Pediatric radiation oncology
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EDITORIAL
Pediatric radiation oncology Arnold C. Paulino
Received: 17 February 2013 / Accepted: 20 February 2013 / Published online: 13 March 2013 # Springer-Verlag Berlin Heidelberg 2013
Pediatric radiation oncology is a subspecialty that deals with the treatment of children using radiation. While cure is the primary goal in many patients, the avoidance of late effects is equally important as approximately 80 % of patients with childhood tumors are expected to be cured in North America, western Europe, and other industrialized nations. The radiotherapeutic approach to children is quite different in many ways compared to adults. Why is pediatric radiation oncology different from adult radiation oncology? Pediatric cancer is uncommon. In the USA, there are only 11, 000 to 12,000 cases per year, accounting for only 0.7 % of the total cancer cases. While leukemias, lymphomas, and brain tumors comprise about 60 % of all childhood cancer cases; the rest primarily consist of a heterogeneous group of tumors such as neuroblastoma, Wilms’ tumor, rhabdomyosarcoma, and various soft tissue and bone sarcomas. Because of their frequency, very few single institution studies with large number of patients have been performed. In North America, several study groups such as the Children’s Cancer Group, Pediatric Oncology Group, National Wilms’ Tumor Study, and Intergroup Rhabdomyosarcoma Study have pioneered the current backbone of treatment for many of these tumors. Whereas more than 60 % of children are enrolled on protocols, only about 3 % of adults are enrolled in studies. Training radiation oncology residents to be proficient in the pediatric radiation oncology can be problematic. In one study, only 75 to 80 % of senior residents felt they received adequate training in pediatric radiation oncology during residency. Furthermore, the average resident saw 11 to 20 cases during the entire residency [1]. Because of concerns that some residents may not see enough pediatric cases, the A. C. Paulino (*) The Methodist Hospital, Houston, TX, USA e-mail: [email protected]
Radiation Oncology Residency Review Committee (RRC) of the Accreditation Council for Graduate Medical Education (ACGME) in the USA has mandated that all residents graduating from an ACGME accredited program see a minimum of 13 pediatric cases during residency. The Radiation Oncology RRC has further stipulated in the Radiation Oncology program requirements that 8 of the required 13 cases be solid tumors. Given the vast heterogeneity of pediatric tumors and their mode of presentation, the resident graduating from an accredited radiation oncology program who is interested in practicing pediatric radiation oncology is likely to need further study either through a fellowship in pediatric radiation oncology or informal training. While many concepts in pediatric and adult radiation oncology are the same, there is one big difference in the radiotherapeutic management of children. Children are more likely to suffer from radiotherapy late effects compared to adults. The main diff
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