Establishment of a UK national referral service for paediatric brachytherapy

Abstract

<h3>Objectives</h3> 1. to establish a national referral pathway for children where brachytherapy might be the most appropriate radiation treatment technique; 2. to assess each patient for the best local therapy technique; 3. to develop expertise within a specialist paediatric brachytherapy team; 4. to ensure systematic follow-up of functional outcomes and disease control. <h3>Methods</h3> A meeting of UK paediatric radiation oncologists agreed the need to develop a national brachytherapy service, as no single centre had enough suitable patients to gain experience and competence. A national sarcoma advisory panel for local control of challenging cases meets monthly virtually. Referrals are typically assessed by a paediatric surgeon and radiation oncologist with examination under anaesthesia and a joint decision made regarding surgery and radiotherapy. A team including an experienced brachytherapy radiation oncologist and a dedicated paediatric radiation oncologist working together with a paediatric surgeon and supported by specialist anaesthesia, radiology, radiographic, physics and paediatric oncology colleagues deliver treatment. Follow-up is in a dedicated multidisciplinary combined clinic. <h3>Results</h3> From 2009 to 2021, 35 patients, referred from 14 principal treatment centres in England, Scotland, Wales and Northern Ireland, have been treated. Two patients had carcinomas; 33 had rhabdomyosarcoma. The treated site was bladder/prostate in 21 patients, cervix/vagina in 7 patients, head and neck 4 patients, perineum/vulva 3 patients. Interstitial catheters were placed percutaneously under ultrasound guidance (or intracavitary catheters for vagina/cervix patients). Afterloaded high dose rate iridium-192 was used. A dose of 27.5 Gy was delivered in five fractions over 3 days in all but two patients. At a median follow-up of 4 years 6 month (range 5 months to 12.8 years) no patients have relapsed or died and functional outcomes are good. <h3>Conclusion</h3> We have successfully established a national referral centre for paediatric brachytherapy achieving excellent outcomes.