THE PEDIATRIC RADIATION ONCOLOGY SOCIETY (PROS): WHY

International journal of radiation oncology, biology, physics, 2018

Our aim was to review the advances in radiation therapy for the management of pediatric cancers made by the Children's Oncology Group (COG) radiation oncology discipline since its inception in 2000. The various radiation oncology disease site leaders reviewed the contributions and advances in pediatric oncology made through the work of the COG. They have presented outcomes of relevant studies and summarized current treatment policies developed by consensus from experts in the field. The indications and techniques for pediatric radiation therapy have evolved considerably over the years for virtually all pediatric tumor types, resulting in improved cure rates together with the potential for decreased treatment-related morbidity and mortality. The COG radiation oncology discipline has made significant contributions toward the treatment of childhood cancer. Our discipline is committed to continuing research to refine and modernize the use of radiation therapy in current and future p...

2021

Cancer is the leading cause of death in children worldwide. Pediatric cancer is challenging to detect early because it generally appears with signs and symptoms that are not typical. The increase in cancer cases in pediatric must be followed by an increase in cancer management in all fields of scientific disciplines. Radiation oncology, as one of the areas of science, has an essential role in definitive, adjuvant, palliative, and prophylactic cancer in pediatric. Apart from these uses, radiation management is a significant contributor to the complications of pediatric cancer survivors. Complications that arise can be in the form of growth retardation, tissue changes, secondary cancer, neurocognitive changes, infertility, or other hormonal dysfunction and preterm labor. An increase in radiation techniques followed the development of treatment machines able to reduce radiation-related morbidity and mortality rates. In pediatric radiotherapy, the entire process from the pre-procedure a...

Journal of Cancer Prevention & Current Research, 2015

This article aims to give a brief description of the history and overview of radiation therapy, as well as its most common pediatrics indications, restraint, sedation and treatment techniques employed, and finally discuss the possible side effects that may occur in our small "great "pediatric patients.

Oncology Issues, 2018

International Journal of Radiation Oncology*Biology*Physics, 2013

Purpose-This study was undertaken to assess historical trends in the use of radiation therapy (RT) for pediatric cancers over the past 4 decades. Methods-The National Cancer Institute's Surveillance, Epidemiology, and End Results database of the 9 original tumor registries (SEER9) was queried to identify patients aged 0-19 years with acute lympholytic leukemia (ALL), acute myeloid leukemia (AML), bone and joint, brain and other nervous system, Hodgkin's lymphoma (HL), neuroblastoma, non-Hodgkin's lymphoma (NHL), soft tissue, Wilms tumor, or retinoblastoma from 1973 to 2008. Patients were grouped into 4 year time epochs. Number and percentage of patients who received RT as a part of initial treatment were calculated per epoch by each diagnosis group from 1973-2008. Results-RT usage for ALL, NHL, and retinoblastoma declined sharply from 57%, 57%, and 30% in 1973-76 to 11%, 15%, and 2% in 2005-08, respectively. Similarly, smaller declines in RT usage were also seen in brain (70% to 39%), bone (41% to 21%), Wilms tumors (75% to 53%), and neuroblastoma (60% to 25%). RT usage curves for Wilms tumors and neuroblastoma were nonlinear with nadirs in 1993-96 at 39% and 19%, respectively. There were minimal changes in RT use for HL, soft tissue cancers, or AML, roughly stable at 72%, 40%, and 11%, respectively. Almost all patients treated with RT were given exclusively external beam radiation therapy (EBRT). However, from 1985-2008, treatments involving brachytherapy, radioisotopes, or combination therapy increased in frequency, comprising 1.8%, 4.6%, and 11.9% of RT treatments in brain cancer, soft tissue cancer, and retinoblastoma, respectively. Conclusions-The use of RT is declining over time in seven out of ten pediatric cancer categories. A limitation of this study is a potential underascertainment of radiotherapy usage in the SEER9 database including the delayed use of RT.

Asian Pacific Journal of Cancer Care

Background: Incidences of pediatric malignancies are increasing. In management of various childhood malignancies like hematological, bone and soft tissue tumors radiotherapy plays a crucial role. RT treatment planning and delivery poses a challenge to clinicians. Hence with this study we wanted to know the radiotherapy practices in our institution. Materials and Methods: This was a retrospective study analyzing case records and RT charts of all pediatric malignancies who received radiation treatment for a period of 3 years from January 2018 to December 2021. Demographic details, RT details, toxicity details were carefully recorded. Results: Details of 73 pediatric malignancy cases who received RT were analyzed. Median age was 10 years and the majority were males (66%). Commonest malignancies which received RT treatment were ALL (30%), Brain tumors (26%) and bone and soft tissue tumors (22%). Radiotherapy was given as a part of radical intent treatment including neo adjuvant, definit...

