title: Twinning partnerships through International Atomic Energy Agency (IAEA) to improve radiotherapy in common paediatric cancers in low- and mid-income countries.
abstract: OBJECTIVE
  The article summarises the current use of radiotherapy (RT) in childhood cancer and suggests methods to improve current practice in regions where outcomes of paediatric cancer patients are inferior to those of high-income countries.
  
  
  METHODS
  The International Atomic Energy Agency (IAEA) is supporting low- and mid-income countries (LMICs) in upgrading cancer care where nuclear applications, particularly RT, are used. A consensus meeting of experts was invited to advise IAEA on the needs for RT in paediatric cancer patients. The current indications for RT were reviewed, together with regional differences in access, practice and outcome.
  
  
  RESULTS
  Regional variations in the use of evidence-based multidisciplinary care including RT were associated with varying outcomes of paediatric cancer patients. The contribution of modern and investigational technology to these differences is uncertain and should be determined in clinical trials. Adequate resources are required to support children through the acute phase of treatment and to permit early recognition and management of late effects. An IAEA sponsored project for prospective data collection to assess the current and future status of radiation treatment in childhood cancer in LMICs has commenced.
  
  
  CONCLUSIONS
  RT remains an essential component of the multidisciplinary management of many paediatric cancers. Excessive variations in outcome are inappropriate and call for action on harmonising training programmes and compliance with evidence-based recommendations. Training projects targeting paediatric cancer care are being implemented and clinical studies comparing new technologies against evidence-based approaches are needed to achieve this goal. The IAEA has an important role in these activities and has commenced prospective data collection in 13 LMICs to monitor trends in treatment techniques and outcomes.
authors.affiliation: Applied Radiation Biology and Radiotherapy, Division of Human Health, IAEA and Department of Radiotherapy and Oncology, University of Turku, Finland. E.Salminen@iaea.org
authors.forename: Eeva
authors.initials: E
authors.lastname: Salminen
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Anacak
authors.forename: Siddartha
authors.initials: S
authors.lastname: Laskar
authors.forename: Rolf-Dieter
authors.initials: RD
authors.lastname: Kortmann
authors.forename: Elsa
authors.initials: E
authors.lastname: Raslawski
authors.forename: Graham
authors.initials: G
authors.lastname: Stevens
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009369:Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects