Pediatric Proton Therapy: Patterns of Care across the United States

Purpose: Children are particularly prone to the late side effects of normal tissue irradiation. For this reason, pediatric solid tumors are a commonly cited indication for proton therapy worldwide. The aim of this survey was to assess pediatric patterns of care across proton centers in the United States. Patients and Methods: A survey was developed and distributed annually to each clinical proton therapy facility in the United States in operation during the years of 2010, 2011, and 2012. Anonymized patient information including age range, tumor site, and diagnosis were collected annually for each patient 18 years old or younger treated between January 1, 2010 and December 31, 2012. Results: There was a 100% response rate from the United States proton therapy centers in operation for each year surveyed. All facilities treated at least 1 pediatric patient each year. A total of 694 pediatric patients were treated in 2012, an increase from 613 patients in 2011 and 465 patients in 2010. Fifty-seven percent of patients in 2012 were under 10 years of age, similar to 2011 and 2010. Anesthesia was required for 45% of patients. The six most common tumor diagnoses treated were ependymoma, medulloblastoma, low- grade glioma, rhabdomyosarcoma, Ewing sarcoma, and craniopharyngioma. In 2012, 19% of treated patients originated in countries outside the United States. Conclusions: The total number of children treated at proton centers in the United States continues to increase, rising 33% since 2010, consistent with the international perception that pediatric patients derive a relative benefit from this rare technology. The average patient is a child ,10 years old with a curable brain tumor or axial sarcoma.