Practice patterns among radiation oncologists treating pediatric patients with proton craniospinal irradiation Journal Article

Authors: Medek, S.; De, B.; Pater, L.; Breneman, J.; Mahajan, A.; Wolden, S.; Vatner, R. E.
Article Title: Practice patterns among radiation oncologists treating pediatric patients with proton craniospinal irradiation
Abstract: Purpose: Craniospinal irradiation (CSI) is an important component of therapy for many pediatric central nervous system malignancies. Proton therapy is increasingly available and used for minimizing radiation exposure to normal tissues. The absence of an exit dose with proton therapy mandates decisions regarding coverage of the vertebral bodies (VB) in non–skeletally mature patients. Although the contents within the thecal sac represent the true clinical target volume (CTV), some physicians target the entire VB in growing children because of concerns over asymmetrical growth. This study aims to assess current practice patterns regarding VB coverage for pediatric patients undergoing CSI. Methods and Materials: Pediatric radiation oncologists were identified from the Particle Therapy Co-Operative Group pediatric subcommittee membership or affiliation with US proton centers. Potential participants were contacted by e-mail with a link to an institutional review board–approved, anonymized web-based survey distributed in June 2017 with follow-up in October 2017. The survey used skip logic and included up to 11 questions regarding practice patterns. Results: Thirty-three physicians responded to the survey (39%), 5 of which were excluded for lack of recent pediatric proton CSI experience. Of the 28 included responses, 23 physicians sometimes treat the entire VB and 5 physicians report always treating the entire VB. Most common responses regarding anterior CTV expansion for uncertainty were no expansion (n = 9) and 3 to 4 mm (n = 8). Most physicians modify the anterior CTV margin to protect normal structures, most commonly esophagus (n = 15), thyroid (n = 6), heart (n = 5), bowel (n = 4), and pharynx (n = 2). Conclusions: Vertebral body coverage in proton CSI varies among radiation oncologists in respect to target delineation, CTV expansions, and modifications for organs at risk. These data suggest the radiation oncology community may benefit from a standardized approach to pediatric proton-based CSI. © 2019 American Society for Radiation Oncology
Keywords: adolescent; child; clinical article; school child; treatment response; united states; follow up; internet; health survey; medical practice; thyroid gland; heart protection; intestine; esophagus; proton radiation; pharynx; craniospinal irradiation; vertebra body; e-mail; human; male; female; priority journal; article; radiation oncologist; central nervous system cancer
Journal Title: Practical Radiation Oncology
Volume: 9
Issue: 6
ISSN: 1879-8500
Publisher: Elsevier Inc.  
Date Published: 2019-11-01
Start Page: 441
End Page: 447
Language: English
DOI: 10.1016/j.prro.2019.06.012
PUBMED: 31279941
PROVIDER: scopus
Notes: Article -- Source: Scopus
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MSK Authors
  1. Suzanne L Wolden
    448 Wolden
  2. Brian Sandeep De
    10 De