{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:27:24Z","timestamp":1792013244603,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Pediatric central nervous system (CNS) tumors often recur despite multimodality therapy. Although re\u2010irradiation (re\u2010RT) has historically been limited by concerns for severe late toxicities, modern techniques have renewed interest in this approach. Proton therapy provides dosimetric advantages that may enable curative re\u2010treatment with reduced normal tissue exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed 54 pediatric patients who underwent proton re\u2010RT for recurrent CNS tumors at our institution (2010\u20132024). Eligible patients had received prior CNS\u2010directed RT at \u226420 years of age. Toxicities were graded per Common Terminology Criteria for Adverse Events (CTCAE) v5.0 as acute (&lt;3 months) or late (\u22653 months). Cumulative dosimetry was assessed by registering RT1 and RT2 plans and converting doses to EQD2 (\n                      <jats:italic>\u03b1\/\u03b2<\/jats:italic>\n                      \u00a0=\u00a02\u00a0Gy). Overall survival (OS) and progression\u2010free survival (PFS) were estimated using Kaplan\u2013Meier methods.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median age at re\u2010RT was 11 years, with a median interval of 28.5 months between RT courses. The median prescribed re\u2010RT dose was 54\u00a0Gy (range, 25\u201360), yielding a cumulative EQD2 of 102.6\u00a0Gy (range, 46.8\u2013112.9). Median OS and PFS were 46.0 and 16.5 months, respectively. Among 16 ependymoma patients, all received full\u2010dose proton re\u2010RT (54\u201359.4\u00a0Gy), yielding a 1\u2010year OS of 91.7% and PFS of 50.0%. Glioma patients had inferior outcomes (1\u2010year OS 55.4%, PFS 41.6%) with a median re\u2010RT EQD2 of 48.1\u00a0Gy. An RT interval of \u226512 months was associated with improved OS and PFS. Composite dosimetry in 21 patients showed a median cumulative brain\n                      <jats:italic>D<\/jats:italic>\n                      <jats:sub>0.1cc<\/jats:sub>\n                      of 109.0\u00a0Gy; only one patient developed Grade 3 radiation necrosis (RN). High\u2010grade acute toxicity occurred in 13.0% of patients, all manageable with supportive care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Proton re\u2010RT for pediatric CNS tumors is feasible and associated with encouraging survival and low rates of serious late toxicity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70371","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T11:10:07Z","timestamp":1777893007000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Feasibility and Safety of High\u2010Dose Proton Re\u2010Irradiation in Recurrent Pediatric Central Nervous System Tumors: A Single\u2010Institution Retrospective Study"],"prefix":"10.1002","volume":"73","author":[{"given":"Jin\u2010Ho","family":"Song","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine The Catholic University of Korea  Seoul South Korea"},{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3835-5750","authenticated-orcid":false,"given":"Jonathan","family":"Baron","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Chavez","family":"Perez","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidharth","family":"Ramesh","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Minturn","sequence":"additional","affiliation":[{"name":"Division of Oncology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavita A.","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Oncology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amish C.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Oncology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean M.","family":"Belasco","sequence":"additional","affiliation":[{"name":"Division of Oncology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0064-2882","authenticated-orcid":false,"given":"Kristina A.","family":"Cole","sequence":"additional","affiliation":[{"name":"Division of Oncology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Oncology Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip B.","family":"Storm","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9266-3685","authenticated-orcid":false,"given":"Peter M.","family":"Madsen","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goldie","family":"Kurtz","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Lustig","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Hill\u2010Kayser","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"LaRiviere","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Pennsylvania  Philadelphia Pennsylvania 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