Treatment with ionising radiation is a valuable component of treatment schedules for a many children and young people with cancer. While some form of radiotherapy has been in use for over 100 years, a series of innovations has revolutionised paediatric radiation oncology. Mostly, high-energy X-ray photons are used, but proton beam radiotherapy is increasingly offered, especially in children and young people. This is to reduce the radiation exposure of healthy normal tissues and so the likelihood of adverse effects. Other methods of radiotherapy delivery include brachytherapy and molecular radiotherapy. The most appropriate treatment technique should be selected for every child. Advances in computers and imaging, developments in the technology of radiation delivery and a better understanding of pathology and molecular biology of cancer, coupled with parallel improvements in surgery and systemic therapy, have led to a transformation of practice in recent decades. Initially an empirical art form, radiotherapy for children has become a technically advanced, evidence-based cornerstone of increasingly personalised cancer medicine with solid scientific foundations. Late sequelae of treatment—the adverse effects once accepted as the cost of cure—have been significantly reduced in parallel with increased survival rates. The delivery of radiotherapy to children and young people requires a specialised multiprofessional team including radiation oncologists, therapeutic radiographers, play specialists and physicists among others. This article reviews the types of radiotherapy now available and outlines the pathway of the child through treatment. It aims to demonstrate to paediatricians how contemporary paediatric radiation oncology differs from past practice.
- child health
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable.
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Contributors All authors are members of the European Society for Paediatric Oncology (SIOP Europe) Radiation Oncology Working Group’s Steering Committee (https://siope.eu/siop-europe-radiation-oncology-working-group/). The concept for this Review came from MG and was developed and refined by all the authors together. All authors contributed sections to the draft manuscript, which was then reviewed and modified by all authors. All authors approved the final submitted version of the manuscript, and all authors made equal contributions.
Funding MG is supported by the National Institute for Health Research University College London Hospitals Biomedical Research Centre and by the Radiation Research Unit at the Cancer Research UK City of London Centre Award (C7893/A28990).
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.