title: Radiation therapy at end of life in children.
abstract: OBJECTIVE
  Few data exist on evaluating utilization patterns of radiotherapy (RT) at the end of life (EOL) in children. Metastatic disease in pediatric patients is not pathognomonic for palliative treatment intent; further complicating the issue are complexities surrounding the very select population of children receiving proton therapy (PrT). We compared data for RT and PrT in terms of death rate within 30 days.
  
  
  METHODS
  We performed chart reviews for patients receiving radiation therapy at age ≤21 years treated at Indiana University Health Proton Therapy Center (IUHPTC) between June 2008 and June 2013 and University of Miami Radiation Oncology Department (UM) between June 2000 and June 2013. Included were patients not completing prescribed courses of RT, and those dying within 30 days of therapy. Comparison was made of differences between practice data for PrT and conventional RT.
  
  
  RESULTS
  At IUHPTC, 2 children of 272 did not complete their courses and died within 30 days (0.7%). At UM, data are available for 425 children; 9 did not complete their courses and 7 died within 30 days (1.6%). Neither the number of patients who did not complete treatment nor the 30-day death rates (P=.21) for PrT and RT were significantly different.
  
  
  CONCLUSIONS
  Delivery of RT for children at EOL is complex. Frequency of RT at EOL in children occurs in is <2% of cases, and is not significantly less frequent in the proton milieu. This appears to be about an order of magnitude less than in adults.
authors.affiliation: 1 Department of Radiation Oncology, University of Miami School of Medicine , Miami, Florida.
authors.forename: Joseph
authors.initials: J
authors.lastname: Panoff
authors.forename: R Victor
authors.initials: RV
authors.lastname: Simoneaux
authors.forename: Nikesh
authors.initials: N
authors.lastname: Shah
authors.forename: Michael
authors.initials: M
authors.lastname: Scott
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Buchsbaum
authors.forename: Peter A S
authors.initials: PA
authors.lastname: Johnstone
authors.forename: Kevin P
authors.initials: KP
authors.lastname: McMullen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005431:Florida; D006801:Humans; D007196:Indiana; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D010166:Palliative Care / Q000706:statistics & numerical data*; D011878:Radiotherapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*; D055815:Young Adult