Palliative radiation oncology in pediatric patients.
Palliative radiation oncology in pediatric patients.
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DOI：
10.21037/apm.2019.05.01
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发表时间：
2019-05
影响因子：
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通讯作者：
G. Stachelek;S. Terezakis;R. Ermoian
中科院分区：
文献类型：
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作者：
G. Stachelek;S. Terezakis;R. Ermoian
放射治疗(RT)为缓解儿童晚期或转移性癌症患者的症状进展提供了一种有效且通常快速的手段。作为儿童姑息治疗的综合、多模式方法的一部分，RT可以作为一种有用的工具来治疗疼痛、脊髓压迫、呼吸困难、神经损害、出血以及肠道或尿路梗阻。无论这些症状是出现在病程较早的阶段，还是出现在接近生命末期的儿童和青少年中，它们都会对患者和照顾者的生活质量产生重大影响。因此，控制症状是最大限度地提高临终关怀的一个重要方面。姑息性RT在儿童和成人中的结果都是有利的。虽然RT已被广泛用作许多成人恶性肿瘤姑息治疗的一个组成部分，但尽管许多儿科肿瘤具有相对的放射敏感性，但它在儿科患者中仍然很少使用。儿童患者姑息性放射治疗的潜在障碍包括护理人员对放射治疗对特定症状的效用认识不足，在讨论从明确的治疗过渡时缺乏舒适度，对辐射相关副作用的担忧，以及父母和照顾者对放射治疗的犹豫不决。姑息性RT的实施也可能受到后勤障碍的阻碍，包括缺乏现场放射设施，无法获得熟悉儿科治疗的放射肿瘤学家，以及可能需要专门的医疗护理，如儿科麻醉。本综述的目的是促进对姑息性放疗在儿童肿瘤学环境中的益处和局限性的更全面的了解，包括儿童和青少年癌症患者所经历的常见症状，这些症状可能是将姑息性放疗整合到姑息治疗范例中的适应症，以及预期的治疗效果。我们描述了姑息性放射疗法的后勤、交付、常见剂量和潜在副作用的管理。虽然姑息性放疗在儿科人群中普遍耐受性良好，但我们也讨论了放疗对不同身体部位的潜在副作用以及预防或缓解的方法。
Radiation therapy (RT) provides an effective and often rapid means to alleviate symptomatic progression in pediatric patients with advanced or metastatic cancer. As part of a comprehensive, multimodality approach to pediatric palliative care, RT can be a useful tool to manage pain, spinal cord compression, dyspnea, neurologic compromise, bleeding, and bowel or urinary obstruction. Whether such symptoms present earlier in the disease course or in children and adolescents approaching the end of life, they can significantly impact the quality of life of patients and caregivers. Control of symptoms is therefore an important aspect in maximizing end of life care. Outcomes for palliative RT in both children and adults are favorable. While RT has been widely adopted as a component of palliative oncologic care for many adult malignancies, it remains infrequently utilized in pediatric patients despite the relative radiosensitivity of many pediatric tumors. Potential barriers to palliative radiation for pediatric patients include insufficient understanding by care providers regarding the utility of RT for a given symptom, lack of comfort in discussing a transition away from definitive management, concern over radiation-related side effects, and hesitancy toward radiation treatment on the part of parents and caregivers. Delivery of palliative RT can also be impeded by logistical obstacles including lack of on-site radiation facilities, unavailability of radiation oncologists comfortable with pediatric treatments, and the potential need for specialized medical care such as pediatric anesthesia. The aim of this review is to foster a more complete understanding of the benefits and limitations of palliative RT in the pediatric oncology setting, including common symptoms experienced by children and adolescents with cancer that may be indications for the integration of RT into palliative care paradigms, as well as the expected efficacy of treatment. We describe the logistics, delivery, common doses for palliative radiation regimens, and management of potential side effects. While palliative RT is generally well tolerated in the pediatric population, we also discuss potential side effects of RT to various body sites and approaches for prevention or mitigation.