Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium

Abstract

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. 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. K E Y W O R D Spalliative radiation therapy, palliative therapy, pediatric radiation therapy Abbreviations: RT, radiation therapy; SBRT, stereotactic body radiation therapy

The adrenergic receptor antagonists propranolol and carvedilol decrease bone sarcoma cell viability and sustained carvedilol reduces clonogenic survival and increases radiosensitivity in canine osteosarcoma cells

“…[10][11][12][13][14][15] In addition to playing a role in primary tumour control, radiation therapy is an important tool in the palliative management of localized and metastatic canine and human bone sarcomas. [16][17][18][19][20][21][22] Treatment of human osteosarcoma and Ewing sarcoma is complicated, in part due to the lack of prospective, randomized trials beyond first-line therapy, and there is a clear need for the development of new approaches to improve clinical outcomes. 9,23 The costs of new drug discovery efforts, particularly for paediatric tumours like osteosarcoma, are often prohibitive, leading to an interest in repurposing existing FDA-approved drugs if they demonstrate anticancer activity.…”

“…These features allow the dog to be an appropriate large animal model of spontaneous bone sarcoma . In addition to playing a role in primary tumour control, radiation therapy is an important tool in the palliative management of localized and metastatic canine and human bone sarcomas . Treatment of human osteosarcoma and Ewing sarcoma is complicated, in part due to the lack of prospective, randomized trials beyond first‐line therapy, and there is a clear need for the development of new approaches to improve clinical outcomes .…”

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)

“…[31][32][33][34] However, knowledge and utilization of pediatric radiotherapy among pediatric oncologists is poor even in HIC. 35 Single fractions of radiotherapy at doses of 4-8 Gy delivered to single or parallel opposed fields is simple to deliver and should be offered by all radiotherapy centers.…”

“…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.…”

“…Palliative radiotherapy in children is effective and durable especially when used as part of a palliative care plan . However, knowledge and utilization of pediatric radiotherapy among pediatric oncologists is poor even in HIC .…”