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.