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

Avani Dholakia Rao, Qinyu Chen, Ralph P. Ermoian, Sara Alcorn, Maria Luisa S. Figueiredo, Michael J. Chen, Karin Dieckmann, Shannon M. Macdonald, Matthew Ladra, Daria Kobyzeva, Alexey V. Nechesnyuk, Kristina Nilsson, Eric C. Ford, Brian A. Winey, Rosangela C. Villar, Stephanie A Terezakis

Research output: Contribution to journalArticle

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. 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.

Original languageEnglish (US)
JournalPediatric Blood and Cancer
DOIs
StateAccepted/In press - 2017

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Palliative Care
Radiotherapy
Pediatrics
Research
Clinical Trials
Proton Therapy
Therapeutics
Ependymoma
Medulloblastoma
Ewing's Sarcoma
Rhabdomyosarcoma
Mediastinum
Osteosarcoma
Pelvis
Neuroblastoma
Brain Neoplasms
Abdomen
Protons
Lymphoma
Histology

Keywords

  • Palliative radiation therapy
  • Palliative therapy
  • Pediatric radiation therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium. / Rao, Avani Dholakia; Chen, Qinyu; Ermoian, Ralph P.; Alcorn, Sara; Figueiredo, Maria Luisa S.; Chen, Michael J.; Dieckmann, Karin; Macdonald, Shannon M.; Ladra, Matthew; Kobyzeva, Daria; Nechesnyuk, Alexey V.; Nilsson, Kristina; Ford, Eric C.; Winey, Brian A.; Villar, Rosangela C.; Terezakis, Stephanie A.

In: Pediatric Blood and Cancer, 2017.

Research output: Contribution to journalArticle

Rao, AD, Chen, Q, Ermoian, RP, Alcorn, S, Figueiredo, MLS, Chen, MJ, Dieckmann, K, Macdonald, SM, Ladra, M, Kobyzeva, D, Nechesnyuk, AV, Nilsson, K, Ford, EC, Winey, BA, Villar, RC & Terezakis, SA 2017, 'Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium', Pediatric Blood and Cancer. https://doi.org/10.1002/pbc.26589
Rao, Avani Dholakia ; Chen, Qinyu ; Ermoian, Ralph P. ; Alcorn, Sara ; Figueiredo, Maria Luisa S. ; Chen, Michael J. ; Dieckmann, Karin ; Macdonald, Shannon M. ; Ladra, Matthew ; Kobyzeva, Daria ; Nechesnyuk, Alexey V. ; Nilsson, Kristina ; Ford, Eric C. ; Winey, Brian A. ; Villar, Rosangela C. ; Terezakis, Stephanie A. / Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium. In: Pediatric Blood and Cancer. 2017.
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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. 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.",
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author = "Rao, {Avani Dholakia} and Qinyu Chen and Ermoian, {Ralph P.} and Sara Alcorn and Figueiredo, {Maria Luisa S.} and Chen, {Michael J.} and Karin Dieckmann and Macdonald, {Shannon M.} and Matthew Ladra and Daria Kobyzeva and Nechesnyuk, {Alexey V.} and Kristina Nilsson and Ford, {Eric C.} and Winey, {Brian A.} and Villar, {Rosangela C.} and Terezakis, {Stephanie A}",
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T1 - Practice patterns of palliative radiation therapy in pediatric oncology patients in an international pediatric research consortium

AU - Rao, Avani Dholakia

AU - Chen, Qinyu

AU - Ermoian, Ralph P.

AU - Alcorn, Sara

AU - Figueiredo, Maria Luisa S.

AU - Chen, Michael J.

AU - Dieckmann, Karin

AU - Macdonald, Shannon M.

AU - Ladra, Matthew

AU - Kobyzeva, Daria

AU - Nechesnyuk, Alexey V.

AU - Nilsson, Kristina

AU - Ford, Eric C.

AU - Winey, Brian A.

AU - Villar, Rosangela C.

AU - Terezakis, Stephanie A

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

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