Treatments

Proton Therapy for Childhood Cancers

Because proton therapy is so targeted, it can work very well for treating cancer in children. Children’s bodies are more sensitive to radiation than adults’ bodies. This puts them at higher risk for serious short- and long-term side effects, like growth and development problems or secondary tumors (cancers that are caused by treatment) later in life. But with proton therapy, we can reduce these risks.

Fred Hutchinson Cancer Center – Proton Therapy has radiation oncologists who specialize in proton therapy for children. We work closely with Seattle Children’s medical oncologists, surgeons, anesthesiologists and other specialists, as well as your child’s referring physician.

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Radiation oncologist A physician who has special training in using radiation to treat cancer. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.

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“I am very thankful to have had proton therapy because the risk of cancer in my body was decreased immensely and my heart was safe during treatment.”
— Cora, childhood cancer patient

Choosing Proton Therapy for Your Child

Here is some basic information about proton therapy and how treatment happens at Fred Hutch. 

Advantages of proton therapy over standard X-ray radiation

Less radiation means fewer short- and long-term side effects and lower risk for serious problems that may result from treatment. Studies show that proton therapy may help protect children from development problems, growth delays, lower IQ, cancer forming in other parts of their body and other health problems, compared to standard X-ray radiation.

Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
An illustration compares proton therapy with standard X-ray radiation for radiation treatment to the head and spine.
These pictures show radiation treatment to the head and spine. This may be done for cancer that started the nervous system, like medulloblastoma, or that spread there from another part of the body. The colored areas get radiation. The black, gray and white areas do not. With proton therapy (left), less healthy tissue is exposed to radiation. With standard X-ray radiation therapy (right), more healthy tissue is exposed.

Medulloblastoma is a common childhood cancer that usually starts in the lower part of the brain in the back of the skull. It often spreads to other parts of the central nervous system (brain and spinal cord). Proton therapy can be a good treatment option because it sends less radiation to the heart, lungs and abdomen compared to standard radiation therapy. Less radiation to these vital organs lowers the chance that your child will have health problems years later.

Standard X-ray radiation therapy for childhood brain cancer can have serious side effects. For example, if radiation hits a part of the brain called the hypothalamus, it might affect chemicals (neurohormones) that are made there. This can affect your child’s levels of growth and thyroid hormones — and how well they grow and develop in the future. The goal with proton radiation therapy is to lower the risk that radiation will harm healthy parts of your child’s brain.

Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. medulloblastoma A fast-growing type of cancer that forms in the cerebellum (the lower, back part of the brain).

Medulloblastomas tend to spread through the cerebrospinal fluid to the spinal cord or to other parts of the brain. They may also spread to other parts of the body, but this is rare. Medulloblastomas are most common in children and young adults. They are a type of central nervous system embryonal tumor.

Advantages of proton therapy over standard X-ray radiation

Physicians usually recommend proton radiation therapy to treat solid tumors in children because it sends less radiation to healthy tissue than standard radiation therapy does.

Childhood cancers treated with proton therapy

These are some of the many childhood cancers that may be treated with protons:

  • Anaplastic astrocytoma 
  • Atypical teratoid/rhabdoid tumor
  • Chordoma
  • Craniopharyngioma 
  • Desmoid tumor 
  • Ependymoma 
  • Ewing sarcoma 
  • Gliomas, including optic pathway/hypothalamic glioma, oligodendroglioma and oligoastrocytoma
  • Glioblastoma
  • Intracranial germ cell tumors (germinoma)
  • Juvenile angiofibromas 
  • Lymphoma 
  • Medulloblastoma 
  • Meningioma
  • Nasopharyngeal carcinoma 
  • Neuroblastoma 
  • Osteosarcoma 
  • Pineoblastoma 
  • Retinoblastoma 
  • Rhabdomyosarcoma 
Lymphoma Cancer that begins in the cells of the immune system. There are two basic categories of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphomas. Cancer that begins in cells of the immune system. There are two basic categories of lymphomas. One is Hodgkin lymphoma, which is marked by the presence of a type of cell called the Reed-Sternberg cell. The other category is non-Hodgkin lymphomas, which includes a large, diverse group of cancers of immune system cells. Non-Hodgkin lymphomas can be further divided into cancers that have an indolent (slow-growing) course and those that have an aggressive (fast-growing) course. These subtypes behave and respond to treatment differently. Both Hodgkin and non-Hodgkin lymphomas can occur in children and adults, and prognosis and treatment depend on the stage and the type of cancer. Neuroblastoma Cancer that forms from immature nerve cells. Usually begins in the adrenal glands but may begin in the abdomen, chest or nerve tissue near the spine. Most often occurs in children younger than age 5. A type of cancer that forms from immature nerve cells. It usually begins in the adrenal glands but may also begin in the abdomen, chest, or in nerve tissue near the spine. Neuroblastoma most often occurs in children younger than 5 years of age. It is thought to begin before birth. It is usually found when the tumor begins to grow and cause signs or symptoms. medulloblastoma A fast-growing type of cancer that forms in the cerebellum (the lower, back part of the brain).

Medulloblastomas tend to spread through the cerebrospinal fluid to the spinal cord or to other parts of the brain. They may also spread to other parts of the body, but this is rare. Medulloblastomas are most common in children and young adults. They are a type of central nervous system embryonal tumor.

Childhood cancers treated with proton therapy

Physicians prefer protons over standard radiation therapy for many different childhood cancers.

