International experts are working to provide evidence-based guidelines for radiation therapy dosing for children

Every year, more than 350,000 children are affected by childhood cancer worldwide. Radiation has drastically improved results, but the damage to healthy tissue can affect a child’s long-term health.

Although clinicians and radiation specialists design treatments based on the most current information available, there is no single leading source of data to make evidence-based decisions specific to children.

Now an international research collaboration is working on a voluntary basis to provide evidence-based guidelines for dosing radiotherapy in children. Results from this effort will help minimize side effects while continuing effective radiation therapy.

An introduction to PENTEC – or Pediatric Normal Tissue Effects in the Clinic – was recently published in the International Journal of Radiation Oncology. PENTEC consists of more than 150 doctors, medical physicists, epidemiologists and other specialists, who volunteer their time and expertise.

This is truly a labor of love. We are all professionals and specialists, but we are also just people who care about what happens to these children after their cancer has been treated. “

Arthur Olch, PhD, Medical Physicist, Los Angeles Children’s Hospital

At the Cancer and Blood Disease Institute at Children’s Hospital in Los Angeles, Dr. Olch works closely with radiotherapy oncologists to help plan radiotherapy treatments and to ensure that radiation equipment is working properly. He is also on the PENTEC steering committee.

PENTEC is organized into 18 research groups, or “task forces,” each focusing on how radiation affects a particular organ system – such as the lungs and respiratory system, or the central nervous system. The group then searches the medical literature for studies and articles reporting doses and results. This often means revising hundreds of articles. After researching the literature and compiling information

In terms of dosage and outcomes, they can correlate the side effects with the radiation dose for each organ.

“We are collecting a tremendous amount of information that allows us to make safe dosing recommendations to the pediatric radiotherapy-oncology community that is supported by evidence,” said Dr. Olch.

But PENTEC’s efforts don’t stop there. The team comes across many case studies that do not contain enough information to contribute to the dose-response curves.

For example, if a study reports side effects, but not the radiation dose that causes those effects, the study cannot be included. PENTEC hopes to change this; they propose reporting standards for future studies, so that guidelines can be formed from as much information as possible.

The specialists who volunteer at PENTEC have been collecting enough information to formulate guidelines for a number of years. This year, the Organ Systems Task Forces have begun to publish their findings and recommendations, and most should be published by the end of the year.

Dr. Olch believes PENTEC will lead to fewer life-altering side effects and a better quality of life for childhood cancer survivors in the future. “What we are doing has very broad implications,” he says. “This will change the course of pediatric radiation therapy and hopefully lead to better outcomes for children with cancer – not just at Children’s Hospital Los Angeles and in the United States, but worldwide.”


Children’s Hospital Los Angeles

Journal reference:

Constine, LS, et al. (2021) Pediatric Normal Tissue Effects in Clinic (PENTEC): An International Collaboration to Assess Normal Tissue Irradiation Dose-Volume-Response Relationships for Children with Cancer. International Journal of Radiation Oncology.

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