Current pattern of care in brain and near-brain tumor radiotherapy for infants and young children: A survey on age restrictions, treatment conditions and decision-making within SIOP Europe

Abstract

Introduction: Radiotherapy (RT) in children under 36 months of age with brain and near-brain tumors remains clinically challenging and harmonized age-related recommendations across Europe are lacking. This study aimed to evaluate current RT practice patterns and age-related decision-making in this population. Methods: A web-based survey among members of the European Society for Paediatric Oncology (SIOPE) assessed institutional experience, lower age limits for RT, technical and disease-related determinants, protocol adherence and follow-up practices. Results: Fifty-two professionals from 23 countries participated. All participants reported treating children under 36 months with RT, although only 58% irradiated children under 18 months and 27% under 12 months. Eighty-two percent worked in centers to which young children were referred and advanced RT techniques were widely available (90%). While international study protocols were commonly applied, only 52% reported having institutional standards for dose and volume constraints differing from those for older children. Lower age limits for general RT were reported by 56% of participants and typically ranged between 12 and 36 months. Craniospinal irradiation was avoided by 87% of these respondents in children under 36 months. Preserving cognitive function was the most important factor in age-related decisions (98%), followed by healthy development (75%). Treatment decisions were predominantly multidisciplinary (98%). Parental involvement required greater attention. Conclusion: RT in children under 36 months is applied cautiously and heterogeneously across Europe. Individual decisions are driven by anticipated toxicities, technical feasibility and disease-related prognosis. Harmonized age-specific RT guidelines and improved long-term follow-up structures are needed to ensure safe and evidence-based care.