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Radiation therapy in the neonate
Insights
Radiation therapy (RT) for neonatal neoplasms is rare but requires careful consideration due to potential increased sensitivity in immature organs. Benefits must be weighed against significant late effects, with strategies to minimize harm when RT is necessary.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neonatal Care
Background:
- Neonatal neoplasms are rare, accounting for a small percentage of childhood cancers.
- Pediatric radiation therapists may encounter cases requiring treatment in very young infants.
- Immature organs in neonates may increase susceptibility to radiation effects.
Purpose of the Study:
- To discuss the considerations for using radiation therapy in neonates.
- To highlight the potential risks and benefits of radiation therapy in infants.
- To explore strategies for minimizing adverse effects of radiation in this population.
Main Methods:
- Review of existing literature and clinical experience regarding neonatal neoplasms and radiation therapy.
- Analysis of the specific vulnerabilities of neonatal organs to radiation.
- Evaluation of treatment strategies for pediatric tumors requiring radiation.
Main Results:
- Neonates may be more susceptible to late effects of radiation therapy due to organ immaturity.
- Radiation therapy should generally be avoided in the first few weeks of life due to heightened liver and kidney sensitivity.
- Some neonatal tumors may not require radiation therapy, or treatment intensity can be reduced.
Conclusions:
- Careful risk-benefit assessment is crucial when considering radiation therapy for neonatal cancers.
- Minimizing radiation exposure and employing advanced techniques can mitigate long-term adverse effects.
- Alternative treatments or reduced radiation doses, possibly with chemotherapy, should be prioritized.
Abstract:
Radiation therapy (RT) is frequently used in the management of children with cancer, but neonatal neoplasms are rare. Newborns represent 1.5% of the children with malignant diseases in the Tumor Registry at the Children's Hospital of Philadelphia over the last 30 years. Thus, occasionally the pediatrics radiation therapist must consider treating the very young infant. The specific radiation effects on growth and development must be weighed in reaching a therapeutic decision. All children are vulnerable to the late effects of radiation therapy, but the neonates may be more susceptible because of the immaturity of important organs such as the brain, lung, liver, kidney, and bone. In general, radiation therapy, should be avoided during the first several weeks of life because of the potential increased sensitivity of the liver and kidneys during that period. If radiation therapy is used at all during infancy, the benefits must be weighed against the possibility of significant late effects. Increasing knowledge of pediatric neoplasms has shown that some tumors (such as mesoblastic nephroma) require no treatment except for surgical excision; and other tumors, such as Stage IV-S neuroblastoma, may require very little treatment. In those tumors that require radiation therapy, the use of chemotherapy may allow reduction of the radiation dose. Furthermore, alterations of time-dose-fractionation schemes and careful attention to tumor volume with the use of special techniques, such as "shrinking fields," may decrease the late adverse effects of treatment.