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Correspondence to Author: Elaijah Islam^1,2,5, Alexandra Chang ³ , Ethan Nguyen ⁴ , Kristen Pang ⁵ , Zara Kazmierczak^1,6,8, Samuel P. McKinnon^1,7,8, Arthur Olch Ph.D.¹ , Ramon Durazo-Arvizu, PhD ⁹ , and Kenneth Wong M.D. ¹ . 

1.Radiation Oncology Program, Children’s Hospital of Los Angeles, and Departments of Radiation Oncology and Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
2.McGovern Medical School at The University of Texas Health Science Center, Houston, Texas
3.Loyola Marymount University, Los Angeles, CA
4.University of California, Irvine, Irvine, CA
5.University of Notre Dame, Notre Dame, IN
6.Jacobs School of Medicine and Biomedical Sciences - University of Buffalo, Buffalo, NY
7.The Warren Alpert Medical School - Brown University, Providence, RI
8.Summer Oncology Research Fellowship (SORF) at Children’s Hospital Los Angeles (CHLA) and at the Norris Comprehensive Cancer Center at Keck School of Medicine at University of Southern California (USC)
9.Biostatistics and Data Analysis Core, Children’s Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA.

DOI: 10.52338/tjoro.2026.5173

Abstract:

he radiation oncology program at Children’s Hospital of Los Angeles (CHLA) offers advanced radiation therapy with photons with a wide range of treatment modalities and techniques such as total body irradiation, stereotactic body radiation therapy or stereotactic radiosurgery with image guidance. The patient’s diagnosis and location of tumor, among other factors, may determine the type of radiation therapy offered to patients. Some patients are referred to outside proton therapy centers if the clinical indication is present since CHLA does not offer proton therapy. Access to proton therapy is challenging because it is not available in Los Angeles County and may be difficult based on socioeconomic factors as proton therapy has a higher treatment cost than photon therapy (2, 4, 8, 9). In prior work that investigated patterns of care between photon and proton therapy recipients, potential racial and socioeconomic disparities in accessibility of proton therapy were identified. Bitterman et al. published in JAMA using data from the Children’s Oncology Group (COG) trials to explore if racial and socioeconomic factors were associated with patients who chose proton therapy. They found that black pediatric patients were least likely to receive proton therapy, and that patients who were more likely to receive proton therapy traveled farther distances for treatment (2). This pattern was corroborated by a subsequent study by Nogueria et al. which utilized the National Cancer Database to also conclude that black patients faced lower odds of receiving proton therapy than white patients. The disparities were most pronounced for cancers where proton therapy was recommended as the preferred radiation modality.

Citation:

Dr. Elaijah Islam, A Single-Institution Analysis: Patterns Of Care In Photon And Proton Radiotherapy In Pediatric Patients. The Journal of Radiation Oncology 2026.