National Association for Proton Therapy and Pediatric Proton Foundation 2011 Survey Reveals 32% Increase in Pediatric Cases Treated at U.S. Proton Centers

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Brain cancer continues to be the main tumor target for proton therapy - an advanced form of radiation treatment according to the National Association for Proton Therapy and the Pediatric Proton Foundation.

Jacob Ralston was diagnosed with Ewing Sarcoma in August 2007 when he was 2 years old.  He received 25 proton therapy treatments at MD Anderson. He is currently NED.  He recently started second grade.

Jacob Ralston, Proton Recipient

I am encouraged that every center treated children and the data suggests many have placed an increased emphasis on treating pediatric cases.

A total of 613 children and adolescents were treated at the nation's nine proton therapy centers in 2011, amounting to a 32 percent increase over 2010 cases, according to a new survey, presented recently at the Children's Oncology Group (COG) meeting in Atlanta. COG is the world's largest organization devoted to childhood and adolescent cancer research. The findings provide the second year of comprehensive review of proton therapy treatment in children.

"Although many different tumors types were treated in 2011, there continues to be an emphasis on pediatric brain tumors and sarcomas," reports Dr. Daniel Indelicato, director of pediatric radiation oncology at the University of Florida Proton Therapy Institute who presented the survey results and who also serves as a Board Member for the Pediatric Proton Foundation (PPF.) "Although in 2011, sixty percent of the patients were treated at four centers, I am encouraged that every center treated children and the data suggests many have placed an increased emphasis on treating pediatric cases." He notes, “The survey results confirm that pediatric proton therapy is resource intense and involves a dedicated multidisciplinary team. Approximately 50% of patients treated in 2011 needed daily anesthesia for treatment and three of six of the most common tumors required the delivery of chemotherapy along with their proton therapy.”

In keeping with its prevalence, approximately 75% of the young patients treated with protons had brain tumors. More than half of children treated were under nine years old. The most frequently treated tumors were ependymomas, low-grade gliomas, and medulloblastomas. Other commonly treated tumors include rhabdomyosarcomas, Ewing sarcomas, and craniopharyngiomas.

“This year, I streamlined the survey that each center completed to gather comprehensive information such as the tumor type and location, amount of treatment required, whether anesthesia was required and nature of the treatment. By using this survey, we were able to speed up the data analysis phase and more systematically categorize the findings,” said Dr. Andrew L. Chang, a radiation oncologist at Hampton University Proton Therapy Institute and a Board Member for the PPF.

"We expect another 5-10 new proton centers to become operational within the next 5 years which will give us more treatment slots to treat children," said Leonard Arzt, Executive Director of NAPT. "It is widely known that proton therapy offers tremendous advantages in treating pediatric cases. The NAPT will continue to support and advocate for this advanced form of radiation treatment for America’s youngest cancer patients."

One of the most important advantages of proton therapy is its capacity to kill tumor cells while sparing healthy tissue nearby, such as in the brain or other vital organs, from the adverse effects of radiation exposure. Traditional radiation in pediatric brain tumors has been associated with long-term neurocognitive deficits including decreases in IQ, difficulties with attention, processing speed and other executive skills. Also, even low dose radiation to glands in the brain may have a life-long detrimental effect on hormone production and growth. Protons have the ability to target tumors with high precision and have no exit dose. The decreased radiation dose outside the tumor is especially critical for children since the risk of secondary, radiation-induced tumors may reach 25% in long term survivors treated with conventional radiotherapy.

"As the mother of a 2-year-old child that was diagnosed with spinal Ewing sarcoma (Jacob Ralston pictured here) and was able to receive proton therapy, my goal is to help all families with the same challenges I encountered gaining access to this treatment. Parents need to understand that proton therapy offers distinct advantages for their child’s treatment over traditional radiation,” said Susan Ralston, Executive Director of the PPF. “I am proud to be involved with pediatric proton therapy and the outstanding doctors in the proton facilities that treat these children. However, even with 10 centers in the U.S. now, access remains an issue as it is estimated that 3,000 newly diagnosed kids might be candidates for proton therapy each year and the capacity to treat that many kids just isn’t available yet," she said.

Both NAPT and the PPF advocate for expanded proton therapy center development and increased treatment access for children. The organizations plan to continue and enhance pediatric data collection and tracking in the future.

About Proton Therapy
Proton beam therapy is an advanced form of radiation therapy used in cancer treatment. It is available at ten operating U.S. centers with several additional facilities in the planning and construction phase. Unlike standard (X-ray) radiation treatment, proton therapy uses high-speed particles that can be more precisely conformed to target the tumor. The power of protons is that higher doses of radiation can be employed to control and manage cancer while significantly reducing damage to healthy tissue and vital organs. For more information, a list of proton centers, and a copy of our slides, visit the National Association for Proton Therapy at or the Pediatric Proton Foundation at

About the National Association for Proton Therapy
The National Association for Proton Therapy (NAPT) is a non-profit organization supported by proton center members and is the Voice of the Proton Community. The NAPT promotes education and public awareness for the clinical benefits of proton beam radiation therapy. Founded in 1990, NAPT is an advocate for the advancement of proton therapy. It serves as a resource center for patients, physicians and health care providers, universities, academic medical centers, hospitals, cancer centers, the Centers for Medicare and Medicaid Services (CMS) and other health care agencies, the U.S. Congress and staff, and the news media. For more information visit the website at

About the Pediatric Proton Foundation
The Pediatric Proton Foundation (PPF) is uniquely positioned as an independent, nonprofit charity that relies on voluntary funding from a variety of sources to be able to provide the most objective information available about pediatric cancer treatment at each proton center in the U.S. Founded in 2008 by Susan Ralston, the mission of the organization is to provide education, advocacy and assistance to families in need of pediatric protons. The PPF is a non-profit 501(c)(3) charitable organization and graciously accepts public donations. For more information, visit the Pediatric Proton Foundation’s website at:

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