Palliative radiotherapy can help control pain in pediatric patients with cancer

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Shorter palliative treatment courses of radiation therapy in pediatric patients with cancer result in high rates of pain control and low toxicity, according to a study.

Researchers analyzed the symptom response and treatment-associated toxicity of 213 pediatric patients with cancer receiving 422 palliative radiotherapy treatment courses. Diagnoses of participants included sarcoma (32.5%), neuroblastoma (24.9%), leukemia/lymphoma (14.9%), and central nervous system tumors (10.9%). Pain was the most common indication for treatment.

There was an overall median of 10 fractions per patient, with 2.5 Gy dose per fraction, and 21 Gy total dose.

There were 166 (39.3%) courses of ≤5 radiation therapy fractions, 117 (27.2%) of 6 to 10 fractions, and 139 (32.9%) of ≥10 fractions. Of the 178 evaluable patients, 85% achieved complete or partial pain relief, including 77.8% receiving ≤5 fractions and 89.6% receiving >5 fractions.

Grade 1 toxicity was present in 38.9% of treatments, grade 2 in 6.4%, and grade 3 in 0.5%.

On multivariable analysis, ≤5 radiation fractions were significantly associated with lower toxicity.

Sudmeier LJ, Madden N, Zhang C, et al. Palliative radiotherapy for children: Symptom response and treatment-associated toxicity according to radiation therapy dose and fractionation. Pediatr Blood Cancer. 2023;e30195. doi: 10.1002/pbc.30195. Epub ahead of print. PMID: 36642970.