SIOPE – Brain tumor group consensus guideline on craniospinal target volume delineation for high-precision radiotherapy

Ajithkumar, TV; Horan, Gail; Padovani, Laëtitia; Thorp, Nicky; Timmermann, Beate; Alapetite, Claire; Gandola, Lorenza; Ramos, Mónica; Beek, Karen Van; Christiaens, Melissa; Lassen‐Ramshad, Yasmin; Magelssen, Henriette; Nilsson, Kristina; Saran, Frank; Rombi, Barbara; Kortmann, Rolf Dieter; Janssens, Geert O.

doi:10.1016/j.radonc.2018.04.016

Cited by 71 publications

(52 citation statements)

References 28 publications

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“…For high-precision CSI techniques, RT-QC adaptations of the former concept described by Carrie et al were performed in order to better evaluate the CTV/PTV and their coverage by the 95% isodose, with a special focus on the critical areas cribriform plate, temporal lobe, and thecal sac (Table 1; [1]). Since 2018, CTV has been evaluated according to the SIOP guideline on craniospinal target volume delineation with additional special focus on skull base foramina [16]. The SIOP PNET5 MB protocol required contouring of organs at risk (OAR) and collection of corresponding dose exposure.…”

Section: Methodsmentioning

confidence: 99%

Pretreatment central quality control for craniospinal irradiation in non-metastatic medulloblastoma

et al. 2020

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Purpose Several studies have demonstrated the negative impact of radiotherapy protocol deviations on tumor control in medulloblastoma. In the SIOP PNET5 MB trial, a pretreatment radiotherapy quality control (RT-QC) program was introduced. A first analysis for patients enrolled in Germany, Switzerland and Austria with focus on types of deviations in the initial plan proposals and review criteria for modern radiation technologies was performed. Methods and patients Sixty-nine craniospinal irradiation (CSI) plans were available for detailed analyses. RT-QC was performed according to protocol definitions on dose uniformity. Because of the lack of definitions for high-precision 3D conformal radiotherapy within the protocol, additional criteria for RT-QC on delineation and coverage of clinical target volume (CTV) and planning target volume (PTV) were defined and evaluated. Results Target volume (CTV/PTV) deviations occurred in 49.3% of initial CSI plan proposals (33.3% minor, 15.9% major). Dose uniformity deviations were less frequent (43.5%). Modification of the RT plan was recommended in 43.5% of CSI plans. Unacceptable RT plans were predominantly related to incorrect target delineation rather than dose uniformity. Unacceptable plans were negatively correlated to the number of enrolled patients per institution with a cutoff of 5 patients (p = 0.001). Conclusion This prospective pretreatment individual case review study revealed a high rate of deviations and emphasizes the strong need of pretreatment RT-QC in clinical trials for medulloblastoma. Furthermore, the experiences point out the necessity of new RT-QC criteria for high-precision CSI techniques.

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Section: Methodsmentioning

confidence: 99%

Pretreatment central quality control for craniospinal irradiation in non-metastatic medulloblastoma

et al. 2020

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“…Comparing the brain and H&N sites of our study and Nabavizadeh et al, margins were also similar (both median 5 mm, IQR 3-5 mm). Margin sizes should be in line with IGRT facilities and all steps in the chain of the (department-speci c) radiotherapy work ow (5,16). Complementary to the standardization and optimization of the organization of patient care, education and clinical research (36), knowledge of geometrical uncertainties including organ motion (37-44) is necessary to develop 'best practice' guidelines, distinguishing between hospital and patient speci c factors.…”

Section: Studymentioning

confidence: 99%

“…Practice guidelines published in 2010 merely focused on the clinical implementation of IGRT (5). Recently, the European Society for Paediatric Oncology (SIOPE) published consensus-based guidelines for children receiving radiotherapy to the vertebrae and the craniospinal axis; the guidelines included recommendations for patient immobilization, imaging, and target delineation, but not speci cally for IGRT practices (16,17). The Pediatric Radiation Oncology Society (PROS) stressed the importance of further investigations of the current status of pediatric IGRT (18).…”

Section: Introductionmentioning

confidence: 99%

A Baseline Survey on the Treatment Workflow and Pediatric IGRT Practice Among European Members of the Project-Based Consortium and the Pediatric Radiation Oncology Society (PROS).

