European practice on neurovascular late effects after pediatric radiotherapy: considerations on dose planning and follow-up - a HARMONIC/SIOPE ROWG survey.

Background and purpose: The risk of developing neurovascular late effects after radiotherapy is an area of concern when treating pediatric brain tumor patients. However, knowledge is sparse regarding best practice for clinical management during the radiotherapy (RT) planning process and follow-up examinations. This study therefore aimed at mapping how the risk of neurovascular late effects is considered for pediatric brain or skull base tumor patients treated with radiotherapy in Europe.

Materials and methods: Two web-based surveys ‑ a RT and a pediatric oncology (PO) survey - were distributed to members of the SIOPE radiotherapy working group or PANCARE and SIOPE brain tumor group, respectively.

Results: The RT survey was completed by 47 participants from 18 different European countries and the PO survey by 33 participants (mostly pediatric (neuro)oncologists) from 15 countries. Overall, the answers highlighted that neurovascular late effects are currently not well included in European clinical practice, neither at the time of radiotherapy nor in the follow-up process.

Interpretation: There is a need for raising general awareness about the topic, as well as for potential risk-stratified prevention measures and follow-up guidelines.