Proton therapy is an alternative to traditional radiation treatment for childhood cancer. Radiation can cause profound side effects for children treated for brain cancer. The brain is very sensitive to this treatment, and children whose brain tissue is radiated at a young age can suffer from cognitive, learning, and developmental challenges later in life. Proton therapy targets only cancer cells, significantly reducing the amount of healthy tissue exposed to radiation. This cancer treatment can potentially give pediatric brain cancer survivors a better quality of life.
Proton therapy at CHOP is offered at the Roberts Proton Therapy Center across from the hospital. The proton therapy team consists of pediatric oncologists, radiation oncologists, anesthesiologists, physicists, dosimetrists, nurses, radiation therapists, child life therapists and other medical professionals who understand the needs of children with cancer.
Proton Therapy to Treat Pediatric Brain Cancer at CHOP
Peter C. Phillips, MD: We have one of the largest brain tumor programs in the world. Radiation therapy is the cornerstone of treatment for brain tumors.
Children have brains that are in development. There are all sorts of standard maturation processes that are going on. We know that radiation therapy can interfere with these. The brain, in fact, is one of the most sensitive organs in the body to the effects of radiation therapy. So when you take a sensitive organ to begin with, and then you compound that with the fact that the child's brain is in development and is particularly susceptible to radiation therapy, that's an important consideration for us.
So radiation side effect can be pretty profound in children. And when we say what are the effects, the most prominent one that we deal with is thinking. How well are you able to think, to remember, to put together ideas, to do abstract reasoning, all the kind of things that are necessary for learning in school and in life. The functional consequence of this is that some of the children that are radiated at very young ages may be so cognitively impaired that they can't live a normal life, they can't live an independent life, they can't function in school normally. They may not even be able to hold a job.
One of the most important advantages of proton radiation therapy is not at this point, in terms of making a patient live longer because it kills the tumor better. But rather, has the potential to make the patient who lives longer, live better because the amount of normal brain that is getting radiated is markedly reduced. That has the potential to make a tremendous difference.
It's not like we're reducing the dose to normal brain; we're eliminating the dose to large portions of normal brain. So what we can say is that if normal brain is not going to get any meaningful radiation, then there's strong reason to suspect that many of these issues in terms of cognitive outcomes, thinking outcomes, learning outcomes should be significantly improved or maybe even eliminated.
You can't take a standardized approach; you can't just look up in a book in this kind of situation and say, "Oh, yes, this is what we should do." It takes a lot of discussion and it takes a lot of our discussion. And thinking and arguing and deciding and coming back and coming at it again before we come up with a final plan. We have a team; no one person can do this. This team really comes together between neurosurgery and the people who are involved directly in terms of helping us control this tumor by taking it out with radiation oncology, with our nurse practitioners, our social workers, our oncologists who really are the people who start with the patient and provide the longitudinal care all the way through the entire time, through the time at which a patient says, "I'm done because I'm out 10 years and I've never seen my tumor come back and I'm ready to go to college."
Topics Covered: Pediatric Brain Tumors