Pediatric Experience and Outcomes from the First Single-Vault Compact Proton Therapy Center

SIMPLE SUMMARY: Protons have unique physical attributes that allow for a reduction in normal tissue dose when treating patients with cancer. For these reasons, proton therapy is of benefit for many children undergoing radiation therapy due to their sensitivity to ionizing radiation. Prior to 2013, only multi-room large proton therapy centers were available with very high cost and space requirements. Here, we sought to evaluate the pediatric experience and survival outcomes at the world’s first single-vault compact center that opened at our institution in 2013. We assessed the demographics of our patients, diagnosis types, treatment approach, need for anesthesia, distance travelled, and increase in our pediatric service by outside referrals for proton therapy. ABSTRACT: The first single-vault compact proton therapy center opened in 2013, utilizing a gantry-mounted synchrocylotron. The center was placed within a large academic radiation oncology department with a high priority for pediatric cancer care. Here we performed a retrospective study of pediatric (≤21 years) patients treated with proton therapy at our institution between 2013–2022. Patient, tumor, and treatment characteristics were obtained including race, socioeconomic status, insurance type, distance travelled, need for anesthesia, and outside referrals for proton therapy. In total, 250 pediatric patients were treated with proton therapy comprising 18% of our proton patient volume. Median follow-up was 3.1 years, 38.4% were female and 83% were white. The majority of cases were CNS (69.6%) and a large number of patients (80/250, 32%) required craniospinal irradiation. Anesthesia was required for 39.6% of patients. Average distance travelled for treatment was 111 miles and 23% of patients were referred from outside institutions for proton therapy. Insurance type was private/commercial for 61.2% followed by Medicaid for 32%. We found that 23% of patients lived in census tracts with >25% of people living below the national poverty line. Overall survival at 3 years was excellent at 83.7% with better outcomes for CNS patients compared to non-CNS patients. There were no cases of secondary malignancy at this early time point. As the world’s first compact proton therapy center, we found that proton therapy increased our pediatric volume and provided proton therapy to a diverse group of children in our region. These data highlight some of the expected patient and tumor characteristics and necessary resources for providing pediatric proton beam therapy.