S1018
Clinical – Paediatric tumours
ESTRO 2026
midline glioma (n=2), diffuse astrocytoma (n=1), germ cell tumor (n=1), posterior fossa anaplastic ependymoma (n=1), and medulloblastoma (n=1). The most common initial radiotherapy regimen was 54 Gy in 30 fractions (60%), followed by 59.4 Gy in 33 fractions (13%). Median time to first relapse was 11 months (range 4–76), with 78.6% relapses occurring locally.Re-irradiation regimens varied from 18 Gy in 10 fractions to 36 Gy in 20 fractions depending on tumor location and intent. Median follow-up was 6 months (range 2–66). The 6-month OS rate was 64%, and the 1- year OS rate was 14%, with median OS after re- irradiation of 6 months (DIPG: 4 months; non-DIPG: 9 months). Re-irradiation improved or stabilized symptoms in 72.7% of patients. Toxicity was mild, with 26.7% grade 1 and 13.3% grade 2, and no grade 3–4 events. Symptom improvement was significantly associated with better survival (log-rank p = 0.0401), and longer time to relapse correlated with improved post-reirradiation survival (Spearman ρ = 0.64, p = 0.013). Conclusion: Re-irradiation was well tolerated and provided substantial symptom control in most patients. Symptomatic improvement and longer intervals to relapse were associated with superior post- reirradiation survival, highlighting its potential as both a palliative and survival-extending strategy in selected pediatric CNS tumor cases. These results underscore the value of re-irradiation, warranting further prospective studies to optimize patient selection and treatment protocols. Keywords: Paediatric, CNS, Re-irradiation Digital Poster 3643 Anaesthesia for radiotherapy in children – An audit of practice Nehal Rishi Khanna 1,2 , Shubham Badewale 1,2 , Nayana Amin 3,4 , Jifmi Jose Manjali 2 , Siddhartha Laskar 1,2 1 Radiation Oncology, Tata Memorial Centre, Mumbai, India. 2 Radiation Oncology, Homi Bhabha National Institute HBNI, Mumbai, India. 3 Anaesthesiology, Tata Memorial Centre, Mumbai, India. 4 Anaesthesiology, Homi Bhabha National Institute HBNI, Mumbai, India Purpose/Objective: To audit the practice of anaesthesia in children receiving radiotherapy (RT) and evaluate the incidence and type of anaesthesia related complications. Material/Methods: Data from all consecutive patients receiving anaesthesia for radiotherapy simulation or treatment for non CNS solid tumors from January 2019 to December 2023 was analyzed retrospectively.
based mainly on temozolomide or nimotuzumab plus vinorelbine in 4 cases. At a median time of 7 months (range 3-39) 24 LFs were in field, 4 out-of-field, 3 marginal and 2 mixed (both in and out-of- field).
Conclusion: While in-field recurrence remains the most common site of failure, almost 30% of patients presents also an a marginal or out-field recurrence, warranting further efforts in terms of treatment volumes and concomitant systemic therapy Keywords: pHGG, radiotherapy, pattern of failure Digital Poster 3477 Re-irradiation in Paediatric Central Nervous System Tumors: Institutional Update onSurvival, Toxicity, and Symptom Control María Sánchez Robles 1 , Carmen Colomina Molina 1 , Sara Estrella Márquez 2 , Ines Ollinger Casin 1 , Julia García Martínez 1 , Oscar Muñoz Muñoz 1 , David B Delgado Leon 1 , Patricia Cabrera Roldan 1 1 Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 2 Radiation Oncology, Hospital Virgen del Puerto, Plasencia, Spain Purpose/Objective: Re-irradiation represents an increasingly valuable option in the management of recurrent central nervous system (CNS) malignancies in children, offering the potential for both palliative benefit and, in selected cases, meaningful disease control. Despite its growing use, clinical evidence and consensus on optimal approaches in this population remain limited. This updated institutional analysis aims to reinforce the role of re-irradiation by assessing its impact on survival, treatment-related toxicity, and symptom control in pediatric CNS tumor recurrence. Material/Methods: This retrospective review included pediatric patients with central nervous system (CNS) tumors who underwent re-irradiation at Hospital Universitario Virgen del Rocío (Seville, Spain) between 2018 and September 2025. A total of fifteen patients were identified, with one case excluded from survival analysis due to loss to follow-up after transfer to another institution. Results: Fifteen patients were included (median age 8 years, range 3–15). Diagnoses comprised DIPG (n=9), diffuse
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