Proton radiotherapy could reduce the risk of fatal second cancers for children with intracranial tumors in low- And middle-income countries

Kyle J. Gallagher, Bassem Youssef, Rola Georges, Anita Mahajan, Joelle Ann Feghali, Racile Nabha, Zeina Ayoub, Wassim Jalbout, Phillip J. Taddei

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: To test our hypothesis that, for young children with intracranial tumors, proton radiotherapy in a high-income country does not reduce the risk of a fatal subsequent malignant neoplasm (SMN) compared with photon radiotherapy in low- and middle-income countries. Materials and Methods: We retrospectively selected 9 pediatric patients with low-grade brain tumors who were treated with 3-dimensional conformal radiation therapy in low- and middle-income countries. Images and contours were deidentified and transferred to a high-income country proton therapy center. Clinically commissioned treatment planning systems of each academic hospital were used to calculate absorbed dose from the therapeutic fields. After fusing supplemental computational phantoms to the patients’ anatomies, models from the literature were applied to calculate stray radiation doses. Equivalent doses were determined in organs and tissues at risk of SMNs, and the lifetime attributable risk of SMN mortality (LAR) was predicted using a dose-effect model. Our hypothesis test was based on the average of the ratios of LARs from proton therapy to that of photon therapy (RLAR)H0: RLAR = 1; HA: RLAR, 1Þ: Results: Proton therapy reduced the equivalent dose in organs at risk for SMNs and LARs compared with photon therapy for which the RLAR for the cohort was 0.69 ± 0.10, resulting in the rejection of H0 (P< .001, a = 0.05). We observed that the younger children in the cohort (2-4 years old) were at a factor of approximately 2.5 higher LAR compared with the older children (8-12 years old). Conclusion: Our findings suggest that proton radiotherapy has the strong potential of reducing the risk of fatal SMNs in pediatric patients with intracranial tumors if it were made available globally.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalInternational Journal of Particle Therapy
Issue number4
StatePublished - Mar 1 2021


  • Global oncology
  • Intracranial tumors
  • Low-
  • Middle-income countries
  • Pediatric proton therapy
  • Secondary malignancies

ASJC Scopus subject areas

  • Atomic and Molecular Physics, and Optics
  • Radiology Nuclear Medicine and imaging


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