Pediatric Radiotherapy Utilization rate (PUR) in a large pediatric oncology center in Low-/Middle-Income country (LIMC): Report on 14473 patients

Abstract

<h3>Objectives</h3> To determine the real-life radiotherapy utilization rate in pediatric cancer patients in a large pediatric cancer institution. Although RUR is specified for most adult cancers, it is seldom reported in childhood tumors. <h3>Methods</h3> A real-life RUR for pediatric tumors was performed in a large low-/middle-income country (LMIC) center from 2009 to 2017 in 2 studies. The RUR was defined as the percentage of patients who received at least one radiotherapy (RT) course from the total number of patients. <h3>Results</h3> The first study included 4390 out of 13,305 pediatric cancer patients with a RUR of 33%. The curative, salvage and palliative RURs were 27.8%, 2%, and 5.7%, respectively. There was a considerable variation in the RUR between various tumors, ranging from 0% in choroid plexus papilloma and other rare tumors to 100% in intracranial germinoma. The second study compared RUR in 2 subsequent periods, 2009-2013 and 2014-2017. RUR was estimated as 32.5% (4707/14473). There was no statistically significant difference for RUR in the two time periods (32.9% versus 32.3%). However, Hodgkin's lymphoma, neuroblastoma, soft tissue sarcoma (rhabdomyosarcoma and non-rhabdo-), and renal tumors RUR increased significantly in 2014 2017 compared to 2009 – 2013. On the contrary, brain tumors, bone tumors, retinoblastoma, and rare pediatric tumors RUR decreased significantly in the same period. Moreover, the RUR varied among different stages within each tumor type. Moreover, 753 patients received 920 palliative RT courses (range 1–9) at a median dose of 30 Gy. <h3>Conclusion</h3> Upon applying the same treatment protocols, different RUR were reported in various tumor types and different periods. The most commonly irradiated metastatic sites were the bone (34%) and the brain (9.8%). However, still, there is underutilization of palliative RT that calls for more efficient multidisciplinary palliative care provision for pediatric cancer patients.