Future issues of proton beam therapy for pediatric malignancies based on the experience of Kobe Proton Center

Abstract

Pediatric malignancies are well indicated for proton beam therapy. In Japan, proton beam therapy for pediatric malignancies has been covered by the public health insurance since April 2016. The Kobe Proton Center was established in December 2017 as the first particle therapy center mainly dedicated to pediatric malignancies in Japan. Its strong points are as follows: (1) the building is connected by a bridge to Kobe Children’s Hospital, and concurrent chemotherapy is available, (2) a full-time anesthesiologist in charge of sedation is available, which is indispensable to the irradiation of young children, and (3) the clinic area is further divided into the children’s and adults’ areas to protect immune-compromised children. The Kobe Proton Center has treated the largest number of pediatric patients yearly in Japan since fiscal year 2018. Future issues of proton beam therapy for pediatric malignancies based on the experience of the Kobe Proton Center are as follows. Regarding patient acceptance, a nationwide collaboration system among proton beam therapy centers should be established and operational. Surgical bioabsorbable spacer placement is useful even in pediatric patients, but its safety has not been proved yet, and this method is currently not widely known. In some adolescents and young adults (AYA) patients, proton beam therapy is not covered by the public health insurance; therefore, the Hyogo prefectural government started the exemption system. For pediatric malignances, even patients with metastases can be completely cured, but proton beam therapy for such patients is currently not covered by the public health insurance. Continuous discussions should be warranted.