Clinical outcomes and toxicity following palliative radiotherapy for childhood cancers

Abstract

Background: Few reports of palliative radiotherapy (RT) for pedialltric malignancies have been published. We described clinical indications, outcomes, and toxicities for children who received palliative RT.Procedure: Pediatric patients (age ≤18 years) treated with palliative RT for incurable cancer from January 1 2008 to February 26, 2014 were included. Diagnosis, details of RT, treatment response, toxicity, and survival were retrospectively reviewed.Results: Forty-six patients received 76 RT courses. Fifteen patients (33%) had ≥2 courses. Median age at palliative RT was 10.3 years; 54% were male. The most common diagnoses were neuroblastoma (20%) and diffuse intrinsic pontine glioma (17%). The most common indications for RT were oligometastatic disease in asymptomatic patients (39%) and pain (25%). The most common treatment sites were brain (32%) and bone (29%). Median RT dose was 30 Gy. Median number of RT fractions was 12. Sixty-five treatment courses (86%) were delivered with fraction sizes ≥2.5 Gy.Twenty-seven treatment courses (36%) were given under general anesthesia. Median follow-up was 3.9 months. Grade 1-2 RT-related toxicity occurred in 21% of treatment courses and 4-8% up to 12 months after RT. Two patients had Grade 3 toxicity during RT (esophagitis). Of symptomatic patients, 91%, 73%, 58%, and 43% had improved or stable symptoms during RT and 0-3, 3-6, and 6-12 months afterwards, respectively. Median survival after palliative RT was 4.2 months. Four of 21 surviving patients (19%) had hospice care at last follow-up. Conclusions:Palliative RT was well tolerated in children with incurable malignancies, with most cases associated with acceptable toxicity, and improved or stable symptoms.

Pediatric Non–Brain Stem High-Grade Glioma: A Single-Center Experience

“…Some studies have declared a higher incidence of seizure in PHGG compared with adult HGG. 5,16 The incidence of seizure has been reported in about 30% of affected children. 17,18 The reported survival for PHGG ranges from 8 to 70 months.…”

“…21,22 Radiotherapy at the dose of 50 to 60 grays fractionated over 6 weeks is a significant compartment of treatment in PHGG. 5 Radiotherapy usually is not used in children younger than 3 years due to its adverse effect on the developing brain. 5,16 The impact of concomitant and adjuvant TMZ therapy on improving survival in adults with HGG has been demonstrated.…”

“…4 Although glioblastoma multiforme (WHO grade IV) is the most common primary brain tumor in adults, anaplastic astrocytoma (WHO grade III) is more common than glioblastoma in children. 5 Recent studies have established that pediatric HGGs (PHCGs) are biologically distinct from their adult counterparts, with nearly half of these patients harboring somatic mutations in histone genes. 6,7 In spite of its relative rarity, HGG is a devastating disease in children with significant morbidity and mortality.…”

Short Hypofractionated Radiation Therapy in Palliation of Pediatric Malignancies: Outcomes and Toxicities

“…Overall, toxicity outcomes in our analysis appear to compare well with those reported in the series where longer courses of palliative pediatric RT were utilized. 8, 22–23 In a study of 76 palliative RT courses for pediatric malignancies of various anatomic sites and histologies, Mak and colleagues noted only two episodes of grade 3 and no grade 4–5 toxicities. 23 In their analysis, median number of RT fractions was 12 and median RT dose was 30 Gy, whereas in our study median number of fractions was 5 and median RT dose was 24 Gy.…”

“…8, 22–23 In a study of 76 palliative RT courses for pediatric malignancies of various anatomic sites and histologies, Mak and colleagues noted only two episodes of grade 3 and no grade 4–5 toxicities. 23 In their analysis, median number of RT fractions was 12 and median RT dose was 30 Gy, whereas in our study median number of fractions was 5 and median RT dose was 24 Gy. It is important to note that given heterogenous dose schemes and short follow-ups in the present and other series examining the utility of palliative RT, it is challenging to draw meaningful conclusions with regard to late toxicities.…”