Clinical outcomes and late endocrine, neurocognitive, and visual profiles of proton radiation for pediatric low-grade XXXX .

@entity1 @entity13 @entity1313 @entity1161 @entity5 @entity11 @entity18489 @entity2744 @entity2339
PURPOSE/OBJECTIVE(S): Primary low-grade @entity11 are common @entity1313 of childhood, many of which require radiation therapy (RT) as definitive treatment. Increased conformality of RT could decrease the incidence and severity of late effects. We report our experience with 32 pediatric @entity1 treated with @entity1161 . METHODS AND MATERIALS: Thirty-two pediatric @entity1 with low-grade @entity13 or spinal cord were treated with @entity1161 from 1995 to 2007. Sixteen @entity1 received at least 1 regimen of chemotherapy before definitive RT. The median radiation dose was 52.2 GyRBE (48.6-54 GyRBE). RESULTS: The median age at treatment was 11.0 years (range, 2.7-21.5 years), with a median follow-up time of 7.6 years (range, 3.2-18.2 years). The 6-year and 8-year rates of progression-free survival were 89.7% and 82.8%, respectively, with an 8-year overall survival of 100%. For the subset of @entity1 who received serial neurocognitive testing, there were no significant declines in Full-Scale Intelligence Quotient (P=.80), with a median neurocognitive testing interval of 4.5 years (range, 1.2-8.1 years) from baseline to follow-up, but subgroup analysis indicated some significant decline in neurocognitive outcomes for young @entity1 (<7 years) and those with significant dose to the left temporal lobe/hippocampus. The incidence of @entity2744 correlated with a mean dose of >= 40 GyRBE to the hypothalamus, pituitary, or optic chiasm. Stabilization or improvement of visual acuity was achieved in 83.3% of @entity1 at risk for radiation-induced @entity18489 . CONCLUSIONS: This report of late effects in @entity1 with low-grade @entity11 after @entity1161 is encouraging. Proton RT appears to be associated with good clinical outcome, especially when the @entity5 location allows for increased sparing of the left temporal lobe, hippocampus, and @entity2339 .
