The evaluation of dose distribution of vertebral growth plates in pediatric patients who underwent craniospinal radiotherapy
The evaluation of dose distribution of vertebral growth plates in pediatric patients who underwent craniospinal radiotherapy
Aim: The aim of this study was to evaluate the suitability of the dose distribution of vertebral growth plates in pediatric patients undergoing craniospinal radiotherapy with the recommendations of the SIOPE radiotherapy study group.Material and Methods: The study included 20 patients under the age of 12 who underwent 3-dimensional conformal craniospinal radiotherapy. For each patient, posterior and anterior primary ossification center of the cervical, thoracal, lumber and sacral vertebrae regions were re-contoured .The mean doses of each primary ossification center were determined and then the gradients were determined. The difference between the average doses of the anterior and posterior ossification centers of the vertebrae was evaluated separately for the cervical, thoracic, lumbar and sacral regions. Data were analyzed with descriptive statistics.Results: The mean doses of the posterior and anterior primary ossification center were respectively 23.62 Gy and 22.54 Gy for those lower than 25 Gy and 34.06 Gy and 33.09 Gy for those who underwent a dose greater than 25 Gy. The dose differences of the anterior and posterior ossification centers in the cervical, thoracal, lumbar and sacral vertebrae is lower than 5 Gy for those who underwent lower dose than 25 Gy.Conclusion: The planning data of craniospinal radiotherapy, which is applied to the cranial region with two lateral fields and the spinal area with single field, complies with the SIOPE recommendations.Primary and secondary ossification centers should be identified as the organ at risk for radiotherapy planning in the pediatric group undergoing craniospinal radiotherapy.
___
- 1.
Sarkar B, Munshi A, Ganesh T, et al. Dosimetric comparison of short and full arc in spinal PTV in volumetric-modulated arc therapy-based craniospinal irradiation. Med Dosim 2019.
- 2.
Follin C, Erfurth EM, Long-Term Effect of Cranial Radiotherapy on Pituitary-Hypothalamus Area in Childhood Acute Lymphoblastic Leukemia Survivors. Curr Treat Options Oncol 2016;17:50.
- 3.
Ishida Y, Sakamoto N, Kamibeppu K, et al. Late effects and quality of life of childhood cancer survivors: Part 2. Impact of radiotherapy. Int J Hematol 2010;92:95-104.
- 4.
Hoeben BA, Carrie C, Timmermann B, et al. Management of vertebral radiotherapy dose in paediatric patients with cancer: consensus recommendations from the SIOPE radiotherapy working group. Lancet Oncol 2019;20:155-66.
- 5.
Emans JB, Ciarlo M, Callahan M, et al. Prediction of thoracic dimensions and spina length based on individual pelvic dimensions in children and adolescents: an age-independent, individualized standard for evaluation of outcome in early onset spinal deformity. Spina 2005;30:2824–29.
- 6.
Canavese F, Dimeglio A. Normal and abnormal spina and thoracic cage development. World J Orthop 2013;4:167–74.
- 7.
Dimeglio A, Canavese F. The growing spina: how spinal deformities influence normal spina and thoracic cage growth. Eur Spina J 2012;21:64–70.
- 8.
Eifel PJ, Sampson CM, Tucker SL. Radiation fractionation sensitivity of epiphyseal cartilage in a weanling rat model. Int J Radiat Oncol Biol Phys 1990;19:661–4.
- 9.
Kennedy C, Bull K, Chevignard M, et al. Quality of survival and growth in children and young adults in the PNET4 European controlled trial of hyperfractionated versus conventional radiation therapy for standard-risk medulloblastoma. Int J Radiat Oncol Biol Phys 2014;88:292–300.
- 10.
Vatner RE, Niemierko A, Misra M, at al.Endocrine deficiency as a function of radiation dose to the hypothalamus and pituitary in pediatric and young adult patients with brain tumors, J Clin Oncol 2018;1;36:2854-62.
- 11.
“https://clinicaltrials.gov/show/NCT02066220” , access date 03 Mayıs 2019