Abstract
Proton beam therapy (PT) offers improved sparing of normal tissue, thus potentially
reducing the risk for treatment related late sequelae and induction of secondary cancer.
In addition, it can be an instrument for intensification of local therapy (“dose escalation”)
for disease currently not sufficiently controlled. Up to now, more than 70 000 patients
have been treated with PT worldwide. In particular, tumors of the ocular fundus, the
base of skull and prostate were targeted. In recent years an increasing number of
children got treated, predominantly when suffering from sarcomas or brain tumors.
In Europe, treatment was applied so far mainly in Switzerland (PSI) or France (Orsay).
However, availability of particle therapy is about to increase considerably within
the next years. The German Working Group of paediatric radiation oncology APRO=Arbeitsgemeinschaft
für Pädiatrische Radioonkologie) is currently trying to embed PT in the multidisciplinary
concepts of the GPOH, and PT experts are appointed for each relevant study. In addition,
prospective documentation of the applied PT is to be performed according to the RISK
protocol. Still, it is mandatory to reach out for the integration of PT into our cooperative
network and the multidisciplinary trials. Best practice solutions have to be established
in order to provide high quality and transparency of any applied particle therapy.
Zusammenfassung
Die Protonentherapie (PT) zeichnet sich durch eine verbesserte Schonung des gesunden
Gewebes aus. Dadurch kann potenziell das Risiko von Nebenwirkungen und der Induktion
von Zweittumoren gesenkt werden. Ebenso kann die PT als Instrument zur lokalen Therapieintensivierung
genutzt werden („Dosiseskalation”) für die Fälle, in denen die lokalen Tumorkontrollraten
bislang unbefriedigend sind. Mittlerweile wird die PT weltweit seit über 50 Jahren
klinisch eingesetzt mit mehr als 70 000 behandelten Patienten. Im Fokus der Partikeltherapie
standen bislang vor allem Tumoren des Augenhintergrundes, Schädelbasistumoren und
Prostatakarzinome. Seit einigen Jahren werden zunehmend aber auch Kinder mit PT behandelt.
Dabei handelt es sich in erster Linie um Patienten mit Knochen- oder Weichteiltumoren
sowie Hirntumoren. Die Therapie erfolgte in Europa bisher überwiegend am Paul Scherrer
Institut in der Schweiz oder in Frankreich/Orsay, die Verfügbarkeit wird aber in den
nächsten Jahren deutlich ansteigen. Die APRO (Arbeitsgemeinschaft für Pädiatrische
Radioonkologie) versucht aktuell, die PT in die multidisziplinären Konzepte der GPOH
zu integrieren und Experten in den Studien zu positionieren. Eine Dokumentation der
durchgeführten Therapie nach RISK ist dabei ebenfalls vorgesehen, um die essenziellen
Belange der Qualitätssicherung und Transparenz zu lösen.
Key words
children - cancer - proton beam therapy - irradiation
Schlüsselwörter
Kinder - Tumor - Protonentherapie - Bestrahlung
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Correspondence
Beate TimmermannMD
University Essen
Westgerman
Protontherapycenter Essen
Am Mühlenbach 1
45147 Essen
Germany
Telefon: +49/201/723 1801
Fax: +49/201/723 5169
eMail: beate.timmermann@uk-essen.de
