SYSTEMATIC REVIEW article
Front. Oncol.
Sec. Pediatric Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1554765
This article is part of the Research TopicInnovative Approaches in Precision Radiation OncologyView all 10 articles
Non-cancer effects after proton beam therapy for pediatric tumors-a narrative review
Provisionally accepted
Anna Zajac- Grabiec1*
Beata Biesaga1,2Monika Krzyzowska1Katarzyna Drosik-Rutowicz3
Justyna U Miszczyk1- 1The Henryk Niewodniczański Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
- 2Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
- 3Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Silesian, Poland
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Radiation therapy can cause serious complications and side effects, especially in children. Proton beam therapy is considered as safer and more effective than traditional photon therapy because this type of modality offers precise radiation dose delivery to cancer cells while minimizing irradiation dose to adjacent normal tissue. However, like any medical intervention, PBT can cause potential adverse consequences and risks. Among the effects of late toxicity after proton therapy, the most frequently mentioned are secondary malignancies. Moreover, pediatric patients undergoing PBT may also experience a range of non-cancer late effects, including brainstem injury, cognitive dysfunctions, and side effects from endocrine or cardiovascular systems. The present type and frequency of non-cancer effects in children after proton therapy.We focused on brainstem injury, cognitive, neuroendocrine, and cardiovascular dysfunctions.The review of the literature shows that PBT reduces the risk of cognitive, neuroendocrine, and cardiovascular dysfunctions concerning those observed after PT. Contradictory results were observed for brain stem injury. The majority of studies found cumulative incidence (CI) of brainstem injury at a relatively low level (0.7% -5.0%) after PBT, as compared to PT. However, some authors underlie a higher rate of brainstem injury in children irradiated due to tumors localized in PF. Therefore, further studies, especially prospective ones, are needed to accurately describe the incidence and risk of late toxicity of proton beam therapy in children.
Keywords: proton beam therapy (PBT), late toxicity, pediatric tumors, Non-cancer effects, photon therapy (PT)
Received: 02 Jan 2025; Accepted: 12 May 2025.
Copyright: © 2025 Zajac- Grabiec, Biesaga, Krzyzowska, Drosik-Rutowicz and Miszczyk. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Anna Zajac- Grabiec, The Henryk Niewodniczański Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
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