Proton Therapy for Childhood Cancers

Audrey Yerian, known to her friends and family as “Audge,” is a 10-year-old competitive cheerleader from Tomball, Texas. Her passion for cheer matches her incredible courage. So, when she was diagnosed with a rare and aggressive childhood brain tumor, she faced it with the same perseverance, courage and passion.

For years, Audrey had experienced brain tumor symptoms, including debilitating migraines and what were believed to be moments of daydreaming, later revealed to be focal seizures. Despite persistent advocacy from her parents, early imaging was delayed by her local doctors. A CT scan in October 2024 was read as a sinus infection by a neuro-radiologist, who missed signs of skull deformation.

But when Audrey began having six or more seizures a day, her parents pushed for an MRI. That scan led to a life-changing diagnosis of a Grade 3 anaplastic pleomorphic xanthoastrocytoma (APXA), a rare type of brain cancer.

Perseverance during brain tumor treatment

On Nov. 11, 2024, Audrey underwent a craniotomy at Texas Children’s Hospital. A craniotomy is the most common surgery to treat brain tumors and surgically remove the tumor. With a quick timeline to meet clinical trial requirements, she was immediately referred to MD Anderson Proton Therapy Center, where she began targeted proton therapy treatments under the care of pediatric radiation oncologist Gohar Manzar, M.D., Ph.D., followed by a two-year oral chemotherapy regimen at Texas Children’s Hospital under a clinical trial by the Children’s Oncology Group (COG).

Because protons can be precisely controlled, pediatric proton therapy is ideal for tumors located near growing tissues in the spinal cord, brain, eyes, ears or mouth.

Manzar recalls in their first day meeting that Audrey realized they had something in common – being an avid Taylor Swift fan. “She noticed my Swiftie status on my badge pin and requested that I play ‘Shake It Off’ on my guitar for her last weekly visit,” says Manzar. “It is the first time I ever played guitar for one of my patients as opposed to ukulele, and it was such a magical experience for all of us. The whole family sang along, and we got into the lyrics, which was so encouraging for Audrey.”

With the support of child life specialist Ellen Reynolds, Audrey completed six weeks of treatment without the need for sedation. This included an MRI that lasted nearly three hours, during which she had to remain completely still with her head secured in place.

My son Benjamin was born weighing only 3 pounds. He stayed in the NICU for seven months. It was challenging and financially draining. We had a kindergartener and toddler at home, while also visiting Benjamin at the hospital every day. 

When Benjamin was able to come home, he had a total parenteral nutrition (TPN) central line, an ostomy bag and a gastrostomy tube (G-tube) to receive nutrition.  

By the time he was 1, he was able to eat and have the ostomy bag and G-tube removed. Life was beginning to feel normal.  

At 2 years old, he jumped into a foam pit at a birthday party and came out holding his head to the side. When I asked if he felt hurt, he said no. I waited a few days thinking he had pulled a muscle in his neck. But the head tilt remained.  

When I took him to his pediatrician, they sent us to physical therapy. After two weeks, nothing had improved. We saw a neurologist who said he seemed happy and healthy with no other symptoms other than a head tilt. The neurologist ordered an MRI to be safe, but I remember her telling me that she did not think they would find anything.  

Before we left the hospital parking lot, I received a call saying the MRI results were in.  

A childhood brain tumor diagnosis 

That is when Benjamin was diagnosed with a type of brain tumor called a Grade 1 pilocytic astrocytoma. His oncologist at our local hospital recommended he start chemotherapy but suggested waiting on radiation therapy to give his body and brain time to grow so they could access the tumor better. 

A few months later, tests showed the tumor had grown. His care team decided to operate. Benjamin had just turned 3 years old when he underwent brain surgery. He then had two weeks of inpatient rehabilitation. This was rough on our family because we had two little girls at home. 

After six years of trying several types of chemotherapy, including two clinical trials, we were ready to try radiation therapy. I knew the tumor was still growing and Benjamin was having symptoms such as sleepiness and increased face paralysis. So, we decided to take a leap of faith, trust God and go to MD Anderson to have his tumor treated with proton beam therapy.  

