Management of vertebral radiotherapy dose in paediatric patients with cancer: consensus recommendations from the SIOPE radiotherapy working group

Bianca A. Hoeben, Christian Carrie, Beate Timmermann, Henry C. Mandeville, Lorenza Gandola, Karin Dieckmann, Monica Ramos Albiac, Henriette Magelssen, Yasmin Lassen-Ramshad, Barbora Ondrová, Thankamma Ajithkumar, Claire Alapetite, Brian V. Balgobind, Stephanie Bolle, Alison L. Cameron, Raquel Davila Fajardo, Stefan Dietzsch, Delphine Dumont Lecomte, Marry M. van den Heuvel-Eibrink, Rolf D. KortmannAnne Laprie, Patrick Melchior, Laetitia Padovani, Barbara Rombi, Giovanni Scarzello, Rudolf Schwarz, Klaus Seiersen, Enrica Seravalli, Nicola Thorp, Gillian A. Whitfield, Tom Boterberg, Geert O. Janssens

Research output: Contribution to journalReview article

Abstract

Inhomogeneities in radiotherapy dose distributions covering the vertebrae in children can produce long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. In the published literature, many often interrelated variables have been reported to affect the extent of potential radiotherapy damage to the spine. Articles published in the 2D and 3D radiotherapy era instructed radiation oncologists to avoid dose inhomogeneity over growing vertebrae. However, in the present era of highly conformal radiotherapy, steep dose gradients over at-risk structures can be generated and thus less harm is caused to patients. In this report, paediatric radiation oncologists from leading centres in 11 European countries have produced recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimise the risk of long-term spinal problems. Based on available information, it is advised that homogeneous vertebral radiotherapy doses should be delivered in children who have not yet finished the pubertal growth spurt. If dose fall-off within vertebrae cannot be avoided, acceptable dose gradients for different age groups are detailed here. Vertebral delineation should include all primary ossification centres and growth plates, and therefore include at least the vertebral body and arch. For partial spinal radiotherapy, the number of irradiated vertebrae should be restricted as much as achievable, particularly at the thoracic level in young children (<6 years old). There is a need for multicentre research on vertebral radiotherapy dose distributions for children, but until more valid data become available, these recommendations can provide a basis for daily practice for radiation oncologists who have patients that require vertebral radiotherapy.

Original languageEnglish
Pages (from-to)e155-e166
JournalThe Lancet Oncology
Volume20
Issue number3
DOIs
Publication statusPublished - Mar 2019

ASJC Scopus subject areas

  • Oncology

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    Hoeben, B. A., Carrie, C., Timmermann, B., Mandeville, H. C., Gandola, L., Dieckmann, K., Ramos Albiac, M., Magelssen, H., Lassen-Ramshad, Y., Ondrová, B., Ajithkumar, T., Alapetite, C., Balgobind, B. V., Bolle, S., Cameron, A. L., Davila Fajardo, R., Dietzsch, S., Dumont Lecomte, D., van den Heuvel-Eibrink, M. M., ... Janssens, G. O. (2019). Management of vertebral radiotherapy dose in paediatric patients with cancer: consensus recommendations from the SIOPE radiotherapy working group. The Lancet Oncology, 20(3), e155-e166. https://doi.org/10.1016/S1470-2045(19)30034-8