Establishment of a UK national referral service for paediatric brachytherapy

Objectives 1. to establish a national referral pathway for children where brachytherapy might be the most appropriate radiation treatment technique;2. to assess each patient for the best local therapy technique;3. to develop expertise within a specialist paediatric brachytherapy team;4. to ensure systematic follow-up of functional outcomes and disease control. Methods A meeting of UK paediatric radiation oncologists agreed the need to develop a national brachytherapy service, as no single centre had enough suitable patients to gain experience and competence. A national sarcoma advisory panel for local control of challenging cases meets monthly virtually. Referrals are typically assessed by a paediatric surgeon and radiation oncologist with examination under anaesthesia and a joint decision made regarding surgery and radiotherapy. A team including an experienced brachytherapy radiation oncologist and a dedicated paediatric radiation oncologist working together with a paediatric surgeon and supported by specialist anaesthesia, radiology, radiographic, physics and paediatric oncology colleagues deliver treatment. Follow-up is in a dedicated multidisciplinary combined clinic. Results From 2009 to 2021, 35 patients, referred from 14 principal treatment centres in England, Scotland, Wales and Northern Ireland, have been treated. Two patients had carcinomas; 33 had rhabdomyosarcoma. The treated site was bladder/prostate in 21 patients, cervix/vagina in 7 patients, head and neck 4 patients, perineum/vulva 3 patients. Interstitial catheters were placed percutaneously under ultrasound guidance (or intracavitary catheters for vagina/cervix patients). Afterloaded high dose rate iridium-192 was used. A dose of 27.5 Gy was delivered in five fractions over 3 days in all but two patients. At a median follow-up of 4 years 6 month (range 5 months to 12.8 years) no patients have relapsed or died and functional outcomes are good. Conclusion We have successfully established a national referral centre for paediatric brachytherapy achieving excellent outcomes.