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@ARTICLE{Blumenfeld:306900,
      author       = {P. Blumenfeld and A. Pryanichnikov$^*$ and Z. Tochner and
                      A. M. Allen and I. Fried and D. Gozal and S. Marzeeq and S.
                      Ledot and S. Winograd and A. Salhab and M. Wygoda and Y.
                      Hillman and J. Feldman and A. Popovtzer},
      title        = {{P}ediatric {CNS} relapse of neuroblastoma treated with
                      upright proton craniospinal irradiation.},
      journal      = {Clinical and translational radiation oncology},
      volume       = {56},
      issn         = {2405-6308},
      address      = {Amsterdam},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2025-02875},
      pages        = {101080},
      year         = {2026},
      note         = {#EA:E041# / 2025 Nov 19:56:101080.},
      abstract     = {Craniospinal 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.},
      keywords     = {Craniospinal irradiation (Other) / Pediatric treatments
                      (Other) / Proton therapy (Other) / Upright radiation therapy
                      (Other)},
      cin          = {E041},
      ddc          = {610},
      cid          = {I:(DE-He78)E041-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41362481},
      pmc          = {pmc:PMC12681917},
      doi          = {10.1016/j.ctro.2025.101080},
      url          = {https://inrepo02.dkfz.de/record/306900},
}