Modern trends in pediatric radiotherapy utilization

Purpose The objective of this study is to update trends in RT utilization for pediatric oncology patients in the United States between 2000 and 2021. Methods We queried a SEER database for pediatric patients aged 0–18 years diagnosed with central nervous system (CNS) tumors, bone/soft tissue sarcomas, Hodgkin's lymphoma (HL), non-Hodgkin's lymphoma (NHL), acute lymphocytic leukemia (ALL), acute monocytic/myeloid leukemia (AML), neuroblastoma, retinoblastoma, or Wilms tumor (WT). Linear regression assessed whether RT utilization changed over time within each of these histology cohorts. Results A total of 55,522 patients were identified and 12,523 (23%) received RT. Overall, RT was most applied with Grade 4 CNS tumors (72.2%) and rhabdomyosarcoma (RMS) (66.7%) and least with retinoblastoma (4.3%) and osteosarcoma (3.8%). There was decrease in the overall rate of RT utilization in pediatric patients between 2000 and 2021 (25–15%; p < 0.0001). RT use increased in RMS (57% to 74%, p < 0.05) and in WT (43% to 55%; p < 0.0001). RT use in low-grade CNS tumors decreased (24% to 10%; p = 0.001) whereas utilization increased in high-grade CNS tumors (69% to 78%; p < 0.0001). A decline in RT was observed for ALL and AML pediatric patients from 14% to 3% (p < 0.0001) and 13–7% (p < 0.001), respectively, as well as in NHL and HL patients, with a decline from 17% to 4% (p < 0.0001) and 45–18% (p < 0.0001), respectively. Conclusions We provide a comprehensive analysis of RT utilization patterns amongst pediatric patients in the 21st century and offer valuable data for healthcare resource planning.