Fractionated stereotactic radiotherapy for pediatric patients with retinoblastoma

Abstract

In this report, we discuss the application of a modified Gill‐Thomas‐Cosman (GTC) relocatable head frame to enable fractionated stereotactic radiotherapy (SRT) of infants under anesthesia. This system has been used to treat two infants, ages 12 and 18 months, for bilateral retinoblastoma on a Varian 6/100 linear accelerator. The GTC head frame was used to reproducibly position and treat the orbits of these children to between 2520 cGy and 3960 cGy in 180‐cGy fractions. A standard head and neck tray, with accompanying thermoplastic mask, was adapted to mount to the head frame to enable these treatments. We found the maximum average deviation in the repeat fixations, as compared with the initial fitting data, to be ±2.2emmm. The overall average difference and standard deviation in measurement was 0.47±0.63.2emmm for the first case and 0.19±0.94.2emmm for the second case, with a combined average of 0.35±0.79.2emmm overall from a total of 381 point measurements. The stereotactic treatment plan (Radionics®) incorporated a single isocenter for each orbit and 3 or 4 arcs per isocenter. An intercomparison has been made between this technique and a standard lateral field technique, designed using the stereotactic radiosurgery (SRS) planning system. Dose‐volume histograms and corresponding normal tissue complication probabilities (NTCP) based on pediatric bone growth inhibition have been calculated for each method for the orbital bone areas. We found that the NTCP is reduced from 95% or more in the standard treatment method to 16% or less with SRT. Use of the modified head frame provides excellent setup reproducibility, facilitates access to patients for anesthesia, and reduces the chances of a poor cosmetic result in these growing children.PACS number: 87.53.Ly

Retinoblastoma

“…Consider the dose to the bony orbit, a common site of secondary malignancies: even optimally applied intensitymodulated radiation therapy will result in 50% of the orbit receiving 50% of the prescribed dose. Higgins et al (2006) used fractionated stereotactic radiation therapy to treat the orbit in children under anesthesia. They found a maximum average deviation to be ± 2 mm.…”

Role and Alternative Modalities of External Beam Radiotherapy in the Management of Retinoblastoma

“…In patients treated with focal SRT, median doses to the tumor, optic chiasm, brainstem, ipsilateral optic nerve, globe, lens, orbital bone, and contralateral orbital bone were 41.92, 0.25, 0.07, 9.98, 19.11, 3.74, 6.73 and 2.31 Gy, respectively. In another study comparing SRT with the standard EBRT in 2 cases with bilateral RB, Higgins et al 57 found the normal tissue complication rate reduced from ≥95% to ≤16% with SRT.…”