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With advances in multimodality therapy, childhood cancer cure rates approach 80%. However, both radiotherapy and chemotherapy may cause debilitating or even fatal “late effects” that are critical to understand, mitigate, or prevent.  QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic) pointed out the uncertainties relating to chronic adverse effects of adult treatments, but the situation is more complicated for children in whom a mosaic of tissues develops at different rates and temporal sequences. Childhood cancer survivors have long life expectancy and may develop treatment-induced secondary cancers and severe organ/tissue injury long after treatment.  Collaborative long-term observational studies and clinical research programs for survivors of pediatric and adolescent cancer provide some dose response data for follow-up periods exceeding 40 years.  Data analysis is challenging due to the influence of both therapeutic and developmental variables. PENTEC (Pediatric Normal Tissue Effects in the Clinic) is a group of physicians, physicists and epidemiologists conducting a critical synthesis of existing literature aiming to:

  1. Develop quantitative evidence based dose/volume guidelines to inform treatment planning and improve outcomes for survivors of radiation therapy for childhood cancers,

  2. Describe relevant physics issues specific to pediatric radiotherapy, and

  3. Propose dose-volume-outcome reporting standards to systematically inform future treatment guidelines.

The following link will take you to the “adult" effort, (IJROBP vol 76, #3 Sep, 2010):



Introductory Papers

Prologue: lays out the project, ground rules for lit search, how to navigate the book

1.  Introduction to scientific issues

2.  Summary of Peds NTCP data and models (Peds QUANTEC in the clinic)

3.  Biodevelopmental considerations in Pediatrics

4.  Peds physics aspects

5.  Epidemiologic considerations

6.  Improving NTCP for peds, and modeling in peds

7.  Contrast Peds vs. Adult QUANTEC --differences and similarities


Organ System Reports

* Central Nervous System Effects/Brain Stem

* Spinal Cord

* Cerebrovascular

* Endocrine Complications of Cancer Therapy

* Ocular Complications due to Cancer Treatment (include CR)

* Head and Neck

* Adverse Effects of Cancer Treatment on Hearing

* The Thyroid Gland (include CR)

* Cardiovascular Effects of Cancer Therapy

* Pulmonary Effects of Antineoplastic Therapy

* Late Gastrointestinal and Hepatic Effects

* The Female Reproductive System: Ovary, Uterus

* Breast (hypoplasia, SMNs)

* The Male Reproductive System: Testes

* Genitourinary: Bladder/Kidney

* Musculoskeletal, Integument

* Total Body Irradiation

* Second Malignancies Following Treatment for Childhood Cancer (include CR)



1.  Accurate accumulation of dose & Dose out of field, Imaging, follow-up, etc.

2.  Biomarkers and surrogate endpoints

3.  Peds Imaging issues

4.  Secondary malignancy as impacted by evolution of technology

5.  Recommendations for reporting and gathering data, recommendations to cooperative groups

6.  Future directions (group effort)

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