Palliative radiation therapy for children with cancer

Abstract

Radiation therapy (RT) is often used as a palliative treatment for children with recurrent malignant disease to ameliorate or prevent symptoms. However, no guidelines exist regarding the clinical indications or dose fractionation for palliative RT. The goal of this report is to provide guidelines for the use of palliative RT in children with cancer. In this guideline, appropriate indications for palliative RT, recommended dose‐fractionation schedules, relevant toxicities, and avenues for future research are explored. RT is an effective palliative treatment for bone, brain, liver, lung, abdominopelvic and head‐and‐neck metastases, spinal cord compression, superior vena cava syndrome, and bleeding. Single‐fraction regimens (8 Gy in one fraction) for children with short life expectancy are recommended for simple, uncomplicated bone metastases and can be considered for some patients with lung or liver metastases. A short, hypofractionated regimen (20 Gy in five fractions) may be used for other indications to minimize overall burden of therapy. There are little data supporting use of more prolonged fractionation regimens, though they may be considered for patients with very good performance status. Future research should focus on response and outcomes data collection, and to rigorously evaluate the role of stereotactic body RT in well‐designed, prospective studies.

Delivery of re‐irradiation and complex palliative radiotherapy using proton therapy in pediatric cancer patients

“…Therefore, palliative photon RT studies report low rates of severe toxicity, generally grade 3 toxicity and lower. 2 Notably, many patients in our study were treated to higher doses typically used for curative intent, even in cases of re-irradiation, suggesting that protons allow for dose escalation to improve the potential for durable local control. Indeed, a median PFS of over 5 months and, in one patient, as long as over 16 months, suggest that durable local control is achievable in appropriately selected patients.…”

“…satile noninvasive approach to mitigate symptoms caused by cancer, such as tumor-related pain, bleeding, and neurologic changes related to compression of the brain or spinal cord. 2 While palliative RT is a mainstay of oncologic care for adults, it has been used less frequently in children. In an international multi-institutional survey of RT use in 3225 patients under 21 from 2010 to 2015, only 11% were treated with palliative-intent RT.…”

“…5 This, coupled with the substantial cost and relative scarcity of proton facilities, has likely led to the reservation of proton RT for curative-intent treatment. 2,6 Indeed, the use of protons in the setting of palliative RT is rare: with one survey reporting that protons were employed in just 1% of 427 RT courses, and specifically reserved for treatment of the brain. 3 At our tertiary referral center, children are increasingly receiving palliative-intent proton radiation therapy (PIPRT) for additional, selected indications.…”

Clinical Profile and Outcome of 806 Pediatric Oncology Patients Treated With Radiotherapy at the Serbian National Cancer Center

“…The role and importance of palliative radiotherapy are the subject of discussion among pediatric radiation oncology professionals, and it represents a low percent of all radiation treatments in children and adolescents. 37,38 There are still no clear guidelines for its use. We expect further directions from international prospective studies for developing palliative radiotherapy as an effective treatment approach.…”

“…The role and importance of palliative radiotherapy are the subject of discussion among pediatric radiation oncology professionals, and it represents a low percent of all radiation treatments in children and adolescents 37,38. There are still no clear guidelines for its use.…”