Cancer Medicine (Mar 2022)

The comparison of acute toxicities associated with craniospinal irradiation between photon beam therapy and proton beam therapy in children with brain tumors

  • Suguru Uemura,
  • Yusuke Demizu,
  • Daiichiro Hasegawa,
  • Tomoko Fujikawa,
  • Shotaro Inoue,
  • Akihiro Nishimura,
  • Ryunosuke Tojyo,
  • Sayaka Nakamura,
  • Aiko Kozaki,
  • Atsuro Saito,
  • Kenji Kishimoto,
  • Toshiaki Ishida,
  • Takeshi Mori,
  • Jyunji Koyama,
  • Atsufumi Kawamura,
  • Yoshinobu Akasaka,
  • Makiko Yoshida,
  • Nobuyoshi Fukumitsu,
  • Toshinori Soejima,
  • Yoshiyuki Kosaka

DOI
https://doi.org/10.1002/cam4.4553
Journal volume & issue
Vol. 11, no. 6
pp. 1502 – 1510

Abstract

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Abstract Introduction This study aimed to evaluate acute toxicities associated with irradiation between the X‐CSI (photon beam craniospinal irradiation) and P‐CSI (proton beam craniospinal irradiation) groups in children with brain tumors. Methods Sixty‐two consecutive patients who received initial craniospinal irradiation (CSI) for brain tumors in our center between January 1, 2011 and May 31, 2021, were included in the study. Acute toxicities were retrospectively evaluated during CSI using Common Terminology Criteria for Adverse Events version 5.0. Maximum grades of fatigue, headache, insomnia, nausea, vomiting, dermatitis, constipation, abdominal pain, oropharyngeal mucositis, and hematological toxicities were evaluated. Results Thirty‐six patients received X‐CSI, and 26 patients received P‐CSI. The median dose of CSI was 18.0 Gy in the X‐CSI group and 23.4 Gy (relative biological effectiveness) in the P‐CSI group (p < 0.001). The P‐CSI group had a lower incidence of more than grade 2 nausea (11.5% vs. 69.4%, p = 0.008) and vomiting (7.7% vs. 38.8%, p < 0.001), compared with the X‐CSI group. Multivariate logistic regression analysis with adjustments for potential confounding factors of doses of CSI showed that proton radiation therapy was associated with a marked reduced risk of more than grade 2 nausea and vomiting during CSI (adjusted odds ratio, 0.050; 95% confidential interval, 0.011–0.24; p < 0.001). Conclusion The present study suggests that P‐CSI reduces the acute gastrointestinal toxicities associated with irradiation.

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