
Contents
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Introduction Introduction
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The patient’s pathway through radiotherapy The patient’s pathway through radiotherapy
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Treatment centres Treatment centres
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Decision making Decision making
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Assessment Assessment
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Informed consent Informed consent
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Positioning and immobilization Positioning and immobilization
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Imaging and target volume definition Imaging and target volume definition
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Planning and dosimetry Planning and dosimetry
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Dose prescription and fractionation Dose prescription and fractionation
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Verification of treatment accuracy Verification of treatment accuracy
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Supportive care Supportive care
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Documentation Documentation
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Follow-up Follow-up
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Types of radiotherapy Types of radiotherapy
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Conventional external beam radiotherapy Conventional external beam radiotherapy
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Intensity-modulated radiotherapy Intensity-modulated radiotherapy
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Stereotactic radiotherapy Stereotactic radiotherapy
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Image-guided and adaptive radiotherapy Image-guided and adaptive radiotherapy
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Proton beam radiotherapy Proton beam radiotherapy
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Brachytherapy Brachytherapy
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Molecular radiotherapy Molecular radiotherapy
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Side effects of treatment Side effects of treatment
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Factors affecting radiation injury to normal tissues Factors affecting radiation injury to normal tissues
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Early side effects Early side effects
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Late side effects Late side effects
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Late central nervous system side effects Late central nervous system side effects
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Late renal side effects Late renal side effects
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Late musculoskeletal and soft-tissue side effects Late musculoskeletal and soft-tissue side effects
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Late pulmonary side effects Late pulmonary side effects
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Late cardiac side effects Late cardiac side effects
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Late endocrine side effects Late endocrine side effects
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Late side effects on fertility Late side effects on fertility
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Late ocular side effects Late ocular side effects
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Late hepatic side effects Late hepatic side effects
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Metabolic syndrome Metabolic syndrome
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Second cancers Second cancers
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Further reading Further reading
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4 C4Radiotherapy in Paediatric Oncology
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Published:September 2020
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Abstract
Radiotherapy is an important part of the combined modality therapy used to cure many childhood cancers. Children should only receive radiotherapy in centres suitably equipped, staffed, and experienced in paediatric radiotherapy, supported by the necessary paediatric backup facilities. Many types of radiotherapy, including image-guided and intensity-modulated radiotherapy, brachytherapy, molecular radiotherapy, and proton beam radiotherapy, are available. Choice of the optimal type for an individual patient should result in the greatest chance of cure with least chance of adverse effects. Over the years, a better understanding of risk stratification, improved diagnostic imaging, research in technical developments, and clinical trials has refined decision making in paediatric radiotherapy. Fewer children now receive radiotherapy than previously, and doses and volumes irradiated have been safely reduced, which has improved the therapeutic ratio.
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