{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T05:20:48Z","timestamp":1783401648269,"version":"3.54.6"},"reference-count":23,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,9,16]],"date-time":"2019-09-16T00:00:00Z","timestamp":1568592000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>In children treated for nasopharyngeal carcinoma, proton therapy and postchemotherapy target volumes can reduce the radiation dose to developing tissue in the brain and the skull base region. We analyzed outcomes in children with nasopharyngeal carcinoma treated with induction chemotherapy followed by moderate\u2010dose proton therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods\/Materials<\/jats:title><jats:p>Seventeen patients with nonmetastatic nonkeratinizing undifferentiated\/poorly differentiated nasopharyngeal carcinoma underwent double\u2010scattered proton therapy between 2011 and 2017. Median age was 15.3 years (range, 7\u201021). The American Joint Committee on Cancer T and N stage distribution included the following: T1, one patient; T2, five patients; T3, two patients; and T4, nine patients; and N1, six patients; N2, nine patients; and N3, two patients. Median radiation dose to the primary target volume and enlarged lymph nodes was 61.2\u00a0Gy (range, 59.4\u201061.2). Uninvolved cervical nodes received 45\u00a0Gy (range, 45\u201046.8). All radiation was delivered at 1.8\u00a0Gy\/fraction daily using sequential plans. In 11 patients, photon\u2010based intensity\u2010modulated radiotherapy was used for elective neck irradiation to optimize dose homogeneity and improve target conformity. All patients received induction chemotherapy; all but one received concurrent chemotherapy. Five received adjuvant beta\u2010interferon therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median follow\u2010up was 3.0 years (range, 1.6\u20107.9). No patients were lost to follow\u2010up. Overall survival, progression\u2010free survival, and local control rates were 100%. Fifteen patients developed mucositis requiring enteral feeding (n\u00a0=\u00a014) or total parenteral nutrition (n\u00a0=\u00a01) during radiotherapy. Serious late side effects included cataract (n\u00a0=\u00a01), esophageal stenosis requiring dilation (n\u00a0=\u00a01), sensorineural hearing loss requiring aids (n\u00a0=\u00a01), and hormone deficiency (n\u00a0=\u00a05, including three with isolated hypothyroidism).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Following induction chemotherapy, moderate\u2010dose proton therapy can potentially reduce toxicity in the brain and skull base region without compromising disease control. However, further follow\u2010up is needed to fully characterize and evaluate any reduction in long\u2010term complications.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.27990","type":"journal-article","created":{"date-parts":[[2019,9,16]],"date-time":"2019-09-16T11:54:20Z","timestamp":1568634860000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Proton therapy following induction chemotherapy for pediatric and adolescent nasopharyngeal carcinoma"],"prefix":"10.1002","volume":"66","author":[{"given":"Haruka","family":"Uezono","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology University of Florida College of Medicine  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5765-1873","authenticated-orcid":false,"given":"Daniel J.","family":"Indelicato","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida College of Medicine  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronny L.","family":"Rotondo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida College of Medicine  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Sandler","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology Nemours Children's Specialty Clinic  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5314-2972","authenticated-orcid":false,"given":"Howard M.","family":"Katzenstein","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology Nemours Children's Specialty Clinic  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roi","family":"Dagan","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida College of Medicine  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M.","family":"Mendenhall","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida College of Medicine  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Mailhot Vega","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida College of Medicine  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1614-0289","authenticated-orcid":false,"given":"Bernadette M.","family":"Brennan","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology Royal Manchester Children's Hospital  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University of Florida College of Medicine  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,9,16]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(03)00956-2"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.27395"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.20823"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22521"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2015.3217"},{"key":"e_1_2_10_7_1","unstructured":"NRG Oncology.Randomized phase II and phase III studies of individualized treatment for nasopharyngeal carcinoma based on biomarker Epstein Barr virus (EBV) deoxyribonucleic acid (DNA). 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