Pediatric Radiology, 2009

The biological effects of radiation result primarily from damage to DNA. There are three effects of concern to the radiologist that determine the need for radiation protection and the dose principle of ALARA (As Low As Reasonably Achievable). (1) Heritable effects. These were thought to be most important in the 1950s, but concern has declined in recent years. The current ICRP risk estimate is very small at 0.2%/Sv. (2) Effects on the developing embryo and fetus include weight retardation, congenital anomalies, microcephaly and mental retardation. During the sensitive period of 8 to 15 weeks of gestation, the risk estimate for mental retardation is very high at 40%/Sv, but because it is a deterministic effect, there is likely to be a threshold of about 200 mSv. (3) Carcinogenesis is considered to be the most important consequence of low doses of radiation, with a risk of fatal cancer of about 5%/Sv, and is therefore of most concern in radiology. Our knowledge of radiation carcinogenesis comes principally from the 60-year study of the A-bomb survivors. The use of radiation for diagnostic purposes has increased dramatically in recent years. The annual collective population dose has increased by 750% since 1980 to 930,000 person Sv. One of the principal reasons is the burgeoning use of CT scans. In 2006, more than 60 million CT scans were performed in the U.S., with about 6 million of them in children. As a rule of thumb, an abdominal CT scan in a 1-year-old child results in a life-time mortality risk of about one in a thousand. While the risk to the individual is small and acceptable when the scan is clinically justified, even a small risk when multiplied by an increasingly large number is likely to produce a significant public health concern. It is for this reason that every effort should be made to reduce the doses associated with procedures such as CT scans, particularly in children, in the spirit of ALARA.

Clinical Oncology, 2021

Aims: Childhood cancer survival is suboptimal in most low-and middle-income countries (LMICs). Radiotherapy plays a significant role in the standard care of many patients. To assess the current status of paediatric radiotherapy, the International Atomic Energy Agency (IAEA) undertook a global survey and a review of practice in eight leading treatment centres in middle-income countries (MICs) under Coordinated Research Project E3.30.31; 'Paediatric radiation oncology practice in low and middle income countries: a patterns-of-care study by the International Atomic Energy Agency.' Materials and methods: A survey of paediatric radiotherapy practices was distributed to 189 centres worldwide. Eight leading radiotherapy centres in MICs treating a significant number of children were selected and developed a database of individual patients treated in their centres comprising 46 variables related to radiotherapy technique. Results: Data were received from 134 radiotherapy centres in 42 countries. The percentage of children treated with curative intent fell sequentially from highincome countries (HICs; 82%) to low-income countries (53%). Increasing deficiencies were identified in diagnostic imaging, radiation staff numbers, radiotherapy technology and supportive care. More than 92.3% of centres in HICs practice multidisciplinary tumour board decision making, whereas only 65.5% of centres in LMICs use this process. Clinical guidelines were used in most centres. Practice in the eight specialist centres in MICs approximated more closely to that in HICs, but only 52% of patients were treated according to national/international protocols whereas institution-based protocols were used in 41%. Conclusions: Quality levels in paediatric radiotherapy differ among countries but also between centres within countries. In many LMICs, resources are scarce, coordination with paediatric oncology is poor or non-existent and access to supportive care is limited. Multidisciplinary treatment planning enhances care and development may represent an area where external partners can help. Commitment to the use of protocols is evident, but current international guidelines may lack relevance; the development of resources that reflect the capacity and needs of LMICs is required. In some LMICs, there are already leading centres experienced in paediatric radiotherapy where patient care approximates to that in HICs. These centres have the potential to drive improvements in service, training, mentorship and research in their regions and ultimately to improve the care and outcomes for paediatric cancer patients.

Journal of Pediatric Hematology/Oncology, 2019

Objective: To question the risks/benefits of ionizing radiation imaging during initial systemic chemotherapy for children with sarcoma. Methods: Results from studies over the last 15 years for the three most common newly diagnosed sarcoma patients, osteosarcoma (OST), Ewing's sarcoma (EWS), and rhabdomyosarcoma (RMS) treated on the Children Oncology Group (COG) open phase III protocols were reviewed. We recorded the number of chest X-Rays, lung CTs, bone scans, and PET scans required for each patient during chemotherapy for each protocol and calculated the total radiation exposure based on chest x-rays delivering 0.2mGy per scan, lung CTs delivering 7.0mGy per scan, bone scans delivering 6.3mGy per scan, and PET delivering 25 mGy per scan (2,3). Additionally, we documented the number of patients who were removed from protocol during chemotherapy (induction or consolidation) because of new or progressive disease detected on required imaging. Results: Combining all the sarcoma protocols, only 196 out of 5,901 patients were found to have cancer progression detected through imagining during chemotherapy. The percent of patients found to have progressive disease by type of sarcoma was 0.2% of EWS, 6.3% of OST, 0.8% of RMS. Out of the patients without progressive disease, a total of 30036 imaging scans during chemotherapy were done. These radiation exposure events totaled 182,621.5 mGy of radiation, exposing the average child to 32.0mGy. Conclusion/Significance: In our preliminary meta-analysis early progressive or relapsed disease was only detected 3.3% of the time in 5901 patients, and the average child was exposed to an ionizing radiation dose of 32 mGy. Decreasing or eliminating these exposures during chemotherapy or replacing those deemed necessary with non-ionizing modalities may tip the risk benefit ratio back towards a benefit.

Diagnostic and interventional radiology (Ankara, Turkey)

The number of radiological exams performed on children increases each year. We assessed the current understanding of radiation doses and risks among a sample group of pediatricians and evaluated whether the latest efforts to improve radiation awareness affected the results. A multiple-choice survey comprising 16 questions was answered by 237 pediatricians in 10 hospitals. Although the overall knowledge was poor, underestimation of radiation doses of common radiological procedures was significantly lower (75.2%) than that reported in previous surveys (87%-97%). In contrast to previous reports, the percentage of underestimates did not increase for computed tomography (74.8%), and residents scored (7.5±5.1) better than specialists (11.0±6.3) in estimating the radiation doses (P < 0.001). Only 3.1% of the pediatricians had received formal education on medical radiation, and 89% were not aware of the ALARA (As Low As Reasonably Achievable) principle. Pediatricians' radiation dose ...