Proton therapy is an advanced type of radiation treatment that uses a beam of protons to deliver radiation directly to the tumor, destroying cancer cells while sparing healthy tissues.  As a result, it minimizes side effects to prevent long-term complications. Because of the physical properties of proton beams, it is ideal for pediatric cancer patients with tumors located near growing tissues, especially in the brain, spine, eyes, ears or mouth. 

Perseverance through proton therapy treatment

In Sept. 2022, when Benjamin was 10 years old, he started proton therapy at MD Anderson under the care of Dr. David Grosshans. He had a wonderful experience at MD Anderson Proton Therapy Center. Benjamin told me it was the easiest treatment he has been through. He bonded with his care team and loved taking naps during treatment. On Nov. 4, he celebrated his last treatment by ringing the gong. 

During treatments, he did not have side effects. But after he completed proton therapy, he experienced some numbness on the left side of his body and weakness in his leg. He continues to go to physical therapy and that helps improve his strength. 

Benjamin is doing well, and the tumor is stable. He is working hard to get caught up at school. Missing school for treatment affected his learning the most. 

My advice to other parents is to bring a book and a snack to treatment. Keep a watchful eye on the patient and most of all, remember to take it one day at a time. 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

When Ben Gadot’s brain tumor symptoms began in 2013, he was just 3 months old. The first sign was a visual change in his eyes.  

“It was as if he was always looking down,” says Cecilia Gadot, Ben’s mom. “We could see mostly just the white part of his eyes.”

ER trip reveals childhood brain tumor

When Cecilia and her husband, Raphael, took Ben to their pediatrician, they were referred to an ophthalmologist. But Ben's health quickly started to decline. Cecilia remembers him being very fussy, crying and vomiting. They took him to a local emergency room.

A CT scan revealed a childhood brain tumor called pilomyxoid astrocytoma. Ben’s diagnosis was a Grade 2 optic pathway glioma.  

Ben started chemotherapy to slow the growth of the tumor at a nearby hospital.  

In 2016, he underwent tumor debulking surgery to remove as much of the tumor as possible. The tumor impaired Ben’s vision, and he started to experience precocious puberty at age 3.

In April 2021, Ben’s care team considered treating him with proton therapy but decided to keep him on chemotherapy to slow the tumor’s growth. In July 2022, Ben underwent a ventriculoperitoneal shunt surgery. By draining extra fluid in his brain, the shunt would help control pressure there.

Brain tumor growth leads to proton therapy treatments

But that September, an MRI showed a slight progression of the tumor. Ben’s care team decided it was time to start proton therapy at MD Anderson  under the care of radiation oncologist David Grosshans, M.D., Ph.D. Because protons can be precisely controlled, pediatric proton beam radiation is ideal for tumors near growing healthy tissues.  

On Oct. 17, 2022, Ben started 28 days of  proton therapy. With his positive attitude and the help of the child life team, he underwent treatments and MRIs without sedation. “The bond he had with his care team brought him a lot of trust and comfort,” says Cecilia.

Ben enjoyed playtime with child life assistant Leon Benavides in the playroom at the Proton Therapy Center before and after treatment.

“MD Anderson’s staff is very supportive and caring, from the front desk to the nurses, doctors, radiation therapists and, most importantly, child life specialists,” says Cecilia. “Ben’s time in the playroom with Mr. Leon was his daily reward and incentive.” 

Finding gratitude with a child in cancer treatment

Cecilia encourages other parents of pediatric cancer patients to find something to be grateful for each day. “The hardest part of treatment is waiting for it to start. Once it starts, it goes pretty smoothly and quickly,” she says. “So, take time to make each day a good day.”

Ben’s appointments were scheduled early in the morning so he could continue his daily routine. Most days he was able to go to school.  

On Nov. 23, 2022, a few days before Thanksgiving, Ben rang the gong with his family and care team cheering him on. “We are so grateful for MD Anderson for not only being the best place to receive proton therapy but for making Ben feel comfortable and cared for along the way.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.