S1019
Clinical – Paediatric tumours
ESTRO 2026
Results: A total of 111 children (mean age 30.7months, range8- 48months, males57%) underwent 1604 anaesthesia procedures (mean 14 procedures per child).The most common diagnosis was neuroblastoma (34%) followed by rhabdomyosarcoma (27%) and wilms tumor (17%). Of these 7 children were offered palliative radiotherapy. Abdomen-pelvis was the most common site (61%) followed by head-neck (25%) and thorax (9%). Majority (85%) were exposed to chemotherapy before RT while 34% were on concurrent chemoradiation. Nine children (majority of them older and non head-neck site) were converted to awake treatment. Compliance to fasting protocol was seen in all. The anaesthetic agent used was intravenous ketamine in 85%, Ketamine with propofol in 14% (propofol top-up due to higher requirement of ketamine) and only propofol in 1 patient. Access was peripheral venous and monitoring was done with ECG, O2 saturation, fraction of inspired O2, and end-tidal CO2. The average procedure time (patient IN-patient OUT) was 14.3 minutes (7.13-29minutes). The average treatment time (beam ON-beam OFF) was 2.76 minutes (0.56-12.49minutes). The average preparation time for anaesthesia (patient IN-CBCT/Rx beam ON) was 7 minutes (3.34-17.25minutes). The rate of anaesthesia-related complications was <1% (2 episodes of desaturation, 1 incidence each of nausea- vomiting, and ketamine allergy). Treatment interruption was seen in 14 patients due to non anaesthesia related issues like febrile neutropenia, infections, febrile seizure and machine breakdown. Conclusion: Ketamine with its rapid onset of anaesthesia, short duration of action, pleasant recovery and favourable side effect profile makes it a safe anaesthetic agent for children receiving radiotherapy in high volume centres. Keywords: Radiotherapy, Anaesthesia, Children, Ketamine Anlotinib Plus Radiotherapy for Newly Diagnosed Pediatric Malignant Brainstem Gliomas: Safety and Efficacy Evaluation Ying WANG 1,2 , Yuanyuan Chen 1,2 1 Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China. 2 State Key Laboratory of Oncology in South China, Sun Yat- sen University Cancer Center, Guangzhou, China Purpose/Objective: Brainstem gliomas (BSGs) are heterogeneous central nervous system neoplasms, with radiotherapy as the standard of care (particularly for diffuse subtypes) but Proffered Paper 3738
limited therapeutic benefit. Due to low incidence, relevant research remains scarce. Anlotinib hydrochloride, a multi-targeted receptor tyrosine kinase inhibitor, suppresses angiogenesis-related kinases (VEGFR1/2/3, FGFR1/2/3) and other tumor- associated kinases. This open-label, prospective, single-arm Phase II trial assessed the efficacy and safety of anlotinib combined with radiotherapy in pediatric patients with newly diagnosed malignant BSGs. Material/Methods: Eligible participants (3–21 years) presented with histopathologically confirmed WHO grade III–IV gliomas or radiologically definitive high-grade BSGs. Treatment included intensity-modulated radiotherapy (IMRT/TOMO/VMAT): total dose 54–60 Gy, 1.8–2 Gy per fraction for 30 fractions. Anlotinib was initiated on radiotherapy Day 1, given concomitantly, and persisted until disease progression. Primary endpoint: 6-month PFS; secondary endpoints: PFS, OS, DCR, quality of life, and safety. Results: Totally 23 participants were accrued (median age 10 years [range 3–21]; male-to-female ratio 9:14), with median follow-up 258 days (40–3356). The 6-month progression-free survival rate reached 100%. Adverse events were grade 1–2, with no grade ≥ 3 toxicities reported; no treatment discontinuation due to adverse events. Common adverse effects: hypothyroidism, gastrointestinal discomfort; no on-treatment deaths. Three patients withdrew due to personal reasons (1 opted for traditional Chinese medicine, 2 voluntarily ceased therapy). Circulating tumor DNA (ctDNA) analysis (11 patients, 23 samples) identified the H3K27M mutation in 7 cases (all from cerebrospinal fluid). H3K27M mutation frequency remained unchanged pre- and post-radiotherapy; post- radiotherapy maxVAF declined, while the number of CSF mutations rose at disease progression. Conclusion: Anlotinib combined with radiotherapy exhibits favorable safety profiles and encouraging efficacy in pediatric patients with newly diagnosed malignant brainstem gliomas. Keywords: pediatric brainstem glioma, Anlotinib, Radiotherapy
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10-year single-centre experience of stereotactic radiosurgery for brain metastases: outcomes, toxicities & comparison of common vs uncommon cancers Ali Hussnain 1 , Amy Case 2 , Nicholas Gomez 1 , Jason Griffiths 3 , Najmus Sahar Iqbal 1 , Sherryl Jenkins 3 , Jillian
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