title: Clinical outcomes of palliative radiation therapy for children.
abstract: OBJECTIVE
  In contrast to studies of adults, there are limited published data regarding palliative radiation therapy (RT) for children, and further study is greatly needed.
  
  
  METHODS
  We performed a retrospective review of all pediatric patients referred to our radiation oncology department over a 5-year span from January 1, 2007, to December 31, 2011.
  
  
  RESULTS
  Of 244 total pediatric patients referred, a subset of 45 (18.4%) were treated specifically with palliative intent for a total of 83 courses of RT. Follow-up data until study closure or death were available for 98% of patients. The median survival after initiation of palliative RT was 6.5 months. Overall, 23% of the children were alive at last follow-up visit, and 77% were deceased. The prescribed RT was completed in 93% of courses; 7% of courses were discontinued because of clinical deterioration due to systemic disease progression. The overall symptom response rate (partial or complete) was 72%. Overall response rate by symptom was 80% for bone pain, 55% for dyspnea or chest pain, 58% for neurologic symptoms, 50% for bleeding, and 100% for liver pain or ascites. Response rates by histology were 100% for leukemias, 91% for neuroblastoma, 76% for Ewing sarcoma, 64% for rhabdomyosarcoma, 54% for osteosarcoma, and 50% for primary central nervous system neoplasms. For responders, the median time from RT initiation to response was 1 week. For 7% of patients, a repeat course of RT for the same site and symptom was performed. No patients experienced RTOG (Radiation Therapy Oncology Group) grade 3 or greater acute or late toxicities.
  
  
  CONCLUSIONS
  RT is a useful palliative tool for pediatric patients that merits continued use and further study.
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California, San Diego.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Rahn
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California, San Diego.
authors.forename: Arno J
authors.initials: AJ
authors.lastname: Mundt
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California, San Diego.
authors.forename: James D
authors.initials: JD
authors.lastname: Murphy
authors.affiliation: Department of Pediatric Hematology and Oncology, Rady Children's Hospital, San Diego, California.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schiff
authors.affiliation: Department of Pediatric Hematology and Oncology, Rady Children's Hospital, San Diego, California.
authors.forename: John
authors.initials: J
authors.lastname: Adams
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California, San Diego. Electronic address: kevinmurphy@ucsd.edu.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004417:Dyspnea / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009369:Neoplasms / Q000209:etiology / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D010146:Pain / Q000532:radiotherapy; D010166:Palliative Care / Q000379:methods*; D016634:Radiosurgery; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D016896:Treatment Outcome