Development Progress of Radiotherapy Recommendations For Low-/Middle-Income Countries (LMICs) via Adapted Resource and Implementation Application (ARIA) Adapted Management Guidelines (AMGs)

Abstract

Objectives

To describe the development and current progress of the ARIA Guide AMG radiation oncology components (ROCs) for hodgkin lymphoma (HOD), low-grade glioma (LGG), unilateral retinoblastoma (RBU), and neuroblastoma (NBL).

Methods

The ARIA Guide AMGs are a systematically derived set of guidelines developed in four phases and adapted to all resource settings based on the input of global representative panels (GRPs) across all World Health Organization regions and World Bank income levels. The strategy, consensus, validation, and dissemination phases integrate existing evidence-based methods, rigorous consensus-based approaches via a classic Delphi process, and expert global representation.

Results

The ARIA Guide GRPs for these four cancer types include 34 radiation oncologists from 17 different countries who have contributed 294 specific comments during three rounds of structured, iterative reviews for HOD, LGG, RBU, and NBL AMGs resulting in 105 AMG radiotherapy integrations. The Delphi statements collectively facilitated agreeance for 18 key controversial radiotherapy areas. Eight more cancer types are currently in strategy phase. All ROCs included indications for radiation therapy (RT); timing of consult and therapy; quality assurance; importance of RT plan peer review; and special considerations. Unique sections included disease-specific technical guidance and, for RBU, the availability of brachytherapy.

Conclusion

Comprehensive global radiation oncology guidelines were uniquely derived and adapted across all resource settings in a clear, detailed, user-centric, and reasonable manner, enabling solutions for improving pediatric cancer care and closing the survival gap between resource settings. The draft (beta) versions in progress of select ARIA Guide AMGs are currently available at: ARIAguide.org (accessible both online and offline).