Prema Rassiah1, Natia Esiashvili2, Arthur J Olch3, Chia-Ho Hua4, Ken Ulin5, Andrea Molineu6, Karen Marcus7, Mahesh Gopalakrishnan8, Susha Pillai9, Nataliya Kovalchuk10, An Liu11, Greg Niyazov12, Jose Peñagarícano13, Fred Cheung14, Adam C Olson15, Cheng-Chia Wu16, Harish K Malhotra17, Iain J MacEwan18, Jacqueline Faught4, John C Breneman19, David S Followill6, Thomas J FitzGerald20, John A Kalapurakal8. 1. Department of Radiation Oncology, University of Utah, Salt Lake City, Utah. Electronic address: prema.rassiah@hci.utah.edu. 2. Department of Radiation Oncology, Emory University, Atlanta, Georgia. 3. Department of Radiation Oncology, University of Southern California and Children's Hospital of Los Angeles, Los Angeles, California. 4. Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. 5. Imaging and Radiation Oncology Core, Rhode Island QA Center, University of Massachusetts Medical School, Lincoln, Rhode Island. 6. Imaging and Radiation Oncology Core, Houston QA Center, MD Anderson Cancer Center, Houston, Texas. 7. Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts. 8. