Craniospinal radiotherapy in children: Electron- or photon-based technique of spinal irradiation

Chojnacka, Marzanna; Skowrońska‐Gardas, Anna; Morawska-Kaczyńska, M.; Zygmuntowicz-Piętka, Anna; Pędziwiatr, Katarzyna; Semaniak, Anna

doi:10.1016/j.rpor.2010.01.005

Cited by 9 publications

(5 citation statements)

References 23 publications

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“…On the other hand, the study by Hood et al demonstrated comparable thyroid and heart doses (±3% of target dose) to those observed in our current study. This may be explained by the different electron energies used in the study by Chojnacka et al In their study they used energies of18-22 MeV to treat children between 4-13 years old, while in our study we used energies of 6 and 12 MeV electrons to treat the five year old phantom, and in the study by Hood et al the electron energies ranged between 9 MeV and 12 MeV (Hood et al 2005, Chojnacka et al 2010. Also, the 3D-CRT out-of-field doses in the heart, thyroid and lungs are comparable to the results observed in the study from Hood et al (2005).…”

Section: Discussionmentioning

confidence: 70%

“…Studies on the associated risks of secondary cancer in children treated with CSI are mainly focusing on the comparison of proton techniques with photon techniques (St Clair et al 2004, Lee et al 2005, Howell et al 2012 and the assessment of the associated decreased risks of secondary cancers (Zhang et al 2013, 2014, Taddei et al 2015. One study actually compared the risks of photon-based techniques with those of electron-based techniques for CSI in children, demonstrating a slightly higher dose to the heart and liver with the photon techniques (Chojnacka et al 2010). Yet another study demonstrated that IMRT was able to spare organs at risk when compared to 3D-CRT (Parker et al 2007).…”

Section: Introductionmentioning

confidence: 99%

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Out-of-field doses from pediatric craniospinal irradiations using 3D-CRT, IMRT, helical tomotherapy and electron-based therapy

et al. 2017

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Medulloblastoma treatment involves irradiation of the entire central nervous system, i.e. craniospinal irradiation (CSI). This is associated with the significant exposure of large volumes of healthy tissue and there is growing concern regarding treatment-associated side effects. The current study compares out-of-field organ doses in children receiving CSI through 3D-conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), helical tomotherapy (HT) and an electron-based technique, and includes radiation doses resulting from imaging performed during treatment. An extensive phantom study is performed, using an anthropomorphic phantom corresponding to a five year old child, in which organ absorbed doses are measured using thermoluminescent detectors. Additionally, the study evaluates and explores tools for calculating out-of-field patient doses using the treatment planning system (TPS) and analytical models. In our study, 3D-CRT resulted in very high doses to a limited number of organs, while it was able to spare organs such as the lungs and breast when compared to IMRT and HT. Both IMRT and HT spread the dose over more organs and were able to spare the heart, thyroid, bladder, uterus and testes when compared to 3D-CRT. The electron-based technique considerably decreased the out-of-field doses in deep-seated organs but could not avoid nearby out-of-field organs such as the lungs, ribs, adrenals, kidneys and uterus. The daily imaging dose is small compared to the treatment dose burden. The TPS error for out-of-field doses was most pronounced for organs further away from the target; nevertheless, no systematic underestimation was observed for any of the studied TPS systems. Finally, analytical modeling was most optimal for 3D-CRT although the number of organs that could be modeled was limited. To conclude, none of the techniques studied was capable of sparing all organs from out-of-field doses. Nevertheless, the electron-based technique showed the most promise for out-of-field organ dose reduction during CSI when compared to photon techniques.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Out-of-field doses from pediatric craniospinal irradiations using 3D-CRT, IMRT, helical tomotherapy and electron-based therapy

et al. 2017

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“…After this, a spinal boost of 45-50 Gy and intracranial boost of 50-54 Gy are conducted. In the case of electrons, 15-22 MeV beams are used in a prone position over the spine [5]. The supine position is more favorable for photons because of its efficient reproducibility [6].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Electrons and Photons Treatment Plans in Medulloblastoma Patients

Ghani¹,

Razzaq²,

Amjad³

et al. 2023

Indonesian Journal of Cancer

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Background: The treatment of medulloblastoma involves surgery, radiotherapy, and adjuvant chemotherapy. In radiotherapy, craniospinal irradiation (CSI) is prescribed, where two lateral cranial fields and one or two spinal beams are applied in CSI. Different multi-field techniques (coplanar and/or noncoplanar) are used to register the prescribed dose. The purpose of this study was to assess plan quality in terms of dose coverage of the spine with both photon and electron beam therapy and the sparing of organs at risks (OARs).Methods: Ten pediatric patients (ages 6 to 10 years) were immobilized in the prone position for simulation. The Clinical Target Volume (CTV) of the organ under treatment, Planning Target volume (PTV) of the organ under treatment, and OARs were contoured. Prowess Panther (v4.71) was used for dose computations. Two lateral parallel-opposed 6 MV photon cranial fields with the spinal beam(s) (either 6 Photons or 21 MeV electrons) were used in planning. Electron beams were added posteriorly on the spine with parallel-opposed cranial fields. The treatment plans were computed for 3600 c Gy in 21 fractions.Results: For comparable conformity number of electron versus photons beam plans (0.68 ± 0.41 versus 0.66 ± 0.47, is not significantly different at p < 0.05) and homogeneity index (1.22 ± 0.03 versus 1.25 ± 0.04, is significantly different at p < 0.05), the photon doses were higher for underlying OARs (heart, liver, and thyroid) and were lower for partially in-field organs (lungs and kidneys) compared to electrons.Conclusions: The underlying organs i.e., thyroid, heart, and liver receive a lesser dose in case of electrons, while partially in-field organs are exposed more compared to photons mainly due to the ballooning effect in electrons. The study shows that both electrons and photons can be used for CSI. However, the electron may be preferred due to its better sparing of underlying structures.

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“…Pediatric medulloblastoma patients treated with CSI all receive spinal doses greater than 15 Gy, regardless of treatment protocol, with patients typically receiving 23 to 36 Gy in combination with chemotherapy. Doses to the heart vary, depending on the RT modality; but have been shown to result in doses to the heart that were approximately 50% and 28% of the spinal dose [15,16]. While the mechanistic underpinning of RT-induced cardiotoxicity is unclear, there is postulation that radiation induced in ammatory reactions, such as the release of tumor necrosis factor, interleukins and transforming growth factor may result in diffuse interstitial brosis [16,17].…”

Section: Introductionmentioning

confidence: 99%

Cardiac dysfunction in medulloblastoma survivors treated with photon irradiation

Cacciotti

Chordas

Valentino

et al. 2022

Neuro-Oncology Practice

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Background Medulloblastoma is an aggressive central nervous system (CNS) tumor that occurs mostly in the pediatric population. Treatment often includes a combination of surgical resection, craniospinal irradiation (CSI), and chemotherapy. Children who receive standard photon CSI are at risk for cardiac toxicities including coronary artery disease, left ventricular scarring and dysfunction, valvular damage, and atherosclerosis. Current survivorship guidelines recommend routine echocardiogram (ECHO) surveillance. In this multi-institutional study, we describe markers of cardiac dysfunction in medulloblastoma survivors. Methods A retrospective chart review of medulloblastoma patients who had photon beam CSI was followed by ECHO between 1980 and 2010 at Lurie Children’s Hospital and Dana-Farber/Boston Children’s Hospital. Results During the 30-year study period, 168 medulloblastoma patient records were identified. Included in this study were the 75 patients who received CSI or spinal radiation and ECHO follow-up. The mean age at CSI was 8.6 years (range, 2.9-20), and the mean number of years between radiation therapy (RT) completion and first ECHO was 7.4 (range, 2-16). Mean ejection fraction (EF) was 60.0% and shortening fraction (SF) was 33.8%. Five patients (7%) had abnormal ECHO results: three with EF <50% and two with SF <28%. Conclusion The majority of medulloblastoma patients who received CSI have relatively normal ECHOs post-treatment; however, 7% of patients had abnormal ECHOs. The implication of our study for medulloblastoma survivors is that further investigations are needed in this population with a more systematic, longitudinal assessment to determine predictors and screenings.

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Craniospinal radiotherapy in children: Electron- or photon-based technique of spinal irradiation

Cited by 9 publications

References 23 publications

Out-of-field doses from pediatric craniospinal irradiations using 3D-CRT, IMRT, helical tomotherapy and electron-based therapy

Out-of-field doses from pediatric craniospinal irradiations using 3D-CRT, IMRT, helical tomotherapy and electron-based therapy

Comparison of Electrons and Photons Treatment Plans in Medulloblastoma Patients

Cardiac dysfunction in medulloblastoma survivors treated with photon irradiation

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