{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:10:42Z","timestamp":1792001442716,"version":"4.4.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2022,2,14]],"date-time":"2022-02-14T00:00:00Z","timestamp":1644796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Brainstem toxicity after radiation therapy (RT) is a devastating complication and a particular concern with proton radiation (PBT). We investigated the incidence and clinical correlates of brainstem injury in pediatric brain tumors treated with PBT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All patients &amp;lt;21 years with brain tumors treated with PBT at our institution from 2007\u20132019, with a brainstem Dmean &amp;gt;30 Gy and\/or Dmax &amp;gt;50.4 Gy were included. Symptomatic brainstem injury (SBI) was defined as any new or progressive cranial neuropathy, ataxia, and\/or motor weakness with corresponding radiographic abnormality within brainstem.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 595 patients were reviewed and 468 (medulloblastoma = 200, gliomas = 114, ependymoma = 87, ATRT = 43) met our inclusion criteria. Median age at RT was 6.3 years and median prescribed RT dose was 54Gy [RBE]. Fifteen patients (3.2%) developed SBI, at a median of 4 months after RT. Grades 2, 3, 4, and 5 brainstem injuries were seen in 7, 5, 1, and 2 patients respectively. Asymptomatic radiographic changes were seen in 51 patients (10.9%). SBI was significantly higher in patients with age \u22643 years, female gender, ATRT histology, patients receiving high-dose chemotherapy with stem cell rescue, and those not receiving craniospinal irradiation. Patients with SBI had a significantly higher V50\u201352. In 2014, our institution started using strict brainstem dose constraints (Dmax \u226457 Gy, Dmean \u226452.4 Gy, and V54\u226410%). There was a trend towards decrease in SBI from 4.4% (2007-2013) to 1.5% (2014\u20132019) (P = .089) without affecting survival.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our results suggest a low risk of SBI after PBT for pediatric brain tumors, comparable to photon therapy. A lower risk was seen after adopting strict brainstem dose constraints.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/neuonc\/noac044","type":"journal-article","created":{"date-parts":[[2022,2,11]],"date-time":"2022-02-11T04:13:18Z","timestamp":1644552798000},"page":"1571-1581","source":"Crossref","is-referenced-by-count":31,"title":["Quantifying the risk and dosimetric variables of symptomatic brainstem injury after proton beam radiation in pediatric brain tumors"],"prefix":"10.1093","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4079-1268","authenticated-orcid":false,"given":"Rituraj","family":"Upadhyay","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, The James Cancer Centre Ohio State University , Columbus, Ohio , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiping","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, The University of Texas MD Anderson Cancer 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