    Anesthesia

    For proton therapy to be precise, the patient needs to be in the exact same position for each treatment and hold very still. To help with this, the care team uses tools like bean bags and masks that keep your child in one place (immobilization devices). Even so, holding still can be hard for very young children. 

    If your child has a hard time staying in one place, their physician may suggest general anesthesia, a medicine that will make your child fall asleep before a procedure. Anesthesiologists from Seattle Children’s, who specialize in working with children, provide our anesthesia services. 

    Although some children may need anesthesia for the entire treatment time, we offer a program for some children aged five and older to encourage them to avoid or wean off the need for anesthesia. We have a child life specialist and other experts who can help your child with this. Anesthesia is not available for adult patients.

    Anesthesia Drugs or other substances that cause a loss of feeling or awareness. This keeps patients from feeling pain during surgery or other procedures. A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body, such as the mouth. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep.
    Anesthesia

    Depending on your child’s age, they may need anesthesia to make them go to sleep before each proton therapy session. Anesthesia makes sure your child will hold still so their treatment is accurate.

    Child life specialists

    We understand that your child’s cancer can be very challenging for your whole family, but you’re not alone. We have a skilled and caring child life specialist to help you. Child life specialists are pediatric health care professionals. They work with children and families in hospitals and other settings. They’re here to help you and your child understand what is happening. Seattle Children’s also offers counseling. 

    A child life specialist can:

    • Explain a condition or treatment in words your child or teen can understand
    • Create a coping plan your child can use during the treatments
    • Offer support during and after treatments
    • Use play to help your child understand medical procedures and express feelings
    • Work with medical staff to learn your child’s exact needs
    • Give you details about child development and the effects of health care on kids
    • Teach you and your child ways to help your child cope and relax
    • Guide you and your family members with ways to talk with your child about treatment

    If your child will be starting treatment or is already in treatment at Fred Hutchinson Cancer Center – Proton Therapy, feel free to reach out to our child life specialist, Erin Behen, directly. Erin can help you learn clear and age-appropriate ways to talk with your child about treatment. Call (206) 306-2812.

    For resources on preparing your child for proton therapy, check out our coloring books and teen guides on the Resources page.

    Child life specialists

    At our proton therapy facility, your family will be able to see a child life specialist for support. We encourage you to reach out to them any time during your child’s proton therapy care.

    A proton therapy care team member shows a young child a small scale model of a CT machine with a doll in place of where the patient would lie-down during the treatment.
    Our child life specialists know many ways to help children understand their treatment and feel more comfortable with getting care. For example, this model of a computed tomography (CT) machine helps young patients learn what to expect during the scan we do to plan their proton therapy.

    Explaining Proton Therapy to Your Child or Teen

    When your child asks questions about cancer or treatment, be honest. If you are not open with them, their mind may come up with ideas that are worse than the truth. Here are some tips and resources to support you in talking with your child. For more support, please call our child life specialist, Erin Behen, at (206) 306-2812.

    Tips for talking with your child about proton therapy
    • Use words that match their age. 
    • Encourage them to share their feelings. 
    • Ask questions. Ask them what they understand (it’s often a lot more than we think) and what they want to know. Don’t overthink your answers. Your first instinct about how to answer is probably a good one. Let them ask follow-up questions.
    • Sometimes children don’t ask questions because they worry about what the answer might be. You can help by letting them know that it’s OK to ask questions. Other times, children might ask the same question many times to work through their feelings. This is normal.
    • Remember that you’re not alone. Our doctors, nurses, child life specialist and other members of the care team are with you and your child each step of the way before, during and after proton therapy.
    • If your child feels nervous about getting proton therapy, they might like to have a tour of the facility to see the radiation technologists and equipment. We will be happy to set up a tour for you. 
    What to expect during proton therapy – coloring books

    Our child life specialist and other team members made coloring books to help your child know what to expect at our proton therapy facility. You can download a printable version based on your child’s needs.

    My child needs a mask and anesthesia 

    My child needs a mask but no anesthesia 

    My child needs anesthesia but no mask 

    My child does not need anesthesia or a mask

    I don’t know what my child needs yet

    What to expect during proton therapy – a guide for teens

    This guidebook was made to help your teenager understand what they can expect when getting proton therapy care at Fred Hutch. Our goal is to help teens feel more comfortable with the proton therapy process and encourage them to ask questions. 

    A Guide for What to Expect During Proton Therapy for Teens (PDF)

    Learn More

    Meet Our Team

    Our proton therapy team is here not only to treat your disease, but to listen to you and take care of you and your family. They are experts in proton therapy who focus on giving you personalized radiation treatment and who understand your questions, needs and concerns.

    Layne  Chapple, ARNP
    Layne Chapple, ARNP
    Advanced Practice Provider
    Advanced Registered Nurse Practitioner
    Hematology Oncology
    Ralph P. Ermoian, MD
    Ralph P. Ermoian, MD
    Physician
    Radiation Oncology
    Stephanie  K. Schaub, MD
    Stephanie K. Schaub, MD
    Physician
    Radiation Oncology

    Child Life Specialist

    Erin Behen, MS, CCLS
    Erin Behen, MS, CCLS

    As a child life specialist, Erin works with children to develop coping mechanisms, discuss treatments, and help parents figure out the best ways to support their children during treatment. Her day may include helping caregivers decide whether a child requires sedation, and if so, preparing the child for it; playing with kids to open up communication and answer questions; giving children choices and a voice in their treatment; and helping them get accustomed to the equipment, processes and side effects.