A rapid review of evidence and recommendations from the SIOPE Radiation Oncology working group to help mitigate for reduced paediatric radiotherapy capacity during the COVID-19 pandemic or other crises.

To derive evidence-based recommendations for the optimal utilisation of resources during unexpected shortage of radiotherapy capacity.

We have undertaken a rapid review of published literature on the role of radiotherapy in the multimodality treatment of paediatric cancers governing the European practice of paediatric radiotherapy. The derived data has been discussed with expert paediatric radiation oncologists to derive a hierarchy of recommendations.

The general recommendations to mitigate the potential detriment of an unexpected shortage of radiotherapy facilities include: (1) maintain current standards of care as long as possible (2) refer to another specialist paediatric radiotherapy department with similar level of expertise (3) prioritise use of existing radiotherapy resources to treat patients with tumours where radiotherapy has the most effect on clinical outcome (4) use chemotherapy to defer the start of radiotherapy where timing of radiotherapy is not expected to be detrimental (5) active surveillance for low-grade tumours if appropriate and (6) consider iso-effective hypofractionated radiotherapy regimens only for selected patients with predicted poor prognosis. The effectiveness of radiotherapy and recommendations for prioritisation of its use for common and challenging paediatric tumours are discussed.

This review provides evidence-based treatment recommendations during unexpected shortage of paediatric radiotherapy facilities. It has wider applications for the optimal utilization of facilities, to improve clinical outcome in low- and middle-income countries, where limited resources continue to be a challenge.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2020 Apr 26 [Epub ahead of print]

Geert O Janssens, Henry C Mandeville, Beate Timmermann, John H Maduro, Claire Alapetite, Laetitia Padovani, Gail Horan, Yasmin Lassen-Ramshad, Karin Dieckmann, Christian Ruebe, Nicky Thorp, Lorenza Gandola, Thankamma Ajithkumar, Tom Boterberg

Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands; Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands., Department of Radiotherapy, The Royal Marsden Hospital, Sutton, United Kingdom; The Institute of Cancer Research, Sutton, United Kingdom., Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ) and German Cancer Consortium (DKTK), Germany., Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands; Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Department of Radiation Oncology & Proton Center, Institut Curie, France., Aix-Marseille University, Oncology Radiotherapy Department, CRCM Inserm, UMR1068, CNRS UMR7258, AMU UM105, Genome Instability and Carcinogenesis, APHM, Marseille, France., Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK., Danish Centre for Particle Therapy, Aarhus, Denmark., Department of Radiotherapy Medical University Vienna, Austria., Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg, Germany., Department of Radiotherapy, The Clatterbridge Cancer Centre, Wirral, UK; The Proton Beam Therapy Centre, The Christie Hospital, Manchester, UK., Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address: ., Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.