Pediatric Radiation Oncology: Overview and Summary Notes

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...

Indian Journal of Medical and Paediatric Oncology

Introduction: Pediatric tumors are a heterogeneous group of malignant conditions requiring multimodal treatment, and management of such cases is at time challenging. We present the clinical profile of pediatric cancer patients who received radiation, either alone or as adjuvant to surgery and chemotherapy; in prophylactic, radical or palliative clinical setting. Aim: This study was envisaged to review our experience of pediatric oncology cases, their clinical and morphological profile, dosage schedule of radiotherapy, and the therapy induced complications. Settings and Design: This was a retrospective, observational study carried out in an apex tertiary care cancer institute of government setup in a developing country. Materials and Methods: The treatment charts and clinical summary of patients who had received radiation over the last 5 years period were retrieved and perused. Various clinical and pathological parameters were studied and inferences drawn. Results: A total of 50 patients got radiation over 5 year study-period, including 37 male and 13 female patients. The commonest age group of presentation was 8-12 years followed by 13-16 years. The mean age of presentation was 9.3 years. The most common diagnosis was hematological malignancies followed by CNS tumors with 21 and 13 patients respectively. Overall the most common indication of RT was in adjuvant setting after surgery as the definitive management, where 24 patients were irradiated; and the next common indication was prophylactic cranial irradiation in 14 patients of childhood leukemias. 10 patients tolerated treatment with Grade 1 site-specific or systemic toxicities while 7 patients developed Grade 2 and more systemic toxicities. 9 patients received craniospinal irradiation, common indications being medulloblastoma and Atypical teratoma rhabdoid tumor (ATRT). 3 patients received concurrent chemotherapy with weekly Inj Vincristine. 17 patients required sedation or short general anaesthesia for radiation planning and execution. Conclusion: External beam Radiotherapy constitutes an important component of management of pediatric cancers. One should be judicious in Radiotherapy planning, execution and monitoring acute and delayed toxicities.

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...

Seminars in Pediatric Neurology, 1997

Brain tumors in children are a diverse group of diseases that require multidisciplinary and subspecialty expertise. Radiation therapy is an established treatment cornerstone for these pediatric tumors. Basic concepts of radiation biology and physics provide a framework for understanding the ongoing evolution in radiation delivery techniques and current treatment paradigms. Standard techniques of pediatric central nervous system radiotherapy are included in this review, as well as newer techniques including conformal therapy, stereotactic radiosurgery, and fractionated stereotactic radiotherapy. Examples are provided to illustrate differences in treatment approaches. The appropriate application of each technique is discussed, and then outcomes and treatment sequelae are compared. Copyright 9 1997 by W.B. Saunders Company R ADIATION WAS FIRST used as a treatment in 1897.1 Physician and public enthusiasm for the beneficial effects of therapeutic radiation was initially excessive and misguided. For example, radiation treatment for acne, arthritis, and tinea capitis once achieved popularity. 2-4 The initial enthusiasm was followed by disappointment and resultant complications that confused both medical and lay understanding of the appropriate uses of radiation "treatment) Furthermore, radiation was identified as the mechanism of atomic catastrophe in Hiroshima and Nagasaki. 5 Coincident with these misunderstandings and misuses, the technology and basic and clinical science of therapeutic radiology have evolved. Advances in radiation biology, clinical medicine (radiotherapy), and medical physics have made pediatric central nervous system irradiation a virtually new field of endeavor where basic paradigms of treatment continue to change. In this framework, this article discusses the basic concepts of radiobiology, physics, and clinical medicine that are essential to an understanding of radiation treatment for pediatric central nervous system tumors. Then, this article discusses how radiation treatment is delivered and reviews expected outcomes of therapy from both tumor and complication vantage points. Finally, future directions and potential applications of radiotherapy are suggested.

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...

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.

Pediatric Blood & Cancer, 2021

Advances in multimodality therapy have led to childhood cancer cure rates over 80%. However, surgery, chemotherapy, and radiotherapy may lead to debilitating or even fatal long-term effects among childhood survivors beyond those inflicted by the primary disease process. It is critical to understand, mitigate, and prevent these late effects of cancer therapy to improve the quality of life of childhood cancer survivors. This review summarizes the various late effects of radiotherapy and acknowledges the Pediatric Normal Tissue Effects in the Clinic (PENTEC), an international collaboration that is systematically analyzing the association between radiation treatment dose/volume and consequential organ toxicities, in developing children as a basis to formulate recommendations for clinical practice of pediatric radiation oncology. We also summarize initiatives for survivorship and surveillance of late normal tissue effects related to radiation therapy among longterm survivors of childhood cancer treated in the past.

National Journal of Medical Research, 2014

Purpose: To evaluate the role of palliative radiotherapy in the management of advanced pediatric malignancies. Methods: Patients coming to the department of radiotherapy S.M.S Hospital were included in the study. Out of 40 patients 36 pediatric patients were selected between Nov 2010 to Nov 2012. 4 Patients were excluded from the study. Inclusion Criteria (1) Advanced Pediatric Malignancy (2) Age 1 to 20 yrs (3) Consents of parents (4) Symptomatic Patients.Exclusion Criteria (1) Early stage Disease (2)Asymptomatic Patients(3)Age <1 yrs and >20 yrs(4)No Consent All of theses 36 children received palliative external beam radiotherapy by cobalt 60. . The two dose schedules were used (1) 625cGy in 3 fractions (2) 30 Gy in 10 fractions. Results: There were 26 boys and 10 girls in the age group of 1 to 19 years, with a median age of 14 years (range of 1-19 years). Predominant symptoms were swelling, pain, bleeding, and weakness of limbs. The median duration of symptoms was 80 days (range of 4-40 days). The histological diagnosis was malignant round cell tumors (17); retinoblastoma (6); neuroblastoma (5); and Ewing's sarcoma (8). All patients presented with advanced stages of disease. Out of 36 patients 18 (50%) had disseminated disease at presentation. Some patients underwent surgery and chemo- therapy and all patients received palliative radiotherapy. Three patients showed complete resolution, 18 patients showed good, while 14 patients had little, 1 did not have any relief in their symptoms. At the completion of treatment, 16 patients had partial response, 8 patients had progressive disease, 10 had stable disease and 2 patients had complete response. Conclusions: So the role of radiotherapy is very important as palliative modality in children with locally advanced lesions.To evaluate the role of palliative radiotherapy in the management of advanced pediatric malignancies. Methods: Patients coming to the department of radiotherapy S.M.S Hospital were included in the study. Out of 40 patients 36 pediatric patients were selected between Nov 2010 to Nov 2012. 4 Patients were excluded from the study. Inclusion Criteria (1) Advanced Pediatric Malignancy (2) Age 1 to 20 yrs (3) Consents of parents (4) Symptomatic Patients.Exclusion Criteria (1) Early stage Disease (2)Asymptomatic Patients(3)Age <1 yrs and >20 yrs(4)No Consent All of theses 36 children received palliative external beam radiotherapy by cobalt 60.. The two dose schedules were used (1) 625cGy in 3 fractions (2) 30 Gy in 10 fractions. Results: There were 26 boys and 10 girls in the age group of 1 to 19 years, with a median age of 14 years (range of 1-19 years). Predominant symptoms were swelling, pain, bleeding, and weakness of limbs. The median duration of symptoms was 80 days (range of 4-40 days). The histological diagnosis was malignant round cell tumors (17); retinoblastoma (6); neuroblastoma (5); and Ewing's sarcoma (8). All patients presented with advanced stages of disease. Out of 36 patients 18 (50%) had disseminated disease at presentation. Some patients underwent surgery and chemotherapy and all patients received palliative radiotherapy. Three patients showed complete resolution, 18 patients showed good, while 14 patients had little, 1 did not have any relief in their symptoms. At the completion of treatment, 16 patients had partial response, 8 patients had progressive disease, 10 had stable disease and 2 patients had complete response. Conclusions: So the role of radiotherapy is very important as palliative modality in children with locally advanced lesions.

International Journal of Radiation Oncology*Biology*Physics, 1983

Single-dose half-body irradiation (HBI), introduced for the palliation of pain from widespread bone metastases in adults, has proved to be successful. Relief is obtained in a high proportion of patients, with upwards of two-thirds experiencing complete relief. Onset of response is fast and clinically valuable duration varies from 5 to 20 weeks. Objective evidence of tumor regression is found less frequently. The dose-limiting toxicity has proved to be acute radiation pneumonitis, with bone marrow tolerance of lesser importance, in spite of the fact that many patients received previous local irradiation and/or chemotherapy. Palliative HBI has not become a valuable treatment in pediatric malignancies, because of a shorter metastatic phase. Pediatric tumors usually have shorter cell cycle times and are more responsive to systemic agents. Results are described in selected institutions, where HBI has been used in the treatment of pediatric malignancies. A single institution pilot study was undertaken at the Princess Margaret Hospital involving 17 patients with Ewing's sarcoma of bone, without overt metastases at diagnosis. Results to date have not been obviously different from overall survival in the first intergroup Ewing's sarcoma study. Overall, the treatment has been shown to be well tolerated and can be given entirely on an out-patient basis. When compared on a historical basis with a previous single dose total body irradiation study, the one year survival rate was increased. HBI appears to be a tolerable treatment, when given concurrently with or sequential to local and systemic treatment.

Pediatric Radiology, 2009

Many pediatric cancer patients undergo multiple diagnostic and therapeutic radiologic procedures over the course of their illnesses and are therefore at high risk for radiation exposure. There are a variety of measures that radiologists can employ to reduce this risk. These include limiting the use of radiation whenever possible, using specific strategies to reduce radiation exposure during interventional procedures, using quality assurance programs to ensure compliance, and maintaining continuing staff radiation safety educational programs. Some of the diagnostic and therapeutic interventional radiologic procedures that are performed in pediatric oncology patients are discussed here, along with specific tips for managing radiation exposure.