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Case studies at RPTC

Case studies of children and adolescents treated at RPTC

Case Study: Rhabdomyosarcoma

In September 2009, we initiated proton therapy on a seven-year-old girl who developed a large tumor in her upper neck: a malignant blastoma of the cervical muscles, a rhabdomyosarcoma. The tumor extended from the right parotid gland to the nasopharynx to the left opposite side, eliminating surgery as an option. The tumor also continued to grow during chemotherapy treatment. The parents and pediatric oncologists decided on proton therapy because it would concentrate the radiation dose on infiltrated tissue and protect the girl’s healthy tissue better than X-ray radiation could. The girl is tolerating proton therapy very well. The tumor has shrunk, making it easier for the girl to breathe through her nose, and she has had no difficulty swallowing. In addition, because the girl’s left parotid gland (figure) was not irradiated, her treatment did not result in dry mouth. The mother reports that her daughter was already noticeably stronger and more active during the course of therapy.

Case Study: Optic Nerve Glioma WHO I

In September 2009, we also began to treat a seven year-old girl suffering from a large (4.2 x 3.8 x 4.5 cm) tumor inside her cranial cavity impinging on her optic nerve that already resulted in blindness on the affected side. Several courses of chemotherapy were unsuccessful in shrinking the optic nerve glioma. Continued lesion growth necessitated a shunt operation, i.e., shunting of cerebrospinal fluid into the abdomen. Proton therapy was indicated. Because the tumor was very close to the optic chiasm (crossing of optic nerves) and the hypothalamus (in the brainstem), the risk of damaging the surrounding structures was very high. It is exactly these situations that showcase the benefits of precise and gentle scanning proton therapy. Precise positioning using vacuum contour beds, fixation the patient’s upper jaw in a maxillary mold, and administration of treatment with the patient in a sleep-like state (deep sedation) are additional measures to ensure an optimal course of treatment. The young patient has tolerated 27 treatments administered thus far (figure) very well. There were no side effects or complications

Case study: Ewing sarcoma

A 16-year-old patient with a Ewing sarcoma of the thoracic spine received proton therapy at our center. Several adjoining thoracic vertebral bodies formed the target area. X-ray planning showed that X_ray therapy would have exceeded the maximum allowable dose for the spinal cord, while proton therapy kept the dose under the upper limit. The patient received 30 treatments (figure). The patient experienced an acute side effect (during radiation or up to three months after completion): a routinely spontaneously healing radiation erythema (radiation-induced skin redness). The post-treatment observation time is not yet sufficient to assess possible late-term side effects or whether a cure was effected. The patient underwent chemotherapy at an external clinic both before and concomitantly with proton therapy. 

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