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Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium
Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA..
Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA..
Univ Washington, Dept Radiat Oncol, Seattle, WA 98195 USA..
Johns Hopkins Sch Med, Dept Radiat Oncol & Mol Radiat Sci, Baltimore, MD USA..
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2017 (English)In: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 64, no 11, article id e26589Article in journal (Refereed) Published
Abstract [en]

Background/Objectives:

The practice of palliative radiation therapy (RT) is based on extrapolation from adult literature. We evaluated patterns of pediatric palliative RT to describe regimens used to identify opportunity for future pediatric-specific clinical trials.

Design/Methods:

Six international institutions with pediatric expertise completed a 122-item survey evaluating patterns of palliative RT for patients 21 years old from 2010 to 2015. Two institutions use proton RT. Palliative RT was defined as treatment with the goal of symptom control or prevention of immediate life-threatening progression.

Results:

Of 3,225 pediatric patients, 365 (11%) were treated with palliative intent to a total of 427 disease sites. Anesthesia was required in 10% of patients. Treatment was delivered to metastatic disease in 54% of patients. Histologies included neuroblastoma (30%), osteosarcoma (18%), leukemia/lymphoma (12%), rhabdomyosarcoma (12%), medulloblastoma/ependymoma (12%), Ewing sarcoma (8%), and other (8%). Indications included pain (43%), intracranial symptoms (23%), respiratory compromise (14%), cord compression (8%), and abdominal distention (6%). Sites included nonspine bone (35%), brain (16% primary tumors, 6% metastases), abdomen/pelvis (15%), spine (12%), head/neck (9%), and lung/mediastinum (5%). Re-irradiation comprised 16% of cases. Techniques employed three-dimensional conformal RT (41%), intensity-modulated RT (23%), conventional RT (26%), stereotactic body RT (6%), protons (1%), electrons (1%), and other (2%). The most common physician-reported barrier to consideration of palliative RT was the concern about treatment toxicity (83%).

Conclusion:

There is significant diversity of practice in pediatric palliative RT. Combined with ongoing research characterizing treatment response and toxicity, these data will inform the design of forthcoming clinical trials to establish effective regimens and minimize treatment toxicity for this patient population.

Place, publisher, year, edition, pages
2017. Vol. 64, no 11, article id e26589
Keywords [en]
palliative radiation therapy, palliative therapy, pediatric radiation therapy
National Category
Pediatrics Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-336285DOI: 10.1002/pbc.26589ISI: 000411059000022OAI: oai:DiVA.org:uu-336285DiVA, id: diva2:1177320
Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2018-01-25Bibliographically approved

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