Conclusions
Our study adds to the limited literature on RT quality for children with cancer in LMIC. Certain cancers (sarcomas and medulloblastoma) and patient groups (preceding treatment outside our institute) had the maximum deviation. Barriers to accessing care and myelotoxicity were the two main reasons for this deviation. Introduction
The role and need for radiation therapy (RT) of childhood cancer treatment is well established.(1) Despite declining trends of use over time,(2) it remains a critical part of multimodality treatment for several childhood cancers.(1) Modern treatment protocols are complex and multidisciplinary and often prescribe in detail the indication, the timing, the field and the dose of RT with additional guidance on managing toxicity.
The delivery of RT thus needs a level of coordination and planning which can be challenging in resource-limited settings.(3) This is because globally access to RT is not uniform and there are deficiencies in availability of RT machines, trained staff, as well as aspects of quality like input of interdisciplinary RT teams, treatment planning protocols, and quality assurance.(3,4) This is an under-researched area in low and middle-income countries (LMIC) including India where most of the childhood cancer cases occur.
In this retrospective study we audit the profile of children undergoing RT at our centre and analyze deviation from accepted norms during their treatment. This information will provide us guidance on how to further improve the delivery of our RT services.