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Observational Study
. 2025 Dec;27(12):4526-4532.
doi: 10.1007/s12094-025-03972-4. Epub 2025 Jun 19.

Development of a practice-based score to predict extended duration of proton beam therapy session in pediatric patients

José M Fernández-de Miguel  1 , Miguel Ángel García-Aroca  2 , Ignacio Manrique Yera  3 , Felipe A Calvo  4 , María Aymerich de Francesci  1 , Jose Manuel Álvarez Avello  1 , Elena Panizo Morgado  5 , Jorge M Núñez-Córdoba  6   7   8
Affiliations
Observational Study

Development of a practice-based score to predict extended duration of proton beam therapy session in pediatric patients

José M Fernández-de Miguel et al. Clin Transl Oncol. 2025 Dec.

Abstract

Purpose: Due to the labor intensity demanded by proton beam therapy (PBT) in pediatric patients, information on operational procedures related to efficiency is crucial to optimize quality and safety. We aimed to identify patient factors that affect the duration of the pediatric PBT session and to develop an easy-to-use predictive score of extended duration.

Methods/patients: This is an observational retrospective cohort study in an academic medical centre, between May 2020 and February 2024. Seventy seven ASA III pediatric patients treated with PBT were recruited.

Results: The mean age was 4.8 years [standard deviation (SD): 2.1] and 52% were women. The mean duration of the PBT session was 50 min (SD: 17). Extended duration of the PBT session (> 45 min) occurred in 39 patients (51%). Five predictors of extended duration were selected for the final prediction model. In the multivariable model, an age > 45 months showed a near eightfold increased odds of extended duration [Odds ratio (OR): 7.76, 95% confidence interval (95% CI) 1.63-36.99, P = 0.010]. The OR (95% CI) for long-term venous access, no recurrent tumors, hydrocephalus, and craniospinal location were 5.91 (1.47 to 23.79), 3.81 (0.67 to 21.69), 3.79 (0.90 to 15.97), and 2.59 (0.69 to 9.76), respectively. This five-variable model was used to build a nomogram-based score with an area under the receiver operating characteristic curve of 0.84 (95% CI 0.76-0.93).

Conclusions: A simple nomogram based on readily available pretreatment data has potential for planning pediatric PBT standard clinical expert practice.

Keywords: Pediatric cancer; Proton beam therapy; Treatment planning.

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Conflict of interest statement

Declarations. Conflict of interest: The authors have no competing interests to declare that are relevant to the content of this article. Ethical approval and informed consent: The study was approved by the Research Ethics Committee of the University of Navarra (Date: June 13, 2024. Project number: 2024.11) and adhered to the Revised Declaration of Helsinki [13]. The need to obtain informed written consent from patients was waived due to the retrospective nature of the study.

Figures

Fig. 1
Fig. 1
Nomogram using 5 readily available clinical characteristics to predict extended duration of proton beam therapy session in pediatric patients. LTVA: long-term venous access. PT: primary tumor (no recurrent tumor). To calculate probability of extended duration, first determine score for each factor by drawing vertical line from that factor to “score”. Then sum all individual values and draw vertical line from “total score” to probability of extended duration
Fig. 2
Fig. 2
ROC curve for the five-variable nomogram to predict extended duration of proton beam therapy sessions. NPV negative predictive value, PPV positive predictive value, Se sensitivity, Sp specificity
See this image and copyright information in PMC

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