{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T13:13:13Z","timestamp":1773148393650,"version":"3.50.1"},"reference-count":31,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2013,6,4]],"date-time":"2013-06-04T00:00:00Z","timestamp":1370304000000},"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":[[2013,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Proton therapy for treatment for high\u2010risk neuroblastoma may offer sparing of organs at risk (OAR) when compared to intensity\u2010modulated X\u2010ray therapy (IMXT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>Double\u2010scattered proton plans and IMXT plans delivering 2,160\u2009cGy to the primary tumor site and other residual disease were developed for 13 consecutive HR\u2010NBL patients. Radiation doses to target volumes and OAR were calculated to determine the optimal modality for each.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients received radiation (5\/13\u2009\u2265\u20092 sites). No patient has experienced local recurrence or clinical organ toxicity. Coverage was excellent using both protons and IMXT: median % dose delivered to 95% clinical target volume was 99% and 100%, respectively. For nine patients with lateralized disease, proton therapy offered sparing of the contralateral kidney both with regard to median dose and dose to 20% (median &lt;1\u2009cGy vs. 362\u2009cGy, <jats:italic>P<\/jats:italic>\u2009=\u20090.01; median 100\u2009cGy vs. 634\u2009cGy, <jats:italic>P<\/jats:italic>\u2009=\u20090.02, respectively). Proton therapy did not reduce ipsilateral kidney dose, and for 2 select patients with lateralized disease IMXT improved overall bilateral renal sparing. Proton therapy improved median bowel (median 33\u2009cGy vs. 590\u2009cGy, <jats:italic>P<\/jats:italic>\u2009=\u20090.01), total body (median &lt;1\u2009cGy vs. 30\u2009cGy, <jats:italic>P<\/jats:italic>\u2009=\u20090.15), and liver dose (median &lt;1\u2009cGy vs. 529, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). When chest RT was required, proton therapy decreased median heart dose and mean lung dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>For most patients (11\/13), proton therapy offered the optimal combination of target coverage and organ sparing, and is a feasible treatment for HR\u2010NBL. We recommend a customized approach with careful evaluation of renal dosimetry; IMXT may be preferred for select patients. Pediatr Blood Cancer 2013;60:1606\u20131611. \u00a9 2013 Wiley Periodicals, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.24606","type":"journal-article","created":{"date-parts":[[2013,6,4]],"date-time":"2013-06-04T12:33:06Z","timestamp":1370349186000},"page":"1606-1611","source":"Crossref","is-referenced-by-count":41,"title":["Proton versus photon radiation therapy for patients with high\u2010risk neuroblastoma: The need for a customized approach"],"prefix":"10.1002","volume":"60","author":[{"given":"Christine","family":"Hill\u2010Kayser","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zelig","family":"Tochner","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Both","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Lustig","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Reilly","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naomi","family":"Balamuth","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Womer","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Maris","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Grupp","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rochelle","family":"Bagatell","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2013,6,4]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.05.6986"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199910143411601"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0911123"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(02)04506-6"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(99)00399-5"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2009.11.003"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.05.004"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1748\u2010717X\u20106\u2010102"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.03.053"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2006.01.027"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.24.8062"},{"key":"e_1_2_5_13_1","unstructured":"FujiH.Proton beam therapy for retroperitoneal neuroblastoma [abstract]. 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