ESTRO 2019 – Expert commentary : Present and future challenges of radiotherapy in adolescents and young adults

  • Cristina Ferrario — Agenzia Zoe
  • Univadis
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Karin Dieckmann is the Vice-Chair of the Department of Radiotherapy, Medical University of Vienna, Austria. She is also course director of the ESTRO Pediatric Teaching Course.

  • Children and young adults (AYAs) are definitely a specific patient population. 
  • One of the main challenges in the paediatric and AYA setting is the small number of patients we meet in our hospitals. This could make it hard for a radiotherapist to be properly trained on how to manage specific problems that young patients face during and after treatment. Moreover, the small number of patients is also one of the reasons why clinical studies are necessary to internationally collect data and develop proper treatment concepts.
  • Moving to a more clinical point of view, radiotherapists need to be aware of side effects, trying to focus their attention especially on the late ones.
  • The most common acute side effects include vomiting, headache, tiredness, and blood count changes depending on the site of the tumour and on the treatment, and the intensity of radio-chemotherapy and can usually be managed with specific medications.
  • But we should always keep in mind that we are treating people with growing organisms, and in many cases long-term survivors. So, for example, if organs at risk are located nearby the treatment target, and they have to be irradiated, long-term side effects can develop even after years.
  • The other big issue when treating AYAs is related to the psychological and emotional aspects of cancer diagnosis and therapy. Radiation oncologists are not trained in managing these nonphysical aspects. You always need to be very empathic in paediatric oncology where communication between doctors and children/AYAs is really intense and different from the one you can have with adults. There are three different partners in this communication: children, parents, and doctors. We always try to bring all these partners together; for me the most important one is the child/young adult. It is important to make the young adult feeling that he/she is the partner in the treatment and to explain the treatment in a way that he/she understands it and can ask questions whenever needed. After finishing the explanation to the patient, the parents are included in the dialogue and they can ask their questions.
  • A curative radiotherapy treatment should aim to eliminate the disease while avoiding (or at least reduce as much as possible) acute and long-term side effects. Technology is moving fast in the radiotherapy field and proton therapy seems to be the way we should follow for cancer treatment in the youngest, especially in patients treated with curative intention. Nonetheless, several very effective and precise photon radiotherapy techniques are available and can be offered even if no protons are available. I’m convinced that not every patient should be referred to a proton centre. We need to be very good in selecting patients and we should have a very good knowledge of different available treatments if we want to reach the goal of really curing the patient without long-term side effects.
  • The combined use of immunotherapy and radiotherapy is one of the hot topics in radiation oncology. Studies are now ongoing but we are at the very beginning of this journey with AYAs.
  • Even if the number of children and young adults is very limited in radiotherapy departments, radiotherapists have to be trained intensively in paediatric radio-oncology. Every second year, ESTRO School organises paediatric oncology courses trying to raise awareness among radiotherapists on the specific needs of their young patients.
  • In conclusion: the right treatment for the right patient. This is what we have to learn, to teach, and to live in our everyday practice.