Windmeijer

Bel

Jong

et al. 2020

Preprint

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Background Image-guided radiotherapy (IGRT) enables high precision tumor treatment with potential for sparing healthy tissues. The value of pediatric IGRT is widely acknowledged, but there is no consensus on ‘best practice’. We aimed to assess clinical pediatric IGRT practice among European members of the Pediatric Radiation Oncology Society (PROS) and members of our project-based consortium.Methods A survey addressing radiotherapy preparation, planning and delivery in seven treatment sites was sent to European PROS members and/or our IGRT project-based consortium (70 institutes). Responses were collected from June-September 2018.Results Of the 42 responding institutes (response rate 60%), 33 indicated to treat children. 28/33 are photon-only institutes, 3/33 are dedicated proton (‘proton-only’) institutes and 2/33 use both. Immobilization includes facial masks (in 100% of brain, craniospinal axis (CSA) and head-and-neck (H&N) treatments), and vacuum cushions (all sites, except brain and H&N). Intensity-modulated radiotherapy and volumetric-modulated arc therapy are most frequently applied ranging from 71%-81% in respectively CSA (20/28), and extremities (21/26), followed by 3D conformal radiotherapy ranging from 36%-69% in respectively H&N (10/28), and extremities (18/26). Isotropic planning target volume (PTV) margins varied widely in brain and abdomen (range, 1-10mm). The use of in-room kilovolt cone-beam computed tomography ranges from 57%-86% in respectively CSA (16/28), and thorax (24/28). Daily online imaging is used by the majority of institutes, ranging from 85%-90% in respectively extremities (22/26) and pelvis (27/30). Offline imaging protocols are used by 14%-21% in respectively H&N (4/28) and thorax (6/28).Conclusions Our survey shows comparable practice in pre-treatment imaging, planning and treatment techniques, and IGRT application among the participating European institutes. However, wide ranges in PTV margin sizes exist, supporting the need to define international ‘best practice’ guidelines for pediatric IGRT, and to aim for consensus on optimal margin definitions in view of available IGRT facilities and workflows among institutes.

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“…There seems to be an increasing awareness of the necessity for a common effort across European CNS tumour specialists to ensure high-quality RT treatment. In that line, the European society of paediatric oncology (SIOPE) Brain Tumour Group has recently published a consensus guideline on craniospinal target volume delineation for high-precision RT, which has the potential to improve the consistency of craniospinal delineation [32].…”

Section: Standardisation Of Treatment: Guidelinesmentioning

confidence: 99%

Radiotherapy practice for paediatric brain tumours across Europe and quality assurance initiatives: Current situation, international survey and future perspectives

Rojas

Clementel

Giralt

et al. 2019

European Journal of Cancer

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The aim of the study is to analyse radiotherapy quality assurance (RTQA) processes in the treatment of paediatric central nervous system (CNS) tumours across Europe. Methods: The RTQA aspects of major past and current European trials for paediatric CNS tumours were reviewed based on study protocols and publications. A survey among radiation oncologists and paediatric oncologists about the practices of RTQA in paediatric CNS tumours across European countries was also performed. Results: Several (inter)national initiatives to implement RTQA are being developed across Europe, with an apparent paradigm shift from retrospective to prospective RTQA. Experts from 21 of 29 contacted countries responded to the survey. National consensus guidelines for paediatric CNS tumours are available in 10 of 21 countries. Twenty-one of 33 experts

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SIOPE – Brain tumor group consensus guideline on craniospinal target volume delineation for high-precision radiotherapy

Cited by 71 publications

References 28 publications

Pretreatment central quality control for craniospinal irradiation in non-metastatic medulloblastoma

Pretreatment central quality control for craniospinal irradiation in non-metastatic medulloblastoma

A Baseline Survey on the Treatment Workflow and Pediatric IGRT Practice Among European Members of the Project-Based Consortium and the Pediatric Radiation Oncology Society (PROS).

Radiotherapy practice for paediatric brain tumours across Europe and quality assurance initiatives: Current situation, international survey and future perspectives

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