Pediatric Infectious Diseases: Open Access

Editorial

In affluent countries, cancer is the second leading cause of death among children. Childhood cancer has been more common during the last few decades. Cure rates have risen steadily in recent years as a result of more specific diagnostic procedures, the implementation of standardised chemotherapy protocols, and current studies focusing on the treatment of toxicities, as well as other factors. Because there are approximately 8 million children in Italy and another 6 million Adolescents and Young Adults (AYA), we anticipate seeing between 260 and 350 children diagnosed with solid malignancies requiring Radiation Therapy (RT) per year. In the paediatric population, long-term survivors have a higher risk of adverse outcomes. Children's late effects, particularly after RT, develop gradually over months or years. Neurocognitive deficits, heart toxicity, endocrinological issues, growth anomalies, and the development of Secondary Malignancies (SMNs) are only a few of them. SMNs are seen in 10%-20% of patients 30 years following treatment. As a result, the use of RT in paediatric oncology is still debatable.

IMRT (intensity-modulated radiotherapy) is a revolutionary way of planning and delivering radiation therapy. IMRT has shown to have tremendous advancements in target conformity, permitting dose escalation to the target volume while sparing other organs at risk, as compared to the existing, well-established approach of three-dimensional conformal radiation therapy (3D-CRT). For numerous reasons, IMRT has been employed with extreme caution in the paediatric population. Enhanced fraction time, the need for precise immobilisation with custom-made steep dosage gradients, and the concern of increased SMN induction due to potentially greater low dose spillage or integral dose (ID) are among them.

Helical Tomotherapy (HT) combines a linear accelerator developed for IMRT with features of a helical computer Megavoltage Tomography-Computerized Tomography (MVCT) scanner to create a unique RT technique and revolutionary treatment equipment. A 6 MV x-ray fan beam modulated by a binary multi-leaf collimator (MLC) is given from a rotating gantry during HT treatment, resulting in a helical beam trajectory, while the patient on the treatment couch moves slowly through the gantry aperture. The MLC has 64 pneumatically controlled leaves that open and close across the slit hole. Each leaf can be closed, covering a piece of the slit, or open, allowing radiation through, or shifting between these states to conduct the intensity modulation. HT also enables MV-CT imaging as well as image registration with the planning CT for patient alignment. Image Guided Radiotherapy (IGRT) makes use of daily CT scanning to produce 3D pictures of body anatomy in order to determine the best treatment options.

Apart from ensuring a precise reproduction of the patient's spatial position, it also allows us to track tumour shrinking or changes in the body in specific cases (e.g., weight loss). Finally, without the problem of junctions, HT patients can be treated in a supine posture, resulting in a more comfortable treatment, especially for children requiring anaesthesia. Because of its capacity to provide highly conformal avoidance of essential structures immediately next to the tumour target, HT may provide an advantage over conventional approaches in some scenarios. This can be seen in a variety of anatomical locations.