Rao Avani Dholakia, Chen Qinyu, Ermoian Ralph P, Alcorn Sara R, Figueiredo Maria Luisa S, Chen Michael J, Dieckmann Karin, MacDonald Shannon M, Ladra Matthew M, Kobyzeva Daria, Nechesnyuk Alexey V, Nilsson Kristina, Ford Eric C, Winey Brian A, Villar Rosangela C, Terezakis Stephanie A
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD.
Department of Radiation Oncology, University of Washington, Seattle, WA.
Pediatr Blood Cancer. 2017 Nov;64(11). doi: 10.1002/pbc.26589. Epub 2017 Jul 11.
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.
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%).
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.
背景/目的：姑息性放射治疗（RT）的实践基于从成人文献的推断。我们评估了儿科姑息性RT的模式，以描述用于确定未来儿科特异性临床试验机会的方案。
设计/方法：六个具有儿科专业知识的国际机构完成了一项122项调查，评估2010年至2015年期间对≤21岁患者的姑息性RT模式。两个机构使用质子RT。姑息性RT被定义为以症状控制或预防立即危及生命的进展为目标的治疗。
在3225例儿科患者中，365例（11%）接受了姑息性治疗，共涉及427个疾病部位。10%的患者需要麻醉。54%的患者接受了转移性疾病的治疗。组织学类型包括神经母细胞瘤（30%）、骨肉瘤（18%）、白血病/淋巴瘤（12%）、横纹肌肉瘤（12%）、髓母细胞瘤/室管膜瘤（12%）、尤因肉瘤（8%）和其他（8%）。适应症包括疼痛（43%）、颅内症状（23%）、呼吸功能不全（14%）、脊髓压迫（8%）和腹胀（6%）。部位包括非脊柱骨（35%）、脑（原发性肿瘤16%，转移瘤6%）、腹部/骨盆（15%）、脊柱（12%）、头/颈（9%）和肺/纵隔（5%）。再照射占病例的16%。技术采用三维适形RT（41%）、调强RT（23%）、传统RT（26%）、立体定向体部RT（6%）、质子（1%）、电子（1%）和其他（2%）。医生报告的考虑姑息性RT的最常见障碍是对治疗毒性的担忧（83%）。
儿科姑息性RT的实践存在显著差异。结合正在进行的关于治疗反应和毒性特征的研究，这些数据将为即将开展的临床试验设计提供信息，以建立有效的方案并尽量减少该患者群体的治疗毒性。
