Practice patterns of photon and proton pediatric image guided radiation treatment: Results from an International Pediatric Research Consortium

Sara Alcorn, Michael J. Chen, Line Claude, Karin Dieckmann, Ralph P. Ermoian, Eric C. Ford, Claude Malet, Shannon M. MacDonald, Alexey V. Nechesnyuk, Kristina Nilsson, Rosangela C. Villar, Brian A. Winey, Erik J. Tryggestad, Stephanie A Terezakis

Research output: Contribution to journalArticle

Abstract

Purpose: Image guided radiation therapy (IGRT) has become common practice for both photon and proton radiation therapy, but there is little consensus regarding its application in the pediatric population. We evaluated clinical patterns of pediatric IGRT practice through an international pediatrics consortium comprised of institutions using either photon or proton radiation therapy. Methods and materials: Seven international institutions with dedicated pediatric expertise completed a 53-item survey evaluating patterns of IGRT use in definitive radiation therapy for patients ≤. 21 years old. Two institutions use proton therapy for children and all others use IG photon therapy. Descriptive statistics including frequencies of IGRT use and means and standard deviations for planning target volume (PTV) margins by institution and treatment site were calculated. Results: Approximately 750 pediatric patients were treated annually across the 7 institutions. IGRT was used in tumors of the central nervous system (98%), abdomen or pelvis (73%), head and neck (100%), lung (83%), and liver (69%). Photon institutions used kV cone beam computed tomography and kV- and MV-based planar imaging for IGRT, and all proton institutions used kV-based planar imaging; 57% of photon institutions used a specialized pediatric protocol for IGRT that delivers lower dose than standard adult protocols. Immobilization techniques varied by treatment site and institution. IGRT was utilized daily in 45% and weekly in 35% of cases. The PTV margin with use of IGRT ranged from 2 cm to 1 cm across treatment sites and institution. Conclusions: Use of IGRT in children was prevalent at all consortium institutions. There was treatment site-specific variability in IGRT use and technique across institutions, although practices varied less at proton facilities. Despite use of IGRT, there was no consensus of optimum PTV margin by treatment site. Given the desire to restrict any additional radiation exposure in children to instances where the exposure is associated with measureable benefit, prospective studies are warranted to optimize IGRT protocols by modality and treatment site.

Original languageEnglish (US)
Pages (from-to)336-341
Number of pages6
JournalPractical Radiation Oncology
Volume4
Issue number5
DOIs
StatePublished - Sep 1 2014

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Image-Guided Radiotherapy
Photons
Protons
Radiation
Pediatrics
Research
Proton Therapy
Therapeutics
Radiotherapy
Central Nervous System Neoplasms
Cone-Beam Computed Tomography
Clinical Protocols
Pelvis
Immobilization
Abdomen

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Practice patterns of photon and proton pediatric image guided radiation treatment : Results from an International Pediatric Research Consortium. / Alcorn, Sara; Chen, Michael J.; Claude, Line; Dieckmann, Karin; Ermoian, Ralph P.; Ford, Eric C.; Malet, Claude; MacDonald, Shannon M.; Nechesnyuk, Alexey V.; Nilsson, Kristina; Villar, Rosangela C.; Winey, Brian A.; Tryggestad, Erik J.; Terezakis, Stephanie A.

In: Practical Radiation Oncology, Vol. 4, No. 5, 01.09.2014, p. 336-341.

