Nordic Society of Paediatric Haematology and Oncology (NOPHO) Radiotherapy Working Group consensus guidelines on radiotherapy for paediatric low-grade gliomas

Abstract

Background and purpose: Paediatric low-grade gliomas (pLGG) are the most common brain tumours in children. Radiotherapy, once the standard treatment for unresectable pLGG, is now used less frequently due to concerns about late side effects. The Nordic Society of Paediatric Haematology and Oncology (NOPHO) Radiotherapy Working Group aims to provide consensus guidelines on the use of radiotherapy for pLGG, addressing the current controversies and facilitating decision-making. Patient/material and methods: The guidelines were developed by clinical/radiation oncologists from the Nordic and Baltic countries and two international experts during a 2-day working group meeting. The meeting included presentations from the international experts and was preceded by a survey on radiotherapy practices and a non-systematic review of the literature on pLGG. Results: We present consensus-based recommendations for radiotherapy of pLGG. The guidelines discuss indications and timing of radiotherapy, age-related considerations, and the impact of genetic predisposition disorders such as neurofibromatosis type 1. Modern radiotherapy techniques, such as proton therapy, are highlighted for their potential to reduce long-term side effects. Interpretation: Radiotherapy remains the most effective treatment for unresectable pLGG, but its use must be carefully weighed against the risk of long-term side effects. The guidelines emphasise a personalised treatment approach, considering the evolving field of targeted therapies and the importance of multidisciplinary input in decision-making.