Radiation therapy still has a role in CAYA acute leukaemia. A number of patients may benefit from radiation therapy.

Overt CNS disease

Although using radiotherapy to treat CNS prophylaxis was an important advance in the treatment of CAYA ALL, it is now recognised that this treatment can have significant long-term effects. Prophylactic CNS radiotherapy has been universally replaced by intrathecal chemoprophylaxis in CAYA.

A meta-analysis of 16,623 patients aged 1–18 years with newly diagnosed ALL treated by 10 cooperative groups found that only patients with overt CNS disease at diagnosis benefited from CNS radiotherapy (Vora et al. 2016). Consequently, most groups continue to recommend CNS irradiation for patients with overt CNS disease at diagnosis or select groups at particularly high risk of CNS recurrence.

Testicular disease

Radiotherapy has had a role in some patients for treating testicular disease.

Haematopoietic stem cell transplantation

Total body irradiation and cranial radiation is used as part of the conditioning regimen for some patients undergoing HSCT (see section 4.2.7).

Palliative care

Radiation therapy in the context of non-curative intent, such as symptom management, can be very effective.

Patients receiving radiotherapy are sometimes treated outside of the specialist cancer service.

It is important that these patients are managed under the recommendations of the local service frameworks of the appropriate state service. This helps to provide a coordinated, sustainable and consistent model of care for delivering radiotherapy to CAYA with acute leukaemia.

Training and experience required of the appropriate specialists

Fellow of the Royal Australian and New Zealand College of Radiologists (or equivalent) with adequate training and experience that enables institutional credentialing and agreed scope of practice in CAYA acute leukaemia.

The training and experience of the radiation oncologist should be documented.

Health service unit characteristics

To provide safe and quality care for patients having radiation therapy, health services should have these features:

• linear accelerator (LINAC) capable of image-guided radiotherapy
• dedicated CT planning
• access to MRI and PET imaging
• automatic record-verify of all radiation treatments delivered
• a treatment planning system
• trained medical physicists, radiation therapists and nurses with radiation therapy experience
• coordination for combined therapy with systemic therapy, especially where facilities are not co-located
• participation in Australian Clinical Dosimetry Service audits
• an incident management system linked with a quality management