Brainstem toxicity after proton or photon therapy in children and young adults with localized intracranial ependymoma: A French retrospective study

• Published in: Radiotherapy and oncology 2024-05, Vol.194, p.110157, Article 110157
• Main Authors: Dalmasso, Céline, Alapetite, Claire, Bolle, Stéphanie, Goudjil, Farid, Lusque, Amélie, Desrousseaux, Jacques, Claude, Line, Doyen, Jérome, Bernier-Chastagner, Valérie, Ducassou, Anne, Sevely, Annick, Roques, Margaux, Tensaouti, Fatima, Laprie, Anne
• Format: Article
• Language: English
• Subjects: Adolescent; Brain Neoplasms / diagnostic imaging; Brain Neoplasms / radiotherapy; Brain Stem / diagnostic imaging; Brain Stem / radiation effects; Child; Child, Preschool; Ependymoma / diagnostic imaging; Ependymoma / radiotherapy; Female; France; Humans; Infant; Life Sciences; Magnetic Resonance Imaging; Male; Photons / adverse effects; Photons / therapeutic use; Proton Therapy / adverse effects; Radiation Injuries / etiology; Radiotherapy Dosage; Retrospective Studies; Young Adult
• ISSN: 0167-8140; 1879-0887; 1879-0887
• DOI: 10.1016/j.radonc.2024.110157

•Adjuvant radiation therapy (proton or photon) is essential for childhood ependymoma.•Proton therapy may spare organs at risk, but possibly induces brainstem toxicity.•We studied symptomatic brainstem injury and asymptomatic radiographic changes.•Asymptomatic punctiform brainstem change was observed in 4.8% of patients.•No new or progressive brainstem-related symptoms emerged (median follow-up: 5.6 years) Ependymoma is the third most frequent childhood braintumor. Standard treatment is surgery followed by radiation therapy including proton therapy (PBT). Retrospective studies have reported higher rates of brainstem injury after PBT than after photon therapy (XRT). We report a national multicenter study of the incidence of brainstem injury after XRT versus PBT, and their correlations with dosimetric data. We included all patients aged