The Role of Palliative Radiotherapy as Adjuvant Therapy for Pain Control in Pediatric Oncology Patients: A Systematic Review and Meta-Analysis

Background: Pain is a common symptom for children and adolescents with treatment-refractory cancers at the end of life (EoL). Palliative radiotherapy (RT) is a noninvasive, outpatient therapy with an acceptable safety profile that helps to mitigate physical pain. It has been proven as an essential treatment modality for symptom control at EoL in the adult population. While the efficacy of palliative RT is well-established in adults, evidence in the pediatric population remains limited. This systematic review aimed to identify and evaluate the current evidence on palliative RT for the treatment of cancer pain in children and adolescents. Methods: Five databases were searched for pediatric empirical quantitative studies. Inclusion criteria include children and adolescents aged ≤21 years old with terminal cancer who received palliative RT for pain relief, single- or multicenter studies with ≥10 cases published in English. The primary outcome was pain control postpalliative RT, and secondary outcomes included reduction in opioid usage. Results: Seven observational retrospective studies ( n = 63 patients/235 metastatic sites/139 palliative RT courses), published between 2003 and 2024, were included. Palliative RT was associated with a 77.9% (95% confidence interval [CI] 71.2–84.6, p = 0.4) reduction in pain when used as an adjuvant therapy across all seven studies. A reduction in opioid use was observed in 43.2% (95% CI 31.8–54.7, p = 0.4) across two studies ( n = 52 patients/17 palliative RT courses). These were not statistically significant results. The subgroup analysis showed that it was associated with 80.0% (95% CI 69.9–90.1, p = 0.9) reduction of pain in patients with bony lesions across two studies ( n = 19 metastatic sites/41 courses). Conclusion: While our meta-analysis does not provide sufficient evidence to show that palliative RT reduced pain in children and adolescents with terminal cancer, it adds to the growing body of evidence supporting integrated approaches to symptom control in pediatric oncology. Further research is needed to substantiate its clinical benefits in augmenting and facilitating optimal EoL care in children and adolescents with advanced malignancies.