Gautam Kumar Sharan¹*, Sahaj Palod¹, Anmol Verma¹ and Vachaspati Mishra²

¹Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Tata Memorial Centre, Muzaffarpur, India
²Department of Radiation Oncology, Globe Healthcare, Lucknow, India

*Corresponding Author: Gautam Kumar Sharan, Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Research Centre, Tata Memorial Centre, Muzaffarpur, India.

Received: December 29, 2025; Published: January 06, 2026

Abstract

Background: Radiotherapy (RT) remains a cornerstone of paediatric oncology but is a significant contributor to late morbidity and second malignancies.

Objective: To synthesise contemporary evidence on risk-adapted RT de-escalation in paediatric malignancies, highlight landmark trials, and delineate scenarios where RT remains indispensable, with special context relevant for Indian and global practitioners.

Materials and Methods: A focused literature search of PubMed, major cooperative-group (e.g., COG, SIOP) and guideline (e.g. NCCN) publications from 2018–2025 was conducted. Selection criteria included paediatric Hodgkin lymphoma, central nervous system (CNS) tumours, Wilms tumour, rhabdomyosarcoma, and neuroblastoma. Landmark trials, meta-analyses, and recent real-world registry data were integrated and discussed.

Results: Major cooperative group trials and recent meta-analyses show that dose and field reduction is feasible in well-defined low-risk groups with favourable biology (e.g., WNT-activated medulloblastoma, early-stage Hodgkin lymphoma). Implementation in real-world settings is increasing but must be cautious because omission or under-treatment may compromise cure and raise relapse risk (a “cautionary tale” exists). Emerging data from advanced RT techniques (protons, vertebral-body-sparing craniospinal irradiation) provide further rationale for volume/intensity reduction.

Conclusion: RT de-escalation can significantly improve the quality of life for survivors while preserving high cure rates when applied judiciously. Multidisciplinary care, careful patient-selection, rigorous adherence to trial-based criteria and lifelong surveillance are key. In low- and middle-income countries (LMICs) such as India, pragmatic adaptation to resource constraints is essential.

Keywords: Paediatric Oncology; Radiotherapy De-Escalation; Risk-Adapted Therapy; Hodgkin Lymphoma; Medulloblastoma (WNT); Proton Therapy

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Citation

Citation: Gautam Kumar Sharan., et al. “De-escalation of Radiotherapy in Paediatric Malignancies: Current Evidence, Practical Considerations, and Future Directions".Acta Scientific Cancer Biology 10.1 (2026): 23-34.

Copyright

Copyright: © 2026 Gautam Kumar Sharan., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.