Authors: Sebastian Dennis-Beron
In study published recently in Pediatric Blood & Cancer investigators from Children’s Hospital Los Angeles (CHLA) (CA, US) demonstrated that young children in a clinical trial assessing the efficacy of reducing radiotherapy, did worse than their counterparts on regular radiotherapy when there were deviations from the treatment protocol.
First author Kenneth K Wong (CHLA) stated: “This study shows that attention to the timing, dose, and location of radiation therapy is crucial.”
The paper qualitatively assessed the Head Start III trail (NCT00392886), which delays or avoids radiation therapy in children with brain tumors. These innovative studies propose novel methods to treat malignant brain tumors – high dose chemotherapy followed by a transfusion of blood stem cells. This treatment thus acts as a substitute for radiation in younger children, where radiation to a developing brain may lead to detrimental side effects in later life. If the disease persists following a course of this proposed therapy, or once the child is older, they then receive radiation therapy.
Only 31 of 220 children received radiation therapy in the Head Start III trail, as the goal was to reduce patient exposure to radiation. Regardless, of those who were selected to receive radiation therapy, a subset of 8 out of the 25 participants had deviances to the treatment plan; the protocol aberrations all occurred in patients aged 6 years or younger.
Wong commented:”Parents or providers may want to delay the start of radiation or reduce the dose or area of exposure – particularly in very young children. But in a study already limiting radiation exposure – patients with these kinds of protocol violations experienced worse outcomes.”
Patients that received treatment in-line with protocol, who were eligible for radiation therapy, and began therapy within 11 weeks of their stem cell transfusion exhibited improved overall survival.
In order to further improve patient outcomes, Wong suggests reducing aberrations to protocol by reviewing treatment plans before beginning radiation therapy.
Wong KK, All S, Waxer J et al. Radiotherapy after high-dose chemotherapy with autologous hematopoietic cell rescue: Quality assessment of Head Start III. Pediatr Blood Cancer. doi: 10.1002/pbc.26529[Epub ahead of print] (2017).
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