The Australian Pediatric Brachytherapy Experience: A Pathway to a National Program

Abstract

Objectives

Pediatric cancers are rare and most children requiring radiation therapy receive external beam radiation (EBRT). Although EBRT may offer organ preservation compared to surgery, it can be associated with significant late effects. Image guided brachytherapy is a highly specialised technique offering both organ preservation and dose conformity to minimise late toxicity. The objective is to report on the set up of the first Australian paediatric brachytherapy service, including patient selection, dosimetric parameters and toxicity outcomes. This includes generating comparative proton plans in cases where imaging was available.

Methods

This is a retrospective mono-institutional review of paediatric brachytherapy in one of the largest paediatric centres in Australia. Outcomes and toxicities are presented as well as brachytherapy versus proton plan comparison in four patients.

Results

A total of 14 patients were treated with adjuvant brachytherapy between 2012-2022. All patients had pelvic tumours with the predominant histology being rhabdomyosarcoma. High dose rate (HDR) brachytherapy was used for 13 patients with one patient receiving low dose rate (LDR) brachytherapy. Only one grade three late toxicity was reported and two patients developed metastatic disease within one year of completion of treatment. The brachytherapy plan was superior to protons in two of four patients and equivocal in one patient.

Conclusion

This retrospective series demonstrates the feasibility and safety of brachytherapy in paediatric pelvic tumours. The initial work presented here demonstrates the value of a comprehensive radiation plan selection for individual paediatric patients.