Radiation Therapy at End of Life in Children

Panoff, Joseph; Simoneaux, R. Victor; Shah, Nikesh; Scott, Michael D.; Buchsbaum, Jeffrey C.; Johnstone, Peter A.S.; McMullen, Kevin P.

doi:10.1089/jpm.2014.0219

Cited by 10 publications

(11 citation statements)

References 13 publications

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“…Similarly, a wide range of anatomic sites were treated, with brain and bone being the most common sites (32% and 29%, respectively), as well other sites within the CNS, abdomen/pelvis, thorax, and soft tissue. This heterogeneity of disease histologies and treatment sites is consistent with other institutional series describing palliative RT in children –…”

Section: Discussionsupporting

confidence: 89%

Clinical outcomes and toxicity following palliative radiotherapy for childhood cancers

Mak

Lee

Balboni

et al. 2017

Pediatric Blood & Cancer

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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.

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Section: Discussionsupporting

confidence: 89%

Clinical outcomes and toxicity following palliative radiotherapy for childhood cancers

Mak

Lee

Balboni

et al. 2017

Pediatric Blood & Cancer

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“…The success rate of palliative RT in our cohort was significantly lower for children in their last 30 dol. This is unsurprising given the usual dynamics of RT response and is consistent with growing consideration of RT in the last 30 dol as a potential overuse metric for adult patients . Whether the designation of “overuse” is appropriate for palliative RT in children in the last 30 dol is unclear, as prognostication to this level of specificity can be extremely challenging and some children in their last 30 dol did appear to benefit.…”

Section: Discussionmentioning

confidence: 79%

The role of radiation therapy in palliative care of children with advanced cancer: Clinical outcomes and patterns of care

Varma

Friedman

Stavas

2016

Pediatric Blood & Cancer

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Background: There are few published data to guide the use and timing of palliative radiation therapy (RT) in children. We aimed to determine the clinical outcomes of palliative RT in children and the relationship with palliative care and hospice referrals.Procedure: A retrospective chart review was performed on all patients younger than 18 years who received palliative RT in our clinic from January 2005 to January 2015. Results:In the specified time period, 50 children underwent 83 courses of palliative RT. Median survival after treatment was 124 days (range, 1-1141 days). Fifteen courses were delivered to children in the last 30 days of life (dol). Palliative RT was successful in 89% of courses delivered before the last 30 dol versus 28% of courses delivered in the last 30 dol (p < 0.0001, Fisher's exact test). At the time of data collection, 43 children were deceased. Altogether, 88% of children who received palliative RT were also referred to our institution's pediatric palliative care team or to hospice at some time in their course. Of the children who died, 74% were referred to hospice and 34% were on hospice while receiving palliative RT. For children not already on hospice, the median time to hospice referral was 96 days after the last fraction (range, 0-924 days). Conclusions:Palliative RT is effective in children with advanced cancer, although less so in the last 30 dol. With careful care coordination and multidisciplinary collaboration, RT can be successfully integrated into supportive and end-of-life care for children with advanced cancer. K E Y W O R D Send of life, hospice, palliative care, patterns of care, radiation oncology, radiotherapy

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“…A total of 20 publications met our inclusion criteria were evaluated, of which 9 studies were from single institutions [4,[9][10][11][12][13][14][15][16] and 11 studies from population registries (Table 1) [1][2][3][17][18][19][20][21][22][23][24]. The patient populations included in these studies varied significantly across different studies.…”

Section: Resultsmentioning

confidence: 99%

Palliative radiation therapy in the last 30 days of life: A systematic review

Park

Lee

Tseng

et al. 2017

Radiotherapy and Oncology

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Radiation Therapy at End of Life in Children

Abstract: Delivery of RT for children at EOL is complex. Frequency of RT at EOL in children occurs in is <2% of cases, and is not significantly less frequent in the proton milieu. This appears to be about an order of magnitude less than in adults.

Cited by 10 publications

References 13 publications

Clinical outcomes and toxicity following palliative radiotherapy for childhood cancers

Clinical outcomes and toxicity following palliative radiotherapy for childhood cancers

The role of radiation therapy in palliative care of children with advanced cancer: Clinical outcomes and patterns of care

Palliative radiation therapy in the last 30 days of life: A systematic review

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