Palliative radiotherapy in pediatric malignancies

Abstract

9050 Background: To evaluate the role of palliative radiotherapy in the management of incurable pediatric malignancies. Methods: Records of 40 pediatric patients treated between Jan’ 2003 and Nov’ 2005 were reviewed and analyzed retrospectively. All of theses 40 children received palliative external beam radiotherapy for symptom control. Palliative radiotherapy was given either as single modality or in addition to surgery, chemotherapy and symptom relief drugs. Information recorded for each patient included age, sex, and extent of disease, histological types, symptomatology, treatment methods and symptom relief. Results: There were 28 boys and 12 girls in the age group of 1 to 18 years, with a median age of 14 years (range of 1–18 years). Predominant symptoms were swelling with or without pain, bleeding, and weakness of limbs. The median duration of symptoms was 90 days (range of 4–50 days). The diagnosis of these children varied with different histologies, most in the group of malignant round cell tumors (11), retinoblastoma (4), neuroblastoma (4), AML with chloromas (3), Ewing’s sarcoma (4). All patients presented with advanced stages of disease. Out of 40 patients 18 (45%) had disseminated disease at presentation. Nine patients underwent surgery while 32 patients received chemotherapy and all but two patients received symptom relief drugs in addition to palliative radiotherapy. The various dose schedules were either 5 Gy or 8 Gy for single fraction treatment while the dose schedules for fractionated radiotherapy ranged from 20 Gy in 5 fractions to 30 Gy in 10 fractions. Four patients showed complete resolution, 20 patients showed good, while 15 patients had little, 1did not have any relief in their symptoms. At the completion of multimodality treatment, 18 patients had partial response, 8 patients had progressive disease, 8 had stable disease and two patients had complete response. The disease status of 4 patients could not be known. Conclusions: The role of radiotherapy as palliative modality in children with locally advanced lesions provides better symptom relief in combination with other modalities of treatment. No significant financial relationships to disclose.

Characterization, treatment and prognosis of retinoblastoma with central nervous system metastasis

“…Based on previous reports [ 16 – 19 ], chemotherapy provides a good palliation of extraocular retinoblastoma, even multi-drug combination chemotherapy was adopted in our department, including vincristine, etoposide/teniposide, carboplatin, and cyclophosphamide, combined with intrathecal injection treatment in each cycle of the chemotherapy. Our results also showed that NSE level in the serum and white blood cell count were significantly reduced after chemo and radiotherapy [ 20 ]. Furthermore, findings of the present study are consistent with Palma et al who reported a significantly improved in treatment with APBSCT [ 21 ], suggesting it play a potential role in the treatment of retinoblastoma.…”

Clinical outcomes and toxicity following palliative radiotherapy for childhood cancers

“…While palliative RT is established for adult malignancies, it is less well characterized in the pediatric population. This single‐institution series of children receiving palliative RT for incurable, advanced malignancies contributes to a small but growing set of data in the literature supporting the continued and routine use of palliative RT in the pediatric setting,– and provides novel detail on RT‐associated toxicity. In our study, palliative RT was well tolerated in children, and associated with low rates of toxicity and improved or stable symptoms in the majority of cases.…”

“…While dose and fractionation schemes for palliative RT have been extensively studied in adults particularly with bone or brain metastases,– the optimal dose for palliating disease in pediatric cancer patients has not been well studied. Bone metastases have been studied in several reports of palliative RT in children, but there continues to be limited data to form a consensus recommendation …”

“…In some radiotherapy (RT) facilities, palliative RT represents up to 25–50% of the patients being treated . In children with advanced cancers, palliative RT is thought to effectively palliate certain symptoms, including pain and bleeding, although relatively few reports have been published on its use –. The goal of this study was to describe the clinical indications, toxicity, and outcomes for children with advanced, incurable cancers treated with palliative RT at our institution.…”

Recommendations for the treatment of children with radiotherapy in low‐ and middle‐income countries (LMIC): A position paper from the Pediatric Radiation Oncology Society (PROS‐LMIC) and Pediatric Oncology in Developing Countries (PODC) working groups of the International Society of Pediatric Oncology (SIOP)

“…Palliative radiotherapy in children is effective and durable especially when used as part of a palliative care plan. [31][32][33][34] However, knowledge and utilization of pediatric radiotherapy among pediatric oncologists is poor even in HIC. 35 The responsibility of the team is to ensure that each child is assessed according to the best available standards, treated according to All pediatric patients requiring RT should be seen and assessed by the RO in clinic prior to the RT planning appointment.…”