{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:10:07Z","timestamp":1792001407281,"version":"4.4.0"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2008,2,27]],"date-time":"2008-02-27T00:00:00Z","timestamp":1204070400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>To determine whether proton radiotherapy has clinical advantages over photon radiotherapy, we modeled the dose characteristics of both to critical normal tissue volumes using data from patients with four types of childhood brain tumors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedures<\/jats:title><jats:p>Three\u2010dimensional imaging and treatment planning data, including targeted tumor and normal tissues contours, were acquired for 40 patients, 10 each with optic pathway glioma (OPG), craniopharyngioma (CR), infratentorial ependymoma (EP), or medulloblastoma (MB). Dose\u2013volume data were collected for the entire brain, temporal lobes, cochlea, and hypothalamus from each patient. The data were averaged and compared based on treatment modality (protons vs. photons) using dose\u2010cognitive effects models. Outcomes were estimated over 5 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Relatively small critical normal tissue volumes such as the cochlea and hypothalamus may be spared from radiation exposure when not adjacent to the primary tumor volume. Larger normal tissue volumes such as the supratentorial brain or temporal lobes receive less of the low and intermediate doses. When applied to longitudinal models of radiation dose\u2010cognitive effects, these differences resulted in clinically significant higher IQ scores for patients with MB and CR and academic reading scores in patients with OPG. Extreme differences between proton and photon dose distributions precluded meaningful comparison of protons and photons for patients with EP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Differences in the overall dose distributions, as indicated by modeling changes in cognitive function, showed that a reduction in the lower\u2010dose volumes or mean dose would have long\u2010term, clinical advantages for children with MB, CR, and OPG. Pediatr Blood Cancer 2008;51:110\u2013117. \u00a9 2008 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.21530","type":"journal-article","created":{"date-parts":[[2008,2,27]],"date-time":"2008-02-27T20:16:30Z","timestamp":1204143390000},"page":"110-117","source":"Crossref","is-referenced-by-count":313,"title":["Proton versus photon radiotherapy for common pediatric brain tumors: Comparison of models of dose characteristics and their relationship to cognitive function"],"prefix":"10.1002","volume":"51","author":[{"given":"Thomas E.","family":"Merchant","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010ho","family":"Hua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemant","family":"Shukla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofei","family":"Ying","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simeon","family":"Nill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Oelfke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,2,27]]},"reference":[{"key":"e_1_2_6_2_2","article-title":"A multi\u2010institution prospective trial of reduced\u2010dose craniospinal irradiation (23.4Gy) followed by conformal posterior fossa (36Gy) and primary site irradiation (55.8Gy) and dose\u2010intensive chemotherapy for average\u2010risk medulloblastoma","author":"Merchant TE","year":"2007","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.11.142"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.07.063"},{"key":"e_1_2_6_5_2","first-page":"94","article-title":"Phase II trial of conformal radiation therapy for pediatric patients with craniopharyngioma and correlation of surgical factors and radiation dosimetry with change in cognitive function","volume":"104","author":"Merchant TE","year":"2006","journal-title":"J Neurosurg"},{"key":"e_1_2_6_6_2","article-title":"Vertebral body growth after craniospinal irradiation","author":"Hartley KA","year":"2007","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(01)02788-2"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.05.028"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.10.038"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-964904"},{"key":"e_1_2_6_11_2","first-page":"444","article-title":"Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: A prospective study by the Children's Oncology Group","volume":"105","author":"Robertson PL","year":"2006","journal-title":"J Neurosurg"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.08.009"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.10211"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1038\/ncponc0090"},{"key":"e_1_2_6_15_2","volume-title":"The Wechsler individual achievement test","author":"The Psychology Corporation","year":"1992"},{"key":"e_1_2_6_16_2","volume-title":"The Wechsler intelligence test for children","author":"The Psychological Corporation","year":"1992"},{"key":"e_1_2_6_17_2","volume-title":"The Wechsler preschool and primary scales of intelligence\u2014revised","author":"The Psychological Corporation","year":"1989"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2006.07.233"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.01.060"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1080\/02841860500218819"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2003.11.028"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(99)00337-5"}],"container-title":["Pediatric Blood &amp; 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