Presenter(s)
M. Pasli1, D. J. Indelicato2, E. Thompson1, C. G. Morris1, N. P. Mendenhall1, and J. A. Bradley1; 1Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, 2Department of Radiation Oncology, University of Florida, Jacksonville, FL
Purpose/Objective(s): Despite introduction of more precise external beam radiation (RT) techniques, the avoidance of secondary neoplasms and chronic health conditions remains an important concern in pediatric oncology. This motivates efforts to rationally reduce and omit RT across the disease spectrum, at both the individual and cooperative group levels. The primary objective of this study is to update trends in RT utilization for pediatric oncology patients in the United States between the years 2000-2021.
Materials/Methods: SEER*Stat software version 9.0.42.0 (seer.cancer.gov/seerstat) was utilized to query SEER Research Plus Data [17 registries, Nov 2023 Sub (2000-2021)] for pediatric patients aged 0-18 years diagnosed with central nervous system (CNS) malignancies, bone and soft tissue sarcomas, Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), acute lymphocytic leukemia (ALL), acute monocytic/myeloid leukemia (AML), neuroblastoma, retinoblastoma, or Wilms tumor between 2000-2021 in the United States. Exported data was then analyzed in JMP Pro Version 18.2.2 (Statistical Discovery LLC, Cary, NC). Linear regression assessed individual cohorts with quadratic or cubic terms added when appropriate. Linear regression assessed whether RT utilization changed over time within each of these histology cohorts.
Results: Between 2000-2021, a total of 55,522 patients were identified and 12,523 (23%) received RT (external beam, brachytherapy, or radioisotope therapy) at some point in their disease course. External beam RT was delivered in 99.3% of patients. Retinoblastoma patients had the highest rate (15%) of isotope/brachytherapy utilization. Overall, RT was most applied in patients with Grade 4 CNS tumors (72.2%) and rhabdomyosarcoma (RMS) (66.7%) and least commonly in patients with retinoblastoma (4.3%) and osteosarcoma (3.8%). There was decrease in the overall rate of RT utilization in pediatric patients between 2000 (25%) and 2021 (15%) (p<0.0001). RT use increased in RMS from 57% to 74%, (p < 0.05). The use of RT in Wilms tumor patients increased from 43% to 55% (p <0.0001). The use of RT in low-grade CNS tumors decreased from 24% to 10% (p = 0.001); in contrast, the use of RT in high-grade CNS tumors increased from 69% to 78% (p <0.0001). A decline in RT use was observed for ALL and AML pediatric patients from 14% to 3% (p<0.0001) and 13% to 7% (p<0.001), respectively. The use of RT in NHL and HL patients declined from 17% to 4% (p <0.0001) and 45% to 18% (p <0.0001), respectively.
Conclusion: This study provides a comprehensive analysis of RT utilization patterns amongst pediatric patients in the 21st century and offers valuable data for healthcare resource planning. Despite a history of high efficacy, treatment paradigms for pediatric lymphoma, leukemia, and low-grade CNS tumors are shifting away from RT. The role of RT may be increasing in RMS, Wilms, and high-grade CNS tumors with intent of improving local control.