While the cure rate of cancer in children has markedly improved in the last few decades, late effects continue to be a problem in survivors. Radiotherapy, which is a major component of treatment in many cancers, is one of the major agents responsible for late toxicity. In the past decade, radiotherapy has been omitted in patients achieving excellent response to chemotherapy, such as in Hodgkin lymphoma and some Wilms tumors with lung metastases. Likewise, response to chemotherapy has been used to determine whether lower doses of radiation can be delivered in intracranial germinoma and pediatric nasopharyngeal carcinoma. Molecular subtyping in medulloblastoma is currently being employed, and in WNT-pathway M0 tumors, the reduction in radiotherapy dose to the craniospinal axis and tumor bed is currently being investigated. Finally, dose escalation was recently evaluated in patients with rhabdomyosarcoma > 5 cm who do not achieve a complete response to initial 9 weeks of chemotherapy as well as for unresectable Ewing sarcoma patients to improve local control.
尽管在过去几十年中儿童癌症的治愈率显著提高，但远期后遗症仍是幸存者面临的一大问题。放疗作为多种癌症治疗的主要手段，是导致远期毒性的重要因素之一。过去十年间，对于化疗反应良好的患者（如霍奇金淋巴瘤和部分伴肺转移的肾母细胞瘤），临床已开始尝试省略放疗。同样，化疗反应也被用于确定颅内生殖细胞瘤和儿童鼻咽癌患者是否可采用较低剂量放疗。目前髓母细胞瘤治疗中已开始应用分子分型技术，针对WNT通路M0型肿瘤，降低全脑全脊髓及瘤床放疗剂量的研究正在进行中。此外，近期研究评估了对化疗反应不佳的横纹肌肉瘤（肿瘤直径>5厘米且初始9周化疗未达完全缓解）以及不可切除尤文肉瘤患者进行剂量递增放疗，以期改善局部控制效果。
肿瘤(癌症)患者之家