One Year of Progress in Pediatric Upright Radiotherapy

A Promise in Practice

The first ever patient was seven years old. He received his treatment awake. 

Since that first treatment, other children have been scanned and treated using the upright system, including a child who required anesthesia for treatment. In our last blog, A Strategic Commitment to Minimizing Anesthesia in Pediatric Radiotherapy Treatments, we spoke about our commitment to reducing the need for anesthesia. Our commitment has never been to eliminate anesthesia from pediatric radiotherapy altogether. For some children, because of their age, individual needs, treatment requirements or other clinical considerations, anesthesia remains necessary to enable treatment to be delivered safely and effectively. 

Our ambition instead, is to help create more options. 

Where a child is able to undergo treatment awake, we want to explore how preparation, education, distraction, communication and the treatment environment can help them feel comfortable and confident enough to do so. Where anesthesia is needed, the priority remains exactly the same: delivering safe treatment in a way that is appropriate for that individual child. 

Our early clinical experience therefore reflects something fundamental to our approach to pediatric upright radiotherapy: the treatment experience should adapt to the child, rather than expecting the child to adapt to the treatment. 

From one storybook to a growing library of support 

In our original article, Toby’s Magic Chair was still in production. 

The idea was simple: if upright radiotherapy was going to be new and unfamiliar to children, could we create something that helped them understand what was going to happen before they experienced it themselves? 

The story follows Toby, a young boy preparing for upright radiotherapy, whose treatment chair becomes the starting point for a series of imaginary adventures. 

Since then, the book has been printed and supplied to children attending for treatment and it is already entering its second print run. 

We are now developing a series of pediatric patient booklets specifically for children and families experiencing upright radiotherapy. These resources will cover the treatment journey as well as more specific aspects of treatment, helping children and their families understand what to expect in clear, accessible and age-appropriate language. 

Importantly, we won’t be developing these resources in isolation. Each booklet will undergo review by our clinical partners to ensure the information is accurate and reflects real clinical practice. They will also be reviewed by members of our Voices of Experience Network, people with lived experience of radiotherapy. 

That combination of clinical expertise and lived experience is essential. A resource can be medically accurate and still fail to answer the questions that matter most to a child or family. 

By bringing those perspectives together, we hope to create information that doesn’t simply explain the technology, but genuinely helps children and families feel better informed and prepared for what lies ahead. 

What comes next?

Almost a year ago, many of the things we were discussing were still intentions. 

Today, children have been treated upright both awake and with anesthesia. Toby’s Magic Chair is being used by children and is entering its second print run. Pediatric information resources are being developed with clinical and lived-experience review. An international multidisciplinary collaboration has published a scientific framework to help guide the safe development of pediatric upright radiotherapy: Upright Positioning in Pediatric Radiotherapy: Rationale, Safety Considerations and a Research Roadmap.

That is meaningful progress. But not just ticking off a list of achievements. It is about continuing to ask the same question we asked at the beginning:

How can we make radiotherapy work better for the individual child receiving it? 

Sometimes that might mean supporting a child to undergo treatment awake. Sometimes it will mean safely delivering treatment under anesthesia. It might mean a storybook that helps a seven-year-old understand their treatment chair, or an information booklet that gives a parent the answers they need before their child’s first appointment. 

And as the clinical experience and evidence surrounding pediatric upright radiotherapy continue to grow, we intend to keep learning, listening and adapting. 

The promise we made almost a year ago remains the same: to put children and families at the heart of how this new approach to radiotherapy develops. 

It’s this commitment that led us to introduce More Heart, our ongoing commitment to rethinking the radiotherapy experience for children, bringing more understanding, imagination, compassion and, above all, more heart to their treatment journey.