Considerations About the risk of Neurovascular Late Effects in Pediatric Radiotherapy

Abstract

Objectives

Survivors of pediatric brain tumors are at an increased risk of developing neurovascular disease, with radiotherapy being a major determinant. The aim of this project was to map how the risk of neurovascular late effects is considered when treating pediatric patients with a brain or skull base tumor with radiotherapy.

Methods

A web-based survey, prepared in the frame of the HARMONIC project (harmonicproject.eu) together with the SIOPE radiotherapy working group (ROWG) was distributed to ROWG members throughout Europe. The survey included 33 questions about neurovascular structures at risk, screening and information of the patients, recommendations, and follow-up programs.

Results

47 participants from 18 European countries completed the survey, with 87% of them treating patients with photon therapy. 39 of the respondents (83%) never delineated specific structures for large vessel disease, mainly because no dose constraints exist (31/39, 79%) and neurovascular structures are not traditionally integrated into pediatric radiotherapy protocols (28/39, 71%). 35 of the respondents (74%) did not screen patients for risk factors of neurovascular disease before radiotherapy. Of the respondents, 22 (47%) informed all patients with a brain or skull base tumor of the risk of large vessel disease after radiotherapy, and 24 (55%) informed all patients of the risk of small vessel disease. 26 (55%) didn't have a follow-up imaging program for neurovascular disease after radiotherapy in pediatric patients, and 32 (68%) didn't have a follow-up program with blood sampling for seromarkers of risks of neurovascular disease. Of note, 94% of the respondents expressed interest in participating in a follow-up workshop on neurovascular disease after radiotherapy in pediatric patients.

Conclusion

Despite a general agreement on the importance of this topic, neurovascular late effects are currently not well included in the clinical practice of European radiotherapy centers.