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

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.

Section: Discussionsupporting

confidence: 87%

Clinical outcomes and toxicity following palliative radiotherapy for childhood cancers

Mak

Lee

Balboni

et al. 2017

“…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.…”

Section: Patients Requiring Palliative Radiotherapymentioning

confidence: 99%

“…[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.…”

Section: Patients Requiring Palliative Radiotherapymentioning

confidence: 99%

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)

Parkes

Hess

Burger

et al. 2017

Pediatric radiotherapy is a critical part of pediatric oncology protocols and the quality of the radiotherapy may determine the future quality of life for long-term survivors. Multidisciplinary team decision making provides the basis for high-quality care. However, delivery of highquality radiotherapy is dependent on resources. This article provides guidelines for delivery of good quality radiation therapy in resource-limited countries based on rational procurement and maintenance planning, protocol development, three-dimensional planning, quality assurance, and adequate staff numbers and training. K E Y W O R D Sadapted treatment regimen, low and middle income countries, LMIC, Pediatric radiotherapy, PODC, PROS

“…In the pediatric population, curative radiation therapy is often used less than other modalities due to concerns regarding adverse effects and secondary malignancies . Curiously, though these concerns are somewhat alleviated in palliative therapy due to the lower dosage used compared to curative therapy, pRT in children remains underutilized . Several factors may contribute to this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

“…3 Curiously, though these concerns are somewhat alleviated in palliative therapy due to the lower dosage used compared to curative therapy, pRT in children remains underutilized. 5 Several factors may contribute to this phenomenon. Parents are often optimistic regarding their child's likelihood of survival, and they desire intensive treatment for their child until the end of life, hoping to achieve cure or to extend life.…”

Section: Introductionmentioning

confidence: 99%

Palliative radiotherapy for pediatric patients: Parental perceptions of indication, intent, and outcomes

Lee

Boyle

Zaslowe-Dude

et al. 2019

Objectives Palliative radiation therapy (pRT) is often used to improve quality of life for pediatric patients. Though palliative doses are generally lower than those for cure, pRT may still introduce undesirable effects. The decision to pursue additional therapy for a child may be challenging and depends on parents’ knowledge and expectations. The goal of this study was to explore parental perceptions of pRT. Methods Twenty‐eight children referred for pRT were enrolled in our prospective study. Parents were counseled regarding the indication and expected outcomes. They then completed a series of questionnaires to assess their understanding of pRT, side effects that their child experienced, and how the outcomes compared to their expectations. Results The majority of parents listed pain relief and addressing new disease as the main indication for pRT. When asked about expectations, the majority chose improvement in quality of life and prolongation of their child's life. Interestingly, 32% of parents expected pRT to cure their child's disease. Most patients undergoing pRT did not experience any adverse symptoms. The outcomes of pRT in the majority of cases exceeded parental expectations. Conclusion Improved quality of life with pRT sometimes blurs the distinction between palliation and cure. We found that most parents understand the aim to improve quality of life, although a proportion of parents perceived pRT as a cure to their child's disease. Despite this, the majority of parents reported that the outcome of the pRT course exceeded their expectations. We postulate that parents derive comfort from pursuing active treatment.