Innovative Approaches to Radiation Delivery in Pediatric Oncology

Background: Radiation therapy plays a vital role in the treatment of pediatric malignancies. However, the developing anatomy and heightened radiosensitivity in children necessitate precision-focused approaches to minimize long-term toxicity. Recent advancements such as Volumetric Arc Therapy (VMAT), (IMRT), and 3DCRT offer enhanced tumor targeting with improved safety profiles. Aim: To compare the clinical outcomes and acute toxicity profiles of 3DCRT, IMRT, and VMAT in pediatric oncology patients undergoing radiation treatment. Methods: A prospective observational study was conducted at IGIMS, Patna, from 2024 to 2025. A total of 120 pediatric patients receiving radiation for various malignancies were included and categorized into three equal groups based on the radiation modality received—3DCRT, IMRT, or VMAT. Data on tumor response, acute toxicity, and treatment tolerability were collected. Statistical analysis was performed using SPSS version 23.0, with p-values <0.05 considered statistically significant. Results: Complete tumor response rates were highest in the VMAT group (80%) compared to IMRT (70%) and 3DCRT (65%). Acute toxicity, especially Grade II–III mucositis, was significantly lower in the VMAT group (15%) than in IMRT (30%) and 3DCRT (35%) (p=0.02). VMAT therapy also demonstrated improved tolerability and reduced hospital admissions for radiation-related complications. Conclusion: VMAT was associated with superior clinical response and lower acute toxicity compared to IMRT and 3DCRT in pediatric oncology patients. Its tissue-sparing capabilities make it a favorable option, particularly in tumors near critical organs. Recommendations: VMAT should be considered in pediatric patients where precision and tissue preservation are paramount. Wider access, cost reductions, and further long-term studies are needed to expand its applicability and confirm benefits in survival and late toxicity outcomes. Keywords: Pediatric oncology, 3DCRT, IMRT, VMAT, Radiation toxicity