Editor—Burnet et al highlight the prejudicial effect on outcomes of the lack of radiotherapy resources in the United Kingdom.1 They cite several cancers occurring in adults but fail to mention children's cancers.
Cancer is one of the four big killing diseases in childhood; after leukaemia, tumours of the central nervous system are the most common cancers in childhood. Brain tumours are categorised as moderate risk diseases by the Department of Health. Radiotherapy, either as an adjunct to surgery or as the sole modality, is an important component of the therapeutic strategy for many of the 400 new cases of childhood brain tumour occurring every year in England and Wales.
In medulloblastoma, five year event free survival rates of up to 70% can now be achieved in some countries2—a figure hardly approached in the United Kingdom. In single site intracranial germinoma the rate can be 90-100%.3 There is currently a lag time of up to six weeks to starting sophisticated neuraxial radiotherapy in children. This is unacceptable for both those tumours with a high doubling time, such as medulloblastoma,2 and those producing distressing symptoms for which radiotherapy is the most effective palliative measure, such as diffuse pontine glioma.4
Burnet et al raise the issue of hyperfractionation; this is a further strategy that may be of value in the treatment of certain children's brain tumours but would be difficult to adopt without appropriate resources. At the request of the Department of Health, a working party produced a standards document in response to public concern about the adequacy of treatment for children with brain tumours under the NHS.5 It is ironic that inadequate radiotherapy facilities continue to hamper endeavours to improve outcomes.
Those centres with specialist multidisciplinary paediatric neuro-oncology teams should be enabled to deliver the optimum treatment to children. On behalf of the children and their families we call not only for the provision of more linear accelerators but also for the clinical oncologists, radiographers, and physicists to operate them.
References
- 1.Burnet NG, Benson RJ, Williams MV, Peacock JH. Improving cancer outcomes through radiotherapy. BMJ. 2000;320:198–199. doi: 10.1136/bmj.320.7229.198. . (22 January.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Berger MS, Magrassi L, Geyer R. Medulloblastoma and primitive neuroectodermal tumors. In: Kaye AH, Laws ER Jr, editors. Brain tumors. Edinburgh: Churchill Livingstone; 1995. [Google Scholar]
- 3.Shibamoto Y, Takahashi M, Abe M. Reduction of the radiation dose for intracranial germinoma: a prospective study. Br J Cancer. 1994;70:984–989. doi: 10.1038/bjc.1994.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Walker DA, Punt JAG, Sokal M. Clinical management of brain stem glioma. Arch Dis Child. 1999;80:558–564. doi: 10.1136/adc.80.6.558. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Walker DA, Hockley A, Taylor R, Watson J, McKeag G, Kennedy C, et al. Guidance for services for children and young people with brain and spinal tumours. London: Royal College of Paediatrics and Child Health; 1997. [Google Scholar]