Trends in radiation therapy administration at a pediatric cancer center in South India

Survival rates in children with cancer have significantly improved with contemporary cancer-directed treatment. The use of radiation therapy (RT) plays a crucial role in enhancing survival and enabling organ/limb preservation, but delayed effects remain a concern. We evaluated how the use of RT has changed at our institution in a lower middle-income country (LMIC) over the past decade. Children (<18 years) who underwent RT from 2013 to 2024 at St. John's Hospital in Bengaluru, India, were included in retrospective data collection from medical records. The use of RT delivery methods was analyzed to document changes in RT decision-making and delivery over 12 years at our institution. Among 122 children (total of 128 courses of RT), 115 received curative RT, and 13 received palliative RT. Key changes observed over 12 years included the following; 1) discontinuation of routine prophylactic cranial irradiation (PCI) in B-lineage Acute Lymphoblastic Leukemia 2) replacing involved field radiation therapy (IFRT) with involved site radiation therapy (ISRT) in Hodgkin Lymphoma, more recently guided by interim PET-CT scans. 3) Limiting craniospinal irradiation (CSI) to Medulloblastoma and Pineoblastoma in brain tumors 4) Using total body irradiation (TBI) as part of conditioning for selected patients needing stem cell transplant (SCT) 5) In bone sarcoma, radiation was used as a limb sparing option and to improve local control post-surgery. 6) Using general anesthesia for young children receiving RT. Our institution was able to implement changes in RT administration for children with cancer, over the last decade. This was in accordance with the evolving standard of care, to minimize risk of late effects, without obvious impact on overall survival.