{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:10:05Z","timestamp":1792001405744,"version":"4.4.0"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,11,17]],"date-time":"2019-11-17T00:00:00Z","timestamp":1573948800000},"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":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Despite the dosimetric advantages of proton therapy, little data exist on patients who receive proton therapy for Ewing sarcoma of the cranium and skull base. This study reports local disease control and toxicity in such patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials\/methods<\/jats:title><jats:p>We reviewed 25 patients (\u226421 years old) with nonmetastatic Ewing sarcoma of the cranium and skull base treated between 2008 and 2018. Treatment toxicity was graded per the Common Terminology Criteria for Adverse Events v4.0. The Kaplan\u2010Meier product limit method provided estimates of disease control and survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median patient age was 5.9 years (range, 1\u201321.7). Tumor subsites included the skull base (48%), non\u2010skull\u2010base calvarial bones (28%), paranasal sinuses (20%), and nasal cavity (4%). All patients underwent multiagent alkylator\u2010 and anthracycline\u2010based chemotherapy; 16% underwent gross total resection (GTR) before radiation. Clinical target volume (CTV) 1 received 45 GyRBE and CTV2 received 50.4 GyRBE following GTR or 54\u201355.8 GyRBE following biopsy or subtotal resection. Median follow\u2010up was 3.7 years (range, 0.26\u20138.3); no patients were lost. The 4\u2010year local control, disease\u2010free survival, and overall survival rates were 96%, 86%, and 92%, respectively. Two patients experienced in\u2010field recurrences. One patient experienced bilateral conductive hearing loss requiring aids, two patients developed intracranial vasculopathy, and 6 patients required hormone replacement therapy for neuroendocrine deficits. None developed a secondary malignancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Proton therapy is associated with a favorable therapeutic ratio in children with large Ewing tumors of the cranium and skull base. Despite its high conformality, we observed excellent local control and no marginal recurrences. Treatment dosimetry predicts limited long\u2010term neurocognitive and neuroendocrine side effects.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.28080","type":"journal-article","created":{"date-parts":[[2019,11,18]],"date-time":"2019-11-18T05:41:07Z","timestamp":1574055667000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Outcomes following proton therapy for Ewing sarcoma of the cranium and skull base"],"prefix":"10.1002","volume":"67","author":[{"given":"Shivam M.","family":"Kharod","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology College of Medicine University of Florida  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 College of Medicine University of Florida  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronny L.","family":"Rotondo","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology College of Medicine University of Florida  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond B.","family":"Mailhot Vega","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology College of Medicine University of Florida  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Uezono","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology College of Medicine University of Florida  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher G.","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology College of Medicine University of Florida  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Bradfield","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology Nemours Children's Health Systems  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Sandler","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology Nemours Children's Health Systems  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology College of Medicine University of Florida  Jacksonville Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,11,17]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"National Cancer Institute.Ewing sarcoma treatment (PDQ\u00ae)\u2010health professional version.2018.https:\/\/www.cancer.gov\/types\/bone\/hp\/ewing-treatment-pdq. 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