Clinical outcomes of palliative radiation therapy for children

Palliative radiation therapy for superior vena cava syndrome in metastatic Wilms tumor using 10XFFF and 3D surface imaging to avoid anesthesia in a pediatric patient—a teaching case

“…Palliative radiation therapy is used frequently in adults, but few published reports have addressed it in children 7, 8, 9, 10. Rahn et al 7 reported 45 children who had a symptomatic improvement at a median of 1 week after radiation therapy initiation, of whom 13% presented with dyspnea or chest pain.…”

“…Rahn et al 7 reported 45 children who had a symptomatic improvement at a median of 1 week after radiation therapy initiation, of whom 13% presented with dyspnea or chest pain. In 19 children with respiratory compromise from thoracic or abdominal disease, Bertsch et al 9 observed a favorable clinical response rate of 72%.…”

“…The majority of children <7 years of age require anesthesia for radiation therapy to facilitate setup and minimize inadvertent movements 7, 11, 12. However, children with mediastinal masses are challenging because their airways are smaller and more compliant and compressible.…”

“…However, we chose a more conformal hypofractionated approach to minimize the lung dose and reduce acute toxicity. With similar goals, Rahn et al 7 treated 34% of their patients using advanced radiation techniques such as IMRT.…”

Management of respiratory symptoms in paediatric palliative care

“…Interventions directed at reducing tumour mass may include palliative chemotherapy, short courses of high dose steroids, such as dexamethasone, and radiotherapy [44]. To date, there are no published randomized controlled trials of steroids for dyspnoea management.…”