monitoring is warranted. Close coordination between hospitals that administer proton radiation therapy is important because increasing numbers of children are being treated by this approach and additionally require chemotherapy or sedation during irradiation.