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Projects
Evolving role of radiation therapy in paediatric cancer
Sakshi Garg, Sandeep Muzumder, S. Nirmala, H.U. Avinash Background and Aim - The survival in children with cancer is excellent with contemporary cancer-directed treatment. Radiotherapy (RT) improves survival and allows organ/limb preservation in various cancers in children. The main concern is the delayed effects of RT. The present evidence-based medicine (EBM) guides the optimisation of RT and chemotherapy, balancing survival and side effects. The aim of the study is to see the impact of EBM and multi-disciplinary teams (MDT) on trends of RT use in children with cancer.
Method - The study included all children (<18 years) undergoing RT from 2013 to 2024 in the Department of Radiation Oncology at St John's Hospital. The data collection was obtained by scanning the RT charts. The analysis was done in Microsoft Excel. The trends in RT decision and delivery over 10 years were analysed.
Results - A total of 123 children with cancer received RT. The RT intent was: Adjuvant=42; Definitive=14; Prophylactic cranial irradiation (PCI)=19; Therapeutic cranial irradiation=8; Total Body irradiation (TBI)=13; ISRT/IFRT=10; Palliative=13 and Craniospinal irradiation (CSI)=4. Since 2017, no patient received PCI for ALL. ISRT/IFRT was received by eight children with Hodgkin's lymphoma (HL) before 2017. Only two patients have received ISRT since 2017 based on interim PET-CT scans. The RT dose received was reduced from 30 Gy to 19.8 Gy. Thirteen patients received TBI as part of stem cell transplants (Relapsed ALL 5; Fanconis Anemia=3; Aplastic Anemia=2; others=3). RT was delayed for low-grade brain tumours till progression or 3 years, whichever is earlier. Patients with ependymoma received RT in a localised field without CSF dissemination. RT decision in Ewings sarcoma was stratified based on pathology response after neoadjuvant chemotherapy and the availability of prosthesis for limb preservation. Fifteen patients received RT under anaesthesia after 2018.
Conclusions - The trends in RT use have changed in the last 10 years, especially in children with ALL, HL, brain tumour and Ewings sarcoma.
