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000306900 1001_ $$aBlumenfeld, Philip$$b0
000306900 245__ $$aPediatric CNS relapse of neuroblastoma treated with upright proton craniospinal irradiation.
000306900 260__ $$aAmsterdam$$bElsevier$$c2026
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000306900 520__ $$aCraniospinal irradiation (CSI) is a technically demanding treatment in pediatric oncology, especially for young children, who often require daily anesthesia. Although proton therapy offers dosimetric advantages over photons by eliminating exit dose and reducing exposure to healthy tissues, its global availability is limited due to the cost and complexity of gantry-based systems. Recently, gantry-less proton therapy with upright positioning has recently emerged as a compact, cost-efficient alternative, integrating robotic positioning and vertical CT-based image guidance. This study reports the first pediatric case of upright proton CSI delivered under intravenous monitored anesthesia care (MAC) using such a system. A four-year-old male patient with relapsed neuroblastoma in the central nervous system received CSI at a dose of 18.0 Gy(RBE) in 12 fractions, along with a simultaneous integrated boost (SIB) of 21.6 Gy(RBE) to the resection cavity. This was followed by a sequential boost to the resection cavity in five fractions, for a total dose of 30.6 Gy(RBE). The treatment was performed in the seated position with customized immobilization, upright volumetric CT verification, and reproducible daily setup. MAC achieved without intubation, allowing continuous airway access. The patient completed the treatment regimen without interruption, did not experience any grade 2 or higher acute toxicities, and demonstrated adequate tolerance of daily anesthesia. This case demonstrates the clinical feasibility of upright proton CSI under MAC and provides proof of concept for the broader adoption of gantry-less proton therapy in complicated cases.
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000306900 650_7 $$2Other$$aCraniospinal irradiation
000306900 650_7 $$2Other$$aPediatric treatments
000306900 650_7 $$2Other$$aProton therapy
000306900 650_7 $$2Other$$aUpright radiation therapy
000306900 7001_ $$0P:(DE-He78)0704701d58e3a0d5f45fbd1018d5aa77$$aPryanichnikov, Alexander$$b1$$eFirst author$$udkfz
000306900 7001_ $$aTochner, Zelig$$b2
000306900 7001_ $$aAllen, Aaron M$$b3
000306900 7001_ $$aFried, Iris$$b4
000306900 7001_ $$aGozal, David$$b5
000306900 7001_ $$aMarzeeq, Sean$$b6
000306900 7001_ $$aLedot, Stéphane$$b7
000306900 7001_ $$aWinograd, Shimshon$$b8
000306900 7001_ $$aSalhab, Ayman$$b9
000306900 7001_ $$aWygoda, Marc$$b10
000306900 7001_ $$aHillman, Yair$$b11
000306900 7001_ $$aFeldman, Jon$$b12
000306900 7001_ $$aPopovtzer, Aron$$b13
000306900 773__ $$0PERI:(DE-600)2885426-3$$a10.1016/j.ctro.2025.101080$$gVol. 56, p. 101080 -$$p101080$$tClinical and translational radiation oncology$$v56$$x2405-6308$$y2026
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