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Treatment of pediatric patients and young adults with particle therapy at the Heidelberg Ion Therapy Center (HIT): establishment of workflow and initial clinical data

Stephanie E Combs1*, Kerstin A Kessel1, Klaus Herfarth1, Alexandra Jensen1, Susanne Oertel1, Claudia Blattmann2, Swantje Ecker3, Angelika Hoess3, Eike Martin4, Olaf Witt25, Oliver Jäkel13, Andreas E Kulozik2 and Jürgen Debus1

Author Affiliations

1 Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany

2 Department of Pediatric Hematology and Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany

3 Heidelberg Ion Therapy Center (HIT), Im Neuenheimer Feld 450, Heidelberg, 69120, Germany

4 Department of Anaesthesiology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany

5 CCU Pediatric Oncology, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, 69120, Germany

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Radiation Oncology 2012, 7:170  doi:10.1186/1748-717X-7-170

Published: 17 October 2012



To report on establishment of workflow and clinical results of particle therapy at the Heidelberg Ion Therapy Center.

Materials and methods

We treated 36 pediatric patients (aged 21 or younger) with particle therapy at HIT. Median age was 12 years (range 2-21 years), five patients (14%) were younger than 5 years of age. Indications included pilocytic astrocytoma, parameningeal and orbital rhabdomyosarcoma, skull base and cervical chordoma, osteosarcoma and adenoid-cystic carcinoma (ACC), as well as one patient with an angiofibroma of the nasopharynx. For the treatment of small children, an anesthesia unit at HIT was established in cooperation with the Department of Anesthesiology.


Treatment concepts depended on tumor type, staging, age of the patient, as well as availability of specific study protocols. In all patients, particle radiotherapy was well tolerated and no interruptions due to toxicity had to be undertaken. During follow-up, only mild toxicites were observed. Only one patient died of tumor progression: Carbon ion radiotherapy was performed as an individual treatment approach in a child with a skull base recurrence of the previously irradiated rhabdomyosarcoma. Besides this patient, tumor recurrence was observed in two additional patients.


Clinical protocols have been generated to evaluate the real potential of particle therapy, also with respect to carbon ions in distinct pediatric patient populations. The strong cooperation between the pediatric department and the department of radiation oncology enable an interdisciplinary treatment and stream-lined workflow and acceptance of the treatment for the patients and their parents.

Proton radiation; Carbon ion radiotherapy; Children