Research output: Contribution to journalArticle

Alcorn, S, Chen, MJ, Claude, L, Dieckmann, K, Ermoian, RP, Ford, EC, Malet, C, MacDonald, SM, Nechesnyuk, AV, Nilsson, K, Villar, RC, Winey, BA, Tryggestad, EJ & Terezakis, SA 2014, 'Practice patterns of photon and proton pediatric image guided radiation treatment: Results from an International Pediatric Research Consortium', Practical Radiation Oncology, vol. 4, no. 5, pp. 336-341. https://doi.org/10.1016/j.prro.2014.03.014
Alcorn, Sara ; Chen, Michael J. ; Claude, Line ; Dieckmann, Karin ; Ermoian, Ralph P. ; Ford, Eric C. ; Malet, Claude ; MacDonald, Shannon M. ; Nechesnyuk, Alexey V. ; Nilsson, Kristina ; Villar, Rosangela C. ; Winey, Brian A. ; Tryggestad, Erik J. ; Terezakis, Stephanie A. / Practice patterns of photon and proton pediatric image guided radiation treatment : Results from an International Pediatric Research Consortium. In: Practical Radiation Oncology. 2014 ; Vol. 4, No. 5. pp. 336-341.
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abstract = "Purpose: Image guided radiation therapy (IGRT) has become common practice for both photon and proton radiation therapy, but there is little consensus regarding its application in the pediatric population. We evaluated clinical patterns of pediatric IGRT practice through an international pediatrics consortium comprised of institutions using either photon or proton radiation therapy. Methods and materials: Seven international institutions with dedicated pediatric expertise completed a 53-item survey evaluating patterns of IGRT use in definitive radiation therapy for patients ≤. 21 years old. Two institutions use proton therapy for children and all others use IG photon therapy. Descriptive statistics including frequencies of IGRT use and means and standard deviations for planning target volume (PTV) margins by institution and treatment site were calculated. Results: Approximately 750 pediatric patients were treated annually across the 7 institutions. IGRT was used in tumors of the central nervous system (98{\%}), abdomen or pelvis (73{\%}), head and neck (100{\%}), lung (83{\%}), and liver (69{\%}). Photon institutions used kV cone beam computed tomography and kV- and MV-based planar imaging for IGRT, and all proton institutions used kV-based planar imaging; 57{\%} of photon institutions used a specialized pediatric protocol for IGRT that delivers lower dose than standard adult protocols. Immobilization techniques varied by treatment site and institution. IGRT was utilized daily in 45{\%} and weekly in 35{\%} of cases. The PTV margin with use of IGRT ranged from 2 cm to 1 cm across treatment sites and institution. Conclusions: Use of IGRT in children was prevalent at all consortium institutions. There was treatment site-specific variability in IGRT use and technique across institutions, although practices varied less at proton facilities. Despite use of IGRT, there was no consensus of optimum PTV margin by treatment site. Given the desire to restrict any additional radiation exposure in children to instances where the exposure is associated with measureable benefit, prospective studies are warranted to optimize IGRT protocols by modality and treatment site.",
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AU - Chen, Michael J.

AU - Claude, Line

AU - Dieckmann, Karin

AU - Ermoian, Ralph P.

AU - Ford, Eric C.

AU - Malet, Claude

AU - MacDonald, Shannon M.

AU - Nechesnyuk, Alexey V.

AU - Nilsson, Kristina

AU - Villar, Rosangela C.

AU - Winey, Brian A.

AU - Tryggestad, Erik J.

AU - Terezakis, Stephanie A

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N2 - Purpose: Image guided radiation therapy (IGRT) has become common practice for both photon and proton radiation therapy, but there is little consensus regarding its application in the pediatric population. We evaluated clinical patterns of pediatric IGRT practice through an international pediatrics consortium comprised of institutions using either photon or proton radiation therapy. Methods and materials: Seven international institutions with dedicated pediatric expertise completed a 53-item survey evaluating patterns of IGRT use in definitive radiation therapy for patients ≤. 21 years old. Two institutions use proton therapy for children and all others use IG photon therapy. Descriptive statistics including frequencies of IGRT use and means and standard deviations for planning target volume (PTV) margins by institution and treatment site were calculated. Results: Approximately 750 pediatric patients were treated annually across the 7 institutions. IGRT was used in tumors of the central nervous system (98%), abdomen or pelvis (73%), head and neck (100%), lung (83%), and liver (69%). Photon institutions used kV cone beam computed tomography and kV- and MV-based planar imaging for IGRT, and all proton institutions used kV-based planar imaging; 57% of photon institutions used a specialized pediatric protocol for IGRT that delivers lower dose than standard adult protocols. Immobilization techniques varied by treatment site and institution. IGRT was utilized daily in 45% and weekly in 35% of cases. The PTV margin with use of IGRT ranged from 2 cm to 1 cm across treatment sites and institution. Conclusions: Use of IGRT in children was prevalent at all consortium institutions. There was treatment site-specific variability in IGRT use and technique across institutions, although practices varied less at proton facilities. Despite use of IGRT, there was no consensus of optimum PTV margin by treatment site. Given the desire to restrict any additional radiation exposure in children to instances where the exposure is associated with measureable benefit, prospective studies are warranted to optimize IGRT protocols by modality and treatment site.

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