Children's Oncology Group's 2013 blueprint for research: radiation oncology

Abstract

Radiation therapy (RT) is used to treat children with CNS tumors, solid tumors or Hodgkin lymphoma. Pediatric radiation oncologists have provided critical input into the development and implementation of concepts for clinical trials to further define the modality's role and test newer methods to reduce side effects or intensify therapy. The quality of pediatric oncology clinical trials that include radiation therapy is linked to the quality of guidelines. Radiation oncology is an adult medical specialty; thus, pediatric radiation oncologists are uniquely positioned to work with adult cancer investigators in the reorganized US National Cancer Institute Clinic Trials Network.

Fig. 1

Involved-field radiation therapy (left) irradiates uninvolved lymph node chains by convention. Involved-nodal radiation therapy (right) irradiates only involved lymph nodes.

Fig. 2

Example of cardiac-sparing whole-lung radiation therapy for Wilms’ tumor. Dose distributions are shown as blue line (950 cGy), green line (750 cGy), and yellow line (500 cGy). Anterior (light blue) and posterior (red) cardiac structures are outlined.

Fig. 3

Example (individual columns) of photon conformal radiation therapy (3DCRT), photon intensity-modulated radiation therapy (IMRT), and conformal proton therapy (3DCPT) for a case of Ewing sarcoma involving the temporal bone. Axial (upper), coronal (middle), and sagittal (lower) images show high-dose (red-orange), intermediate-dose (green), and low-dose (blue) regions by method.

Fig. 4

Example of stereotactic body radiotherapy plan for vertebral body metastasis from Ewing sarcoma. The radiation dose distribution (contour lines) displayed on the axial CT scan is shaped to minimize dose to the spinal cord. Liver (light green) and left kidney (orange) are shaded.