ESTRO 2024 - Abstract Book

S2015

Clinical - Paediatric

ESTRO 2024

77

Digital Poster

Palliative radiotherapy in children: implementation of Swedish national guidelines

Anna Embring 1,2 , Anna Asklid 1 , Malin Blomstrand 3 , Martin P. Nilsson 4 , Måns Agrup 5 , Anna-Maja Svärd 6 , Charlotta Fröjd 3 , Ulla Martinsson 7 , Ingrid Fagerstöm Kristensen 4 , Jacob Engellau 4 1 Karolinska University Hospital, Department of Radiotherapy, Stockholm, Sweden. 2 Karolinska Institute, Department of Oncology-Pathology, Stockholm, Sweden. 3 Sahlgrenska University Hospital, Department of Oncology, Gothenburg, Sweden. 4 Skåne University Hospital, Department of Hematology, Oncology and Radiation Physics, Lund, Sweden. 5 Linköping University, Department of Oncology, Biomedical and Clinical Sciences, Linköping, Sweden. 6 Umeå University, Department of Radiation Sciences, Oncology, Umeå, Sweden. 7 Uppsala University, Department of Immunology, Genetics and Pathology, Uppsala, Sweden

Purpose/Objective:

Palliative radiotherapy in paediatric patients has in several studies been suggested to be underutilized and clinical guidelines are scarce. To address these problems the Swedish Workgroup of Paediatric Radiotherapy (SBRTG) compiled consensus guidelines on palliative radiotherapy in children.

Material/Methods:

A literature review on palliative radiotherapy in paediatric patients was performed in early 2022. The results of this review were presented and discussed at a SBRTG-workshop. Following the workshop guidelines on palliative radiotherapy based on best available evidence were finalised and implemented during 2022.

Results:

We hereby present the Swedish national guidelines on palliative radiotherapy in children:

• Palliative radiotherapy should be avoided if the patient has a life expectancy of less than 30 days. • Standard fractionation for painful bone metastases is 8 Gy x 1. • Standard fractionation for soft tissue metastases and/or spinal cord compression is 4 Gy x 5. • For patients with metastases of osteosarcoma you may consider giving 3 Gy x 13 instead of standard fractionation, because higher doses have been shown to achieve longer duration of symptom relief. This assumes, however, that the patient is in good general condition and that the size of the volume that is planned to be irradiated is reasonable. In case of shorter expected survival, 4 Gy x 5 is given also to patients with metastases of osteosarcoma. Results from the literature review and the national guidelines have been presented at several local and national meetings and educational activities with both paediatric oncologists and paediatric radiation oncologists in Sweden. An interview with 23 leading senior physicians working with solid tumours in paediatric oncology in Sweden unanimously said that this initiative has increased their awareness of palliative radiotherapy as a possible treatment option, and it is likely that they will refer more patients for palliative radiotherapy.

Conclusion: