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The treatment for pediatric tumors requires interdisciplinary cooperation to integrate multimodality treatments in order to achieve the optimal control rate of the primary lesion, reduce the probability of recurrence, and thereby improve survival.

The common indications for radiotherapy are as follows:

1. For some radiosensitive tumors, such as CNS germ cell tumors and early Hodgkin's lymphoma, definitive radiotherapy combined with chemotherapy is suggested.

2. In the adjuvant settings, radiotherapy aims to eradicate the residual tumor at the primary lesion site and increase locoregional control; said radiotherapy is used for primary CNS tumors, soft tissue sarcoma, neuroblastoma, and Wilms’ tumors.

3. As a conditioning treatment, total body irradiation before a bone marrow transplant is performed to make the patient ready to accept new and healthy stem cells and help remove the residual cancer cells.

4. Palliative radiotherapy can alleviate the discomfort caused by the tumor, such as compression of some unresectable, recurring or metastatic tumors, such as inoperable sarcoma, recurring lymphoma, retinoblastoma, craniopharyngioma, and other metastatic lesions.

Last but not least, proton therapy is known to have better dose distribution and cause fewer complications in comparison with photon therapy. However, tumor location and daily organ motion should be taken into serious consideration. Proton dose distribution is very sensitive to the changes of treatment path length, so please have a detailed discussion with your physician to customize your proton therapy.

Article author: Dr. Shih-Min Lin