Deviation from radiation treatment protocol in young children being treated for brain neoplasms was associated with decreased overall survival, according to a report in the journal Pediatric Blood & Cancer.1 

“This study shows that attention to the timing, dose, and location of radiation therapy is crucial,” explained Kenneth Wong, MD, assistant professor of Clinical Radiation Oncology at the Children’s Hospital of Los Angeles, in a news release.2

The Head Start III trial utilizes high-dose chemotherapy with autologous hematopoietic cell rescue (AuHCR) to treat young children with central nervous system cancers.1

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According to a news release from the Children’s Hospital of Los Angeles, the Head Start III trial protocol includes limiting the patient’s exposure to radiation in the hopes of protecting the developing brain. Once patients are older or if the tumor persists then they are treated with radiation therapy.2 

Dr Wong and colleagues conducted a quality assessment of the Head Start III trial.

The study included 220 children with recently diagnosed CNS neoplasms with 42 patient records reviewed to determine adherence to the radiation treatment protocols. In total, 8 of 25 patients were found to have treatment protocol violations for indication, dose, or volume of radiation therapy. All radiation treatment protocol violations were in children younger than 6 years, and the investigators identified 2 cases where radiation could have been avoided.

Furthermore, the authors note that the protocol violations were associated with decreased overall survival in the children aged 6 years or younger.

“When indicated, starting radiation therapy soon after neutrophil and platelet recovery may improve the outcome for these high-risk children,” the investigators write.1


1. Wong KK, All S, Waxer J, et al. Radiotherapy after high-dose chemotherapy with autologous hematopoietic cell rescue: quality assessment of Head Start III [published online April 5, 2017]. Pediatr Blood Cancer. doi:10.1002/pbc.26529

2. Further reductions in radiotherapy to young children with brain tumors results in less successful outcomes [news release]. Los Angeles, CA: Children’s Hospital Los Angeles; April 6, 2017. Accessed April 20, 2017.