Madrid
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Marina (fictitious name) is 3 years old. He is a native of northern Spain, and in June 2020 he was diagnosed with a left orbital embryonal rhabdomyosarcoma (a type of soft tissue sarcoma), due to a lump in the lower eyelid that the mother noticed was progressively increasing in size. It is a malignant tumor in the orbital cavity that can cause displacement of the eyeball, vision problems, increased volume of the tissues around the eye or pain, with all that this entails for the minor.
The treatment of tumors in the pediatric population is carried out in a homogeneous manner, following the recommendations of the «international multidisciplinary protocols», points out Dr. Carme Ares, head of Radiation Oncology at the
Quirónsalud Proton Therapy Center, located in Pozuelo de Alarcon (Madrid), the first of its kind in Spain, both in public and private healthcare.
Specifically, the patient received three cycles of chemotherapy between July and August, presenting a very good tumor response, with a reduction of more than two thirds of the initial tumor volume. In addition, and according to the protocol, this patient, due to her age, pathology and location of the tumor, was a candidate for consolidation treatment with proton therapy concomitant with chemotherapy.
In accordance with the recommendations of the
Spanish Society of Radiation Oncology (SEOR), proton therapy is a very beneficial type of external radiotherapy in Kids with cancer as it is a special modality of radiotherapy that uses proton beams instead of electrons or X-rays, so that the irradiation dose can be shaped more locally in the tumor volume to be irradiated, and the dose is reduced or eliminated irradiation received by surrounding healthy tissues, which leads to a reduction in the risk of developing toxicity on these tissues.
In children it is essential that the adverse effects secondary to treatment are as few as possible. The normal tissues and organs that are found around the volume to be irradiated are in the development phase and are especially sensitive to the irradiation dose they receive. By reducing or eliminating the dose to these tissues we will reduce or eliminate the risk of developing these adverse effects or toxicities. The sequelae of cancer treatments can often impair and threaten their future quality of life and development as adults.
Very useful in children with Sarcomas
Thus, proton therapy, according to this scientific society, is especially indicated in the pediatric population, in which in the majority of oncological pathologies, patients will manage to be long survivors by being able to control the disease.
Proton therapy is also especially indicated for those tumors that require high doses of irradiation to be controlled, doses that would not be tolerated by the surrounding normal organs and tissues, and that could not be administered with conventional external radiotherapy techniques with photons because they carry a high risk of toxicities.
With the proton beams also reduces the risk of developing second tumors induced by the radiotherapy received, another of the sequelae that appear after radiotherapy in children, who are more sensitive to radiation.
«The healthy tissues around the volume to be irradiated are developing tissues and are more sensitive to irradiation, so when rreduce the dose in these tissues the risk of developing toxicities in the normal tissues around the tumor is reduced”, defends the specialist of
Quironsalud, which in its first 2 years of activity has successfully treated more than 100 pediatric patients.
For Dr. Ares, in the case of Marina the benefit “was clear”, since it was a pediatric patient, with a tumor in the orbital cavity of the eye, which could be treated with protons. “A dose is administered to be able to control the tumor locally without exceeding the tolerance dose in visual structures and other surrounding tissues. Therefore, we more likely guarantee the non-appearance of long-term toxicity, such as changes in vision, or the development of dry eyes, for example”, he details.
In this case too, and in a coordinated manner, it was organized with the department of
Pediatric Oncology of the University Hospital Quirónsalud Madrid the concomitant administration of the necessary chemotherapy cycles and their respective controls.
«The patient had an excellent tolerance to the treatment, presenting some dermatitis (irritation of the skin) at the level of the eyelids of the left eye. In these pediatric cases, correct collaboration and very good coordination between the different departments is essential, with privileged contact with the referring doctors, since it depends on this that the treatment is administered optimally and the family, despite being far from your place of origin, always feel a good support network from professionals”, explains the specialist in proton therapy.
More indications:brain tumors
Another case that could illustrate the benefits of early therapy in children is that of Juan (fictitious name), a three-year-old boy who in September 2020 was diagnosed with a frontoparietal anaplastic ependymoma (a primary tumor in the central nervous system, in this case in the brain), as a result of a picture of alterations in the balance and disconnection from the environment.
The tumor was completely resected surgically and in accordance with established protocols, and given the histology of the tumor, it was indicated for treatment with proton therapy. postoperative due to the patient’s age and by the location to be treated.
Central nervous system tumors (brain and spinal cord) are the most frequent solid tumors in the pediatric population, and a very high percentage of these tumors require external radiotherapy in the multidisciplinary management of these pathologies
These children with brain tumors benefit from receiving this external radiotherapy with proton beams, by reducing the dose that structures and organs located at the cranial level close to the tumor volume and that are in full development will receive, reducing the risk of developing toxicities such as neurocognitive deficits, visual deficits, auditory deficits, endocrine deficits, growth deficits, vascular events and the development of secondary tumors.
In addition, in the specific case of the pediatric population, and according to the recommendations of the
SEOR, proton therapy is ideal for treating tumors located in the central nervous system or those that are close to organs at risk (bone marrow, heart, lungs, kidneys, gonads).
The patient began his treatment in mid-December 2020 and finished in early February 2021. «During the same did not present acute complications and completed it with excellent tolerance. The patient, who comes from another country, even met the Three Wise Men, who visited the
Proton Therapy Center to meet all the children and gave them gifts
He lived through the experience of a heavy snowfall in Madrid (not seeing his treatment interrupted because of this, thanks to the volunteers who provided their vehicles to transport the patients on those days), and he rang the dream bell on the last day of treatment, reflecting the end of a stage accompanied by his brother and his father”, explains Dr. Ares.
In addition, as pointed out by Dr. Ignacio Azinovic, medical director of the
Quirónsalud Proton Therapy Center, with the arrival in Spain of this treatment «no cancer patient, neither adult nor pediatric, should leave our country to benefit from this technique».