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Table 1 Summary of literature describing dosimetric results achieved by PBT and comparison of PBT vs photons

From: Proton therapy in the most common pediatric non-central nervous system malignancies: an overview of clinical and dosimetric outcomes

Author (year)Treatment planning study assessmentNumber of PBT pediatric patientsPBT results
Retinoblastoma
 Krengli (2005) [17]PBT with different beam arrangements/tumor locations;
Isodose comparison, DVH analysis (for target and OARs)
Homogeneous target coverage, effective OARs-sparing.
Potential reduction of SMNs and side effects.
 Lee (2005) [18]PBT vs 3D-CRT, electrons and IMRT;
Isodose comparison, DVH analysis (target coverage
and mean orbital volume receiving ≥5Gy)
3/8Superior target coverage
and orbital bone dose-sparing
Hodgkin lymphoma
 Andolino (2011) [19]BS-PT vs 3D-CRT;
DVH analysis (breast parameters);
paired t-test
10Significant reduction of
dosimetric breast parameters
 Hoppe (2012) [20]INPT vs 3D-CRT and IMRT;
Mean heart doses, mean doses to cardiac subunits;
Wilcoxon paired t-test
2/13 total INPT patients (including adults)Reduction of mean heart dose
and mean doses to all major cardiac subunits
(p < 0.05) (entire cohort)
 Hoppe (2012) [21]INPT vs 3D-CRT and IMRT;
50% reduction in the body V4; mean doses to OARs;
paired t-tests
1/10 total INPT patients (including adults)Reduced body V4 (p < 0.01) and mean doses to OARs
(entire cohort)
 Hoppe (2014) [4]aINPT vs 3D-CRT and IMRT;
integral body dose; mean doses to OARs
5/15 total INPT patients (including adults)Reduced integral dose and mean doses to OARs (entire cohort)
 Knäusl (2013) [22]Treatment planning comparison
(dosimetric parameters and DVHs for target and breast, thyroid, lungs, heart, bones) and SMNs assessment between PET-based RT with 3D-CRT, IMRT and PBT
10The PET-based treatment planning ensures dosimetric advantages for OARs. PBT can further improve these results in terms of toxicity risk reduction
Soft tissue sarcoma
 Weber (2004) [23]IMPT vs IMRT, dose-escalated IMPT;
DVH analysis (for target and OARs),
inhomogeneity coefficient, conformity index
5Similar level of tumor conformation,
improved homogeneity with mini-beam IMPT,
substantial reduction of OARs integral doses,
dose-escalation always possible
Rhabdomyosarcoma
 Miralbell (2002) [24]PBT, IMPT vs conventional RT and IMRT;
model-based SMNs risk assessment
1/2Reduction of SMNs risk by a factor of ≥2
 Ladra (2014) [25]PBT vs IMRT;
dosimetric parameters for target and OARs;
paired t-tests, Fisher’s exact test
54Comparable target coverage (p = 0.82).
Reduced mean integral dose.
Significant sparing for 26 of 30 OARs (p < 0.05)
 Kozak (2009) [26]PBT vs IMRT;
dosimetric parameters for target
(target covarage and dose-conformity) and OARs
two-tailed, Wilcoxon signed-rank test
10Acceptable and comparable target coverage.
Significant superior OARs-sparing, except for ipsilateral cochlea and mastoid / borderline significance for ipsilateral parotid (p = 0.05)
 Cotter (2011) [27]PBT vs IMRT;
dosimetric parameters for target and OARs
Wilcoxon signed-rank test
7Comparable target coverage.
Significant reduction in mean OARs dose (p < 0.05) and
bone volume receiving > 35 Gy
 Lee (2005) [18]PBT vs 3D-CRT and IMRT;
Isodose and dose-volume comparison
for target and OARs
3/8Superior target coverage and OARs dose-sparing
(0% of mean ovarian volume received ≥2 Gy)
 Yock (2005) [28]PBT vs 3D-CRT;
DVH analysis for OARs (orbital and CNS structures)
7Superior OARs dose-sparing
Wilms tumor
 Hillbrand (2008) [29]Passively scattered/scanned beams PBT
vs conventional RT and IMRT;
DVH analysis (liver and kidney dosimetric parameters);
model-based SMNs risk assessment
4/9Superior dose-sparing for liver and kidney (mean liver and kidney dose reduced by 40–60%).
Reduced SMNs risk with scanned beams PBT
  1. DVH Dose-volume histogram, SMNs Second malignant neoplasms, BS-PT Breast-sparing proton therapy, INPT Involved-node proton therapy
  2. aStudies by Hoppe based on the patients cohort enrolled in an institutional review board-approved protocol at the University of Florida Proton Therapy Institute