Table 2.
The potential non-cancer effects of proton therapy, such as neurocognitive function, growth and development, and quality of life in pediatric patients.
| Author | Patients | PRT initiation age [yrs] | Cancer type | Type of PBT | Medium dose [Gy] | CRT | Post-PRT observation time [yrs] | Incidence of neurocognitive impairment |
|---|---|---|---|---|---|---|---|---|
| Mash et al. (2023) (27) |
12 | 4.6 | Low-Grade Glioma Embryonal tumor Ependymoma |
– | 53.55 | ± | 8.9 | No incidence of neurocognitive impairment: No changes in white matter integrity. |
| Ali et al. (2021) (28) |
41 | 2.0 | Glioma-42.3% Medulloblastoma/ PNET-7.7% Ependymoma-19.2% Atypical teratoid rhabdoid tumor Primitive neuroectodermal tumor Germinoma – 11.52% Other-15.4% |
– | nd | + | 2.3 | No incidence of neurocognitive impairment |
| Child et al. (2021) (29) |
58 | 7.7 | Glioma-25.9% Medulloblastoma/ PNET-32.7% Ependymoma-13.9% Germ Cell Tumor-17.2% Other-10.3% |
PS | F: 50.4 CSI: 54.0 |
nd | 6.1 | Variable - F vs CSI: FSIQ - 13.3% vs 28.6%) VCI - 3.3% vs 28.6% PRI – 10% vs 17.9%), WMI - 10% (F), 17.9% PSI – 30% vs 46.4% Fine Motor – 26.7% vs 60.7 Switching (Verbal) - 26.7% vs 17.9% Switching (Graphomotor) – 30% vs 46.4% Inhibition/Switching – 23.3% vs 32.1% Verbal Learning – 20% vs 32.1% Verbal Memory vs16.7% vs 21.4% Visual Learning 10% vs 25% Visual Memory 13.3% vs 14.3% Attention 13.3% vs 17.9% Omissions 3.3% vs 10.7% Reading fluency 23.3% vs 42.9% Writing fluency 26.7% vs 53.6% Math Fluency 33.3% vs 42.9% |
| Weusthof et al. (2021) (30) |
26 | 9.4 | Glioma-42.3% Medulloblastoma/ PNET-7.7% Ependymoma-19.2% Craniopharyngioma – 3.8* Germinoma – 11.52% Other-15.4% |
– | 51.3 | ± | 3.5 | No incidence of neurocognitive impairment |
| Yip et al. (2020) (31) |
14 | Medulloblastoma – 36.0% | – | nd | nd | 4.3 | No incidence of neurocognitive impairment |
|
| Kahalley et al. (2020) (32) |
37 | 8.6 | Medulloblastoma | PBS | 54.0 | 10 | No incidence of neurocognitive impairment |
|
| Gross et al. (2019) (33) |
58 | 7.4 | Craniopharyngioma - 8.6% Medulloblastoma/PNET - 44.8% Ependymoma –8.6% Germinoma -15.5% Glioma -15.5% Other - 6.9% |
– | nd | ± | 2.6 | No incidence of neurocognitive impairment |
| Peterson et al. (2019) (34) |
22 | 10.0 | nd | – | nd | nd | nd | No incidence of neurocognitive impairment |
| Yang et al. (2018) (35) |
4 | 5.9 | Atypical meningioma Retinoblastoma Ependymoma |
PBS | nd | + | nd | No incidence of neurocognitive impairment |
| Pulsifer et al. (2018) (36) |
60 | 12.3 | Medulloblastoma – 38.3% Gliomas – 18.3% Craniopharyngioma – 15.0% Ependymoma – 11.7% Other – 16.7% |
PBS | 52.2 | ± | 3.6 | FSIQ – 40% Processing Speed – 35% |
| Kahalley et al. (2016) (37) |
90 | 9.2 | Glioma – 22.2% Medulloblastoma/PNET – 37.8% Ependymoma – 4.4% Germ cell tumor – 18.9% Other – 16.7% |
90% PS 10% PBS |
54 | 5 | No incidence of neurocognitive impairment |
CRT, conformal radiotherapy; CSI, craniospinal irradiation; F, focal; FSIQ, Full Scale Intelligence Quotient; nd, no data; PRI, Perceptual Reasoning Index; PSI, Processing Speed Index; VCI, Verbal Comprehension Index; WMI, Working Memory Index.; PBS, PS.