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Adaptive radiotherapy in paediatric patients: a SIOP Europe ROWG survey on practice patterns across Europe
Andrada Turcas1,2, Stephanie Bolle3, Raquel Davila Fajardo4,5
1Institute of Advanced Studies in Science and Technology, Babeș-Bolyai University, 40084, Romania.
The British Journal of Radiology
|March 11, 2026
Summary
Adaptive radiotherapy (ART) for children is inconsistently used across Europe, with significant variations in implementation and adaptation criteria. Barriers include a lack of evidence, equipment, and guidelines for wider adoption.
Area of Science:
- Oncology
- Radiation Oncology
- Medical Physics
Background:
- Adaptive radiotherapy (ART) offers potential benefits for pediatric patients due to their sensitivity to radiation and rapid anatomical changes.
- Current ART implementation in pediatric oncology across Europe is not well-characterized.
Purpose of the Study:
- To assess the current status of adaptive radiotherapy (ART) implementation in pediatric oncology centers across Europe.
- To identify common techniques, indications, infrastructure, and barriers to ART adoption in children.
Main Methods:
- An online survey was distributed to SIOP-Europe affiliated centers, collecting data on ART practices.
- The survey included 21 questions covering ART implementation, techniques, indications, and technical infrastructure.
Main Results:
- ART is available in 68% of surveyed European centers, with higher-volume centers more likely to implement it.
- Implementation varies significantly, with daily adaptation used by only 15% and offline ART by 50% of centers.
- Key barriers include a need for more evidence (50%), specialized equipment (52%), and guidelines (39%).
Conclusions:
- Adaptive radiotherapy (ART) use in pediatric oncology across Europe is highly variable and limited.
- Substantial heterogeneity exists in the frequency and criteria for ART adaptation, highlighting the need for standardization.
- This survey provides a baseline for guiding future standardization and clinical validation of ART in pediatric patients.
