Results
A total of 275 children with cancer (< 18 years of age) received RT from 1st January 2009 to 31st December 2019 in the three MICC units. Of these 68 (24.7%) were excluded (RT was given for refractory/relapse disease (n=64), for palliation of metastatic site (n=3) and for lung metastasis (n=1)) and 207 were included (59% male, mean age 9.3 years, 68% from India, 67% received preceding treatment at MICC). The most common ICCC categories were CNS tumours (44%), lymphomas (13%), leukemias and soft tissue sarcomas (10% each), bone sarcomas (8%) and all others (15%).
Of the 207 included patients, 182 were examined for deviation of TTS, TDD and TTC as they belonged to the 13 diagnoses in which there were more than five patients (table 2 and table 3). The mean TTS, TTD and TTC are displayed in table 2. 43 children (23.6%) had deviation in TTS, 11 (6.0%) in TDD and 45 (24.7%) in TTC while 79 children (43.4%) had at least one deviation in any of these three parameters. Deviation from these and their association with age, gender, nationality, type of cancer and preceding treatment are displayed in Table 3. Type of cancer was significantly associated with deviation in all three parameters. TTS deviations were greatest in Ewing sarcoma and nonrhabdomyosarcoma soft tissue sarcoma, and renal tumours; TDD deviations were greatest in brain stem gliomas; and TTC deviations were greatest in nonrhabdomyosarcoma soft tissue sarcoma, medulloblastoma and primitive neuroectodermal tumour, and Ewing sarcoma. In addition location of preceding treatment and nationality were also significantly associated with deviation of TTS.
Table 4 lists the reasons attributed to these deviations. TTS was mostly impacted by issues around accessing care like preceding treatment outside our centres, logistical challenges of finance or approval for treatment, and travelling home or for second opinion. No specific reason was identified for TDD deviations. Myelotoxicity was the most common reason for deviations in TTC but we could not establish the reason in a third of the patients.