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Young children stricken with neurological cancers are among the groups thought to most benefit from high-tech proton therapy. And a new survey suggests they make up the bulk of patients under 18.

Last year, all nine proton therapy centers in the United States treated children, and half of the kids treated were under eight years of age, according to the survey, which was released this week and commissioned by the Pediatric Proton Foundation and the National Association for Proton Therapy. And the overwhelming majority of kids received the therapy for hard-to-treat brain tumors.



According to the survey, the first to ever create a national portrait of proton therapy use in kids, 465 children and teenagers underwent proton therapy treatments in 2010. Of these patients, 53 percent were under eight, with about one-third between one and four years old.

Nearly three-quarters of the tumors afflicted the brain or brainstem, and nearly one out of five involved the skull, head or neck. Six percent involved the abdomen or pelvis, and three percent the axial skeleton (which includes the upper spine and chest).

The most common tumor -- present in 71 cases -- was an ependymoma, a kind of cancer of the central nervous system.

Although all operating centers treat children, 66 percent of patients in the survey were treated at just three centers: Massachusetts General Hospital in Boston, M.D. Anderson Cancer Center in Houston and University of Florida's Proton Therapy Institute in Jacksonville.

Another key finding of the study was the need for multidisciplinary teams. Half of the most common tumors required concurrent chemotherapy treatment, and half of the young patients had to be anesthetized during their therapy.

Nonetheless, the study acknowledged some limitations: for instance, the researchers didn't always have full detail on the tumor's site or subsite, and the ICD-9 codes they used weren't always reliable.

Benefits for children

Proton therapy uses precisely controlled blasts of radiation to scramble the DNA of cancer cells. Because of the way protons operate, less radiation reaches healthy tissue.

The centers that offer this treatment are expensive, often costing tens of millions of dollars to build. But many researchers think children and adolescents can benefit from the more precise dosing of protons, as they're more radiosensitive than adults.

Limiting the "exit dose" during treatment is also believed to be especially useful for pediatric neurological tumors, as traditional radiation therapies have been linked with later cognitive deficits and attention disorders, according to the NAPT.

The study was presented at the Children's Oncology Group meeting in Atlanta this week by Dr. Daniel Indelicato, a radiation oncologist with the University of Florida.