Experience of Pediatric Radiation Oncology Peer Review Meetings: First Step Toward Centralizing Pediatric Radiotherapy in Pakistan

Introduction: Stark disparities in pediatric cancer outcomes persist between high and low sociodemographic index (SDI) regions due to fragmented healthcare systems and limited subspecialty expertise. In Pakistan, where pediatric radiation oncology expertise is not widely available, ensuring quality assurance (QA) is critical to mitigate errors that can lead to suboptimal treatment outcomes and long-term consequences in children. To address this, virtual Pediatric Radiation Oncology Peer Review Meetings (PROPRMs) were initiated in 2022 to foster collaborative decision-making and standardize treatment across the country. Methods: This study analyzed data from June 2022 to March 2025 from virtual PROPRM sessions organized by the Aga Khan University Hospital. Multidisciplinary meetings involving radiation and pediatric oncologists from multiple centers across the country transitioned from monthly to fortnightly. Case volume, clinical diagnoses, and management adjustments were documented and analyzed using descriptive statistics. Results: A total of 130 cases were reviewed across 46 sessions. The most common diagnostic categories were soft-tissue sarcomas (33.8%) and bone tumors (16.2%). Notably, consensus-driven changes in management were recommended in 70.8% of cases. The primary modifications (43.1%) directly involved radiation therapy (RT) planning, specifically regarding radiotherapy dose, technique, and organ-at-risk (OAR) constraints. The sessions also identified recurring educational gaps and systemic needs for improved multidisciplinary coordination. Conclusion: The virtual PROPRM model is a feasible and effective strategy for centralizing specialized expertise and improving QA in resource-limited settings. By identifying systemic gaps and standardizing care, this framework offers a sustainable pathway toward reducing global disparities in childhood cancer outcomes.