Hypofractionated Stereotactic Ablative Radiotherapy for Recurrent or Oligometastatic Tumours in Children and Young Adults

Abstract

Aims: Cancer remains a leading cause of death in children and adolescents in the developed world. Despite advances in oncological management, rates of primary treatment failure remain significant. Radiation of recurrent or metastatic disease improves survival in adults but there is little data to support clinical decision making in the paediatric/teenage and young adult population. Materials and methods: We present a retrospective case series of 14 patients treated with stereotactic ablative body radiotherapy or stereotactic radiosurgery at The Royal Marsden Hospital from September 2011 to December 2015. Eligible patients were aged <25 years, with Lansky/Karnofsky performance status 60 with confirmed relapsed or metastatic tumour in fewer than three sites. Follow-up was in accordance with standard clinical care and included regular outpatient review and radiological surveillance. Local control, progression-free survival and overall survival are presented. Results: Data for 14 patients with 18 treated lesions were included. The median patient age was 15 years (range 5e20 years). Nine patients were treated for local recurrence and five for metastatic lesions. All patients had already undergone multiple previous treatments. Eleven patients had undergone previous radiotherapy. The median interval between the completion of initial radiotherapy and reirradiation was 29.0 months (range 0.2e49.5 months). The median follow-up was 3.4 years (range 0.28e6.4 years). The 1-year local control rate was 78.6% and the 2-year local control rate was 57.1%. Overall median survival was 58.4 months (95% confidence interval 33.8e82.9 months). Cumulative biologically effective doses (BED) over 200 Gy were associated with late toxicity (P ¼ 0.04). Conclusion: Radical doses of short-course hypofractionated radiotherapy can achieve excellent local control and may contribute to the prolongation of overall survival. There is a need for prospective trials exploring the use of ablative radiotherapy in metastatic disease in paediatric/teenage and young adult patients in order to establish safe and effective treatment schedules.

Radical radiotherapy for paediatric solid tumour metastases: An overview of current European protocols and outcomes of a SIOPE multicenter survey

“…Also in the literature, evidence for hypofractionated stereotactic radiotherapy in children is limited. Some studies showed the feasibility of a stereotactic technique, with varying dose and fractionation schemes [26,39,45]. Local control rates ranged from 50 to 85% at a median follow-up of 2 years, with no acute or severe late toxicities observed [26,39,44].…”

“…Some studies showed the feasibility of a stereotactic technique, with varying dose and fractionation schemes [26,39,45]. Local control rates ranged from 50 to 85% at a median follow-up of 2 years, with no acute or severe late toxicities observed [26,39,44]. Casey et al retrospectively evaluated the indications for a radiotherapy dose and fractionation schedule with curative intent of 49 bone metastases in RMS and ES patients [12].…”

“…Deciding between conventional and stereotactic approaches depended on reasons including the number of lesions, volume size and dose constraints for organs at risk. Six out of 20 departments, four in France, used a stereotactic technique according to an institutional or a national protocol [38,39], yielding varying dose prescriptions (16e50 Gy) and fractionation schemes (1e7 fractions), depending on the primary tumour type, metastatic site, as well as radiotherapy department.…”

Stereotactic Body Radiation Therapy for Ventricular Arrhythmias: Efficacy, Safety and Image Analysis-First Asian Population Study

“…We enrolled young patients because that patients receiving SBRT reported overall good quality of life in general, associated with better global health status and lower indirect costs of productivity loss [15,16], which are much more important in young rather than old patients. In children and young adults, SBRT prolonged overall survival without signi cant toxicities [17]. The maturation of SBRT contributed to decades of technical and clinical advancement, including managing cardiac and respiratory motions, de ning safe radiation dosing levels for critical organs, and setting quality assurance standards globally.…”

Dosimetric feasibility of hypofractionation for metastatic bone/bone marrow lesions from paediatric solid tumours

“…In adults, the current radiotherapy approach for oligometastatic disease is strongly focused on hypofractionation and outcomes are associated with favourable local tumour control and limited toxicity for lesions within the bone, lymph nodes and soft tissue [10][11][12][13]. In contrast, the available literature on hypofractionation in children is mainly limited to retrospective and case studies for both cranial and extra-cranial metastatic disease [14][15][16]. In these studies, dose and fractionation schedules varied widely (total dose range 20-60 Gy in 1-10 fractions, dose per fraction range 5-20 Gy).…”