Source:Radiotherapy and Oncology
Author(s): Thankamma Ajithkumar, Gail Horan, Laetitia Padovani, Nicky Thorp, Beate Timmermann, Claire Alapetite, Lorenza Gandola, Monica Ramos, Karen Van Beek, Melissa Christiaens, Yasmin Lassen-Ramshad, Henriette Magelssen, Kristina Nilsson, Frank Saran, Barbara Rombi, Rolf Kortmann, Geert O. Janssens
ObjectiveTo develop a consensus guideline for craniospinal target volume (TV) delineation in children and young adults participating in SIOPE studies in the era of high-precision radiotherapy.Methods and materialsDuring four consensus meetings (Cambridge, Essen, Liverpool, and Marseille), conventional field-based TV has been translated into image-guided high-precision craniospinal TV by a group of expert paediatric radiation oncologists and enhanced by MRI images of liquor distribution.ResultsThe CTVcranial should include the whole brain, cribriform plate, most inferior part of the temporal lobes, and the pituitary fossa. If the full length of both optic nerves is not included, the dose received by different volumes of optic nerve should be recorded to correlate with future patterns of relapse (no consensus). The CTVcranial should be modified to include the dural cuffs of cranial nerves as they pass through the skull base foramina. Attempts to spare the cochlea by excluding CSF within the internal auditory canal should be avoided. The CTVspinal should include the entire subarachnoid space, including nerve roots laterally. The lower limit of the spinal CTV is at the lower limit of the thecal sac, best visible on MRI scan. There is no need to include sacral root canals in the spinal CTV.ConclusionThis consensus guideline has the potential to improve consistency of craniospinal TV delineation in an era of high-precision radiotherapy. This proposal will be incorporated in the RTQA guidelines of future SIOPE-BTG trials using CSI.
https://ift.tt/2J2R77s
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