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

• Published in: Pediatric blood & cancer 2017-11, Vol.64 (11), p.n/a
• Main Authors: Rao, Avani Dholakia, Chen, Qinyu, Ermoian, Ralph P., Alcorn, Sara R., Figueiredo, Maria Luisa S., Chen, Michael J., Dieckmann, Karin, MacDonald, Shannon M., Ladra, Matthew M., Kobyzeva, Daria, Nechesnyuk, Alexey V., Nilsson, Kristina, Ford, Eric C., Winey, Brian A., Villar, Rosangela C., Terezakis, Stephanie A.
• Format: Article
• Language: English
• Subjects: Abdomen; Adolescent; Adult; Anesthesia; Background radiation; Bone tumors; Brain; Brain tumors; Child; Child, Preschool; Clinical trials; Compression; Ewing's sarcoma; Female; Follow-Up Studies; Hematology; Humans; Infant; Infant, Newborn; Institutions; International Agencies; Irradiation; Leukemia; Lungs; Lymphoma; Male; Mediastinum; Medulloblastoma; Metastases; Neck; Neoplasm Staging; Neoplasms - pathology; Neoplasms - radiotherapy; Neuroblastoma; Oncology; Osteosarcoma; Pain; Palliation; Palliative Care; palliative radiation therapy; palliative therapy; pediatric radiation therapy; Pediatrics; Pelvis; Practice Patterns, Physicians' - standards; Prognosis; Protons; Radiation; Radiation therapy; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Intensity-Modulated - methods; Rhabdomyosarcoma; Sarcoma; Spine; Toxicity; Tumors; Young Adult
• ISSN: 1545-5009; 1545-5017; 1545-5017
• DOI: 10.1002/pbc.26589

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.