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The radiotherapy utilization rate in pediatric tumors: An analysis of 13,305 patients
Mai K Bishr1, Mohamed S Zaghloul2, Caroline Elmaraghi3
1University College London Hospitals NHS Foundation Trust, United Kingdom.
Insights
The radiotherapy utilization rate (RUR) for pediatric tumors in a low- and middle-income country (LMIC) was 33%, with significant variation across tumor types and stages. Palliative radiotherapy use was notably low, highlighting a need for improved palliative care in pediatric oncology.
Area of Science:
- Oncology
- Radiation Oncology
- Pediatric Cancer Care
Background:
- Radiotherapy utilization rate (RUR) data is scarce for pediatric tumors, especially in low- and middle-income countries (LMICs).
- Understanding RUR in LMICs is crucial as they bear the majority of the global pediatric cancer burden.
Purpose of the Study:
- To investigate the real-world radiotherapy utilization rate (RUR) for pediatric tumors.
- To analyze the RUR across different tumor types, stages, and treatment intents (curative, salvage, palliative) in a large LMIC center.
Main Methods:
- Retrospective review of electronic medical records for pediatric cancer patients treated between 2010-2017.
- RUR calculated as the percentage of patients receiving at least one radiotherapy course out of the total patient cohort.
Main Results:
- A total of 13,305 pediatric cancer patients were analyzed, with 4,390 (33%) receiving radiotherapy.
- Curative, salvage, and palliative RURs were 27.8%, 2%, and 5.7%, respectively.
- Significant RUR variations observed from 0% (choroid plexus papilloma) to 100% (intracranial germinoma); palliative RT underutilized, particularly for bone and brain metastases.
Conclusions:
- This study provides the first insights into pediatric tumor RUR in an LMIC setting, identifying needs and deficits.
- The low utilization of palliative radiotherapy underscores the need for enhanced multidisciplinary palliative care for pediatric cancer patients.
- Findings emphasize the importance of integrating RUR data with cancer registries to better define pediatric radiotherapy requirements.
Purpose:
Although the radiotherapy utilization rate (RUR) is determined for most adult cancers, it is seldom reported in childhood tumors, particularly in low- and middle-income countries (LMIC) where the majority of pediatric cancer patients reside. This study aims to investigate the real-life RUR for pediatric tumors in a large LMIC center.
Materials And Methods:
The electronic files of patients treated at a single institution during 2010-2017 were reviewed and the RUR was defined as the percentage of patients who received at least one radiotherapy (RT) course from the total number of patients.
Results:
A total of 4390 out of 13,305 pediatric cancer patients received at least one RT course with a RUR of 33%. The curative, salvage, and palliative RURs were 27.8%, 2%, and 5.7%, respectively. There was a considerable variation in the RUR between various tumors, ranging from 0% in choroid plexus papilloma and other rare tumors to 100% in intracranial germinoma. Moreover, the RUR varied among different stages within each tumor type. Overall, 753 patients received 920 palliative RT courses (range 1-9) at a median dose of 30 Gy. The most commonly irradiated metastatic sites were the bone (34%) and the brain (9.8%).
Conclusion:
This is the first analysis to provide valuable insights into the RUR for childhood tumors. Together with population-based pediatric cancer registries, this will help decipher pediatric RT needs and deficits. Additionally, the underutilization of palliative RT calls for multidisciplinary palliative care provision for pediatric cancer patients.
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