Paediatric tumours

With regard to paediatric illnesses, tumours are considered a rather rare occurrence. Nevertheless, with the incidents and malformative pathologies, they represent one of the primary causes of death in young children.

Over the last ten years there has been a significant annual increase of such cases in Europe and Italy. In our country we have an incidence of about 14 new patients every 100,000 in children aged 0 to 14, with an annual estimate of 1600-1700 new cases.

Originally, paediatric cancer was defined as a development disorder since it was due to alterations in the mechanisms that promote normal growth and tissue differentiation. Genetic factors are primarily implicated in children’s tumours while in adults, environmental mutagens are involved.  The subdivision according to the type of cancer is as follows: over half are "leukaemia and lymphomas" (haematological tumours) followed by "paediatric solid tumours" (tumours originating from the other organs, usually forming masses), with the latter most frequently represented by brain tumours.

Nevertheless, the growing scientific progress, improvement in support therapies, and use of increasingly complex and multimodal therapeutic approaches with all specialists involved in paediatric oncology leads to an 80% survival rate. This milestone increased the long-term survival rate and consequently an increase in the number of children and adolescents who reach adulthood after treatment. On the other hand, it also led to an increase in later complications linked to individual and combined treatments with a subsequent compromise in the quality of life.

Treatment

Radiation therapy is universally recognized as a fundamental step in the treatment of “paediatric solid tumours” because it allows local control of the growth of the neoplasm. On the contrary, the irradiation of the healthy tissue around the tumour leads to an inhibition in the growth and development of numerous signs and symptoms affecting the tissues involved.

Proton therapy, an external beam radiation technique that uses proton particles, is mainly indicated for paediatric neoplasms. The increasingly precise definition of the volumes of irradiation with the support of dedicated imaging and the radiobiological characteristics of the proton beam are potential advantages that reduce the exposure of organs at risk near the tumour and the overall dose to healthy tissues. This last aspect is strongly correlated with the onset of later multi-organ toxicity but above all with the reduction of future appearance of secondary neoplasms induced by radio-chemotherapy treatments, concepts of vital importance in paediatric oncology.