Survey about the adaptive radiotherapy:
Andrada Turcas, Radiation Oncologist Oncology Institute Cluj-Napoca, Romania
The SIOPE Radiation Oncology Working Group also worked on a survey about the us of adaptive radiotherapy (ART) in pediatric radiation oncology.
Surface guided radiotherapy practice across the SIOPE affiliated centers:
Enrica Seravalli, Medical Physicist, UMCU, The Netherlands
The results of the survey on the SGRT practice conducted in 2021 and 2023 across the SIOPE affiliated centers were recently published: https://academic.oup.com/bjr/article/97/1157/1044/7623083
One issue that came up from this work was the lack of a guideline for using SGRT in pediatric patients. Responders who provided their contact information in the survey were invited to join an online meeting to discuss how to address this need. It was decided that a guideline would be created based on the experiences of SGRT users working with children.
If you have experience using SGRT with pediatric patients, please contact us. We are still seeking enthusiastic participants to contribute to the project.
Survey on the spleen as an organ at risk in pediatric radiotherapy
PI: Mark Gaze
Status: survey closed, project completed
A subgroup formed of SIOPE-Radiation Oncology Working Group members, and colleagues from University College London Hospitals, has been working to gauge the level of understanding of the risk of mortality from overwhelming post-splenectomy infection arising from incidental irradiation of the spleen in pediatric radiotherapy practice, and to develop straightforward evidence-based guidance to mitigate this risk.
The following recommendations have been made:
- Pediatric radiation oncologists should delineate the spleen and record the dose received as the standard of care, and communicate this and the level of risk to other relevant clinicians.
- Clinical trial protocols and radiotherapy guidelines should mandate contouring of the spleen and give a dose objective of ALARA or ideally a mean <10 Gy, if this can be achieved without compromise to target volume coverage.
- To reduce the risk of mortality from OPSI, a mean spleen dose ≥10 Gy should be regarded as significant, and the need to recommend prophylaxis should be considered.
- Professional organizations should work to increase awareness of the risks associated with incidental irradiation of the spleen through new or revised evidence-based guidelines and continuing professional development activities.
- Information for parents and patients should explicitly mention the risk and the recommendation for prophylaxis above a defined spleen dose.
- Recently, a manuscript based on this work has been published in the European Journal of Cancer (see “ Recent Publications ”).
Management of vertebral radiotherapy dose in pediatric patients with cancer: consensus recommendations from the SIOPE radiotherapy working group
PI: Bianca Hoeben, Geert Janssens
Status: project closed
Inhomogeneous radiotherapy dose distribution over the vertebrae in children can cause long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. Risk of involuntary inhomogeneous doses over the vertebrae is higher with highly-conformal radiotherapy techniques as are used today.
The aim of the project was to gather information regarding normal vertebral development in childhood and the disruptive influence of radiotherapy on vertebral growth, and to establish recommendations for modern radiotherapy techniques.
After a survey that was distributed among SIOPE-affiliated centers, results were discussed alongside the evidence from literature in a group of pediatric radiation oncologists from 27 leading centers in 11 European countries. The group produced consensus recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimize the risk of long-term spinal problems ( Hoeben et al. Lancet Oncology 2019;20(3):e155-166 and doi: 10.1016 /S1470-2045(19)30034-8 ).
Future multicenter studies regarding the effects of conformal radiotherapy techniques on vertebral growth will provide more data to re-evaluate and update these recommendations.