Feasibility of craniospinal irradiation in supine position for medulloblastoma in children population. Comparison of different therapeutic dosimetric data

Abstract

S294reports of practical oncology and radiotherapy 1 8 ( 2 0 1 3 ) S289-S305 "tumoral repopulation", "radiotherapy delays", "treatment interruptions", "overall treatment time", etc. Additionally, we traced the bibliographic references indicated in the articles previously selected. Special attention was paid in the quality of data reported, carefully divided into univariate or multivariate analysis. Results. Fifty-five papers were considered to fit the purposes of the present study: 49 original data from retrospective series and 3 were pooled-data analysis of previously published series, with a median of 426 patients per article (range 42-4668). The other 3 papers included one editorial, one commentary and a literature review. Larynx was the most frequently reported site (22 articles, 40%), followed by mixed locations (19 articles, 35%) and oropharynx (5 articles, 9%). The majority of the original and pooled-data studies (46/52-88.4%) showed some evidence of a negative relationship between OTT prolongation and LRC or SV. From 50 articles that analyzed LRC, 44 (88%) showed a significant deleterious effect of OTT prolongation, 27 of them by multivariate analyses. And from 16 articles reporting SV data, 14 (87.5%) showed the same effect, 10 of them by multivariate analyses. Conclusions. Consistent evidence exists about a negative outcome in LRC and SV, when OTT is prolonged during a RT course for H&NC. Over 88% of the studies reporting LRC and/or SV endpoints showed its detrimental effect, mostly by multivariate analysis of restrospective data. Taking into account the overwhelming ethical difficulties to perform any randomized clinical trial, prospective or retrospective observational studies are the unique evidence available to deal with this important issue.http://dx.

Prospective study on dosimetric comparison of helical tomotherapy and 3DCRT for craniospinal irradiation – A single institution experience

“…a number of beam directions vary from one (dorsal) to three (dorsal plus two oblique lateral) and different field matching techniques are used. Furthermore, intensity modulated dose plans using intensity modulated radiotherapy (IMRT) alone or combined with rotational dose delivery systems, the so-called volumetric modulated arc therapy (VMAT) 6,7 were introduced for CSI. However, none of these approaches enables to omit field matching, which may cause unintentional underdose or overdose in the spinal cord if the minimal set-up error occurs and, thus, can contribute to disease recurrence or lead to severe side effects.…”