Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium

Title

Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium

Creator

Rao AD; Chen Q; Ermoian RP; Alcorn SR; Figueiredo MLS; Chen MJ; Dieckmann K; MacDonald SM; Ladra MM; Kobyzeva D; Nechesnyuk AV; Nilsson K; Ford EC; Winey BA; Villar RC; Terezakis SA

Identifier

Publisher

Pediatric Blood And Cancer

Date

2017

Subject

Childhood Cancer/rt [radiotherapy]; Palliative Therapy; Anesthesia; Article; Brain Metastasis; Cancer Patient; Child; Cone Beam Computed Tomography; Conformal Radiotherapy; Electron Therapy; Ependymoma; Ewing Sarcoma; Health Survey; Histopathology; Human; Intensity Modulated Radiation Therapy; Intestine Obstruction; Leukemia; Lymphoma; Major Clinical Study; Malignant Neoplasm; Medulloblastoma; Metastasis; Neuroblastoma; Osteosarcoma; Pain; Primary Tumor; Priority Journal; Proton Therapy; Radiation Dose Fractionation; Radiosensitivity; Re-irradiation; Respiratory Tract Disease; Rhabdomyosarcoma; Spinal Cord Compression; Stereotactic Body Radiation Therapy; Stomach Distension

Description

Background/Objectives: The practice of palliative radiation therapy (RT) is based on extrapolation from adult literature. We evaluated patterns of pediatric palliative RT to describe regimens used to identify opportunity for future pediatric-specific clinical trials. Design/Methods: Six international institutions with pediatric expertise completed a 122-item survey evaluating patterns of palliative RT for patients <=21 years old from 2010 to 2015. Two institutions use proton RT. Palliative RT was defined as treatment with the goal of symptom control or prevention of immediate life-threatening progression. Results: Of 3,225 pediatric patients, 365 (11%) were treated with palliative intent to a total of 427 disease sites. Anesthesia was required in 10% of patients. Treatment was delivered to metastatic disease in 54% of patients. Histologies included neuroblastoma (30%), osteosarcoma (18%), leukemia/lymphoma (12%), rhabdomyosarcoma (12%), medulloblastoma/ependymoma (12%), Ewing sarcoma (8%), and other (8%). Indications included pain (43%), intracranial symptoms (23%), respiratory compromise (14%), cord compression (8%), and abdominal distention (6%). Sites included nonspine bone (35%), brain (16% primary tumors, 6% metastases), abdomen/pelvis (15%), spine (12%), head/neck (9%), and lung/mediastinum (5%). Re-irradiation comprised 16% of cases. Techniques employed three-dimensional conformal RT (41%), intensity-modulated RT (23%), conventional RT (26%), stereotactic body RT (6%), protons (1%), electrons (1%), and other (2%). The most common physician-reported barrier to consideration of palliative RT was the concern about treatment toxicity (83%). Conclusion: There is significant diversity of practice in pediatric palliative RT. Combined with ongoing research characterizing treatment response and toxicity, these data will inform the design of forthcoming clinical trials to establish effective regimens and minimize treatment toxicity for this patient population.

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Citation List Month

Oncology 2017 List

Collection

Citation

Rao AD; Chen Q; Ermoian RP; Alcorn SR; Figueiredo MLS; Chen MJ; Dieckmann K; MacDonald SM; Ladra MM; Kobyzeva D; Nechesnyuk AV; Nilsson K; Ford EC; Winey BA; Villar RC; Terezakis SA, “Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium,” Pediatric Palliative Care Library, accessed December 3, 2021, https://pedpalascnetlibrary.omeka.net/items/show/11180.

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