Spectroscopic MRI-guided Proton Therapy for Pediatric High-Grade Glioma
This trial aims to assess the feasibility and safety of using spectroscopic MRI (sMRI) to define high dose (60 Gy) target volumes for proton therapy. Pediatric high-grade glioma (pHGG) is a devastating disease with a 3-year overall survival of less than 30%, and it is responsible for over 40% of childhood brain tumor mortality. Although its morphology and histology appear similar to adult HGG, the distinct genetic and molecular differences presented in pHGG have hampered the success of novel therapeutic treatments based on adult HGG research. Additionally, current standard of care radiation therapy (RT) mirrors that of adult HGG with standard anatomical imaging to guide RT. However, clinical imaging is unable to fully capture the extent of tumor especially as pHGG lesions are typically non-contrast enhancing. sMRI can provide a highly sensitive biomarker for tumor, and our previous studies have shown regions with a ratio of Cho/NAA ≥ 2x are correlated with metabolically active tumor. Proton therapy is an advanced radiation modality that allows for effective targeting of tumor with significant reduction of radiation exposure to surrounding healthy tissue as compared to conventional photon RT. We aim to evaluate the benefits of combining sMRI with proton therapy by reporting patient toxicity, quality of life, disease response, and clinical outcomes from treatment.