Adverse late health outcomes among children treated with <scp>3D</scp> radiotherapy techniques: Study design of the <scp>Dutch</scp> pediatric <scp>3D‐RT</scp> study

Beijer, Josien G M; Kok, Judith L.; Janssens, Geert O.; Streefkerk, Nina; Vries, Andrica C H de; Slagter, Cleo; Maduro, John H.; Kroon, P.S.; Grootenhuis, Martha A.; Broeder, Eline van Dulmen‐den; Loonen, Jacqueline; Wendling, M.; Tissing, Wim J. E.; Pal, Helena J. van der; Louwerens, Marloes; Bel, Arjan; Hartogh, Jaap den; Loo, Margriet van der Heiden‐van der; Kremer, Leontien; Teepen, Jop C.; Ronckers, Cécile M.

doi:10.1002/cnr2.1620

Cited by 2 publications

(3 citation statements)

References 55 publications

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“…19 The use of radiotherapy in stage III treatment is associated with well-known acute and long-term side effects, including a significantly higher risk of VOD/SOS, cardiomyopathy, retroperitoneal fibrosis, scoliosis, diabetes, and most importantly, secondary malignant tumors. 20 A limitation of the current study is that the treatment of patients with CN-WT varied within the same stage groups. This was secondary to the change in some of the staging criteria between the studies, a lack of obligatory rapid central pathology review, and "unknown clinical reasons."…”

Section: Discussionmentioning

confidence: 96%

“…Furthermore, AV treatment regularly results in subclinical and histological changes in the liver, underlining the significance of avoiding unnecessary treatment 19 . The use of radiotherapy in stage III treatment is associated with well‐known acute and long‐term side effects, including a significantly higher risk of VOD/SOS, cardiomyopathy, retroperitoneal fibrosis, scoliosis, diabetes, and most importantly, secondary malignant tumors 20 …”

Section: Discussionmentioning

confidence: 99%

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Omission of adjuvant chemotherapy in patients with completely necrotic Wilms tumor stage I and radiotherapy in stage III: The 30‐year SIOP‐RTSG experience

Vujanić,

Graf,

D'Hooghe

et al. 2024

Pediatric Blood & Cancer

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BackgroundCompletely necrotic Wilms tumor (CN‐WT) following preoperative chemotherapy has been regarded as low‐risk WT since the International Society of Paediatric Oncology (SIOP) 93‐01 study, and patients have been treated with reduced postoperative therapy. The aim of the study was to evaluate whether the omission of adjuvant chemotherapy in patients with localized CN‐WT stage I and radiotherapy in stage III was safe.Patients and methodsThe retrospective observational study of outcomes of patients diagnosed with localized CN‐WT on central pathology review and treated according to the SIOP 93‐01 and SIOP‐WT‐2001 protocols (1993–2022).ResultsThere were 125 patients with localized CN‐WT: 90 with stage I, 10 with stage II, and 25 with stage III. Sixty‐two of 125 (49.6%) patients had a discrepant diagnosis and/or staging between the institutional pathologist and central pathology review. In the group of 90 patients with stage I, postoperative chemotherapy was not given to 41 (46%) patients, whereas 49 patients received postoperative chemotherapy—in the latter group, two patients relapsed, and one of them died. One stage I and one stage II patient developed chemotherapy‐induced toxicity and died. Nineteen of 25 patients with stage III received no flank radiotherapy. No stage III patient relapsed or died. The overall 5‐year event‐free survival (EFS) estimate for the entire cohort (stages I–III) was 96.8% [95% confidence interval, CI: 93.6%–99.6%] and the overall survival (OS) was 97.6% [95% CI: 95.0–100%]. The EFS and OS were 97% and 98%, respectively, for stage I, and 100% for stage III.ConclusionOmission of postoperative chemotherapy for patients with CN‐WT stage I, and radiotherapy for stage III is safe. Rapid central pathology review is required to assign appropriate treatment and avoid treatment‐related side effects.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Omission of adjuvant chemotherapy in patients with completely necrotic Wilms tumor stage I and radiotherapy in stage III: The 30‐year SIOP‐RTSG experience

Vujanić,

Graf,

D'Hooghe

et al. 2024

Pediatric Blood & Cancer

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“…The Dutch 3D study, an ongoing endeavor, encompasses 126 patients who have undergone craniospinal RT for CNS tumors, with a predominant focus on medulloblastoma (90 patients), as well as other histologies and treatment sites. This study aims to compile and standardize digital radiotherapy records from various multi-center resources, with the ultimate objective of enabling the future calculation of organ-specific radiation doses for childhood cancer survivors who received treatment during the 3D era [ 25 ]. Therefore, while 3D-CRT technique may have advantages in terms of reducing the volume of low dose bath, the use of advanced techniques such as IMRT, VMAT, and proton therapy can also reduce the risk of secondary malignancy by minimizing the dose to the surrounding normal tissues [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Current practices of craniospinal irradiation techniques in Turkey: a comprehensive dosimetric analysis

Şenkesen,

Tezcanlı,

Alkaya

et al. 2024

Radiat Oncol

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Objective This study evaluates various craniospinal irradiation (CSI) techniques used in Turkish centers to understand their advantages, disadvantages and overall effectiveness, with a focus on enhancing dose distribution. Methods Anonymized CT scans of adult and pediatric patients, alongside target volumes and organ-at-risk (OAR) structures, were shared with 25 local radiotherapy centers. They were tasked to develop optimal treatment plans delivering 36 Gy in 20 fractions with 95% PTV coverage, while minimizing OAR exposure. The same CT data was sent to a US proton therapy center for comparison. Various planning systems and treatment techniques (3D conformal RT, IMRT, VMAT, tomotherapy) were utilized. Elekta Proknow software was used to analyze parameters, assess dose distributions, mean doses, conformity index (CI), and homogeneity index (HI) for both target volumes and OARs. Comparisons were made against proton therapy. Results All techniques consistently achieved excellent PTV coverage (V95 > 98%) for both adult and pediatric patients. Tomotherapy closely approached ideal Dmean doses for all PTVs, while 3D-CRT had higher Dmean for PTV_brain. Tomotherapy excelled in CI and HI for PTVs. IMRT resulted in lower pediatric heart, kidney, parotid, and eye doses, while 3D-CRT achieved the lowest adult lung doses. Tomotherapy approached proton therapy doses for adult kidneys and thyroid, while IMRT excelled for adult heart, kidney, parotid, esophagus, and eyes. Conclusion Modern radiotherapy techniques offer improved target coverage and OAR protection. However, 3D techniques are continued to be used for CSI. Notably, proton therapy stands out as the most efficient approach, closely followed by Tomotherapy in terms of achieving superior target coverage and OAR protection.

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Adverse late health outcomes among children treated with 3D radiotherapy techniques: Study design of the Dutch pediatric 3D‐RT study

Cited by 2 publications

References 55 publications

Omission of adjuvant chemotherapy in patients with completely necrotic Wilms tumor stage I and radiotherapy in stage III: The 30‐year SIOP‐RTSG experience

Omission of adjuvant chemotherapy in patients with completely necrotic Wilms tumor stage I and radiotherapy in stage III: The 30‐year SIOP‐RTSG experience

Current practices of craniospinal irradiation techniques in Turkey: a comprehensive dosimetric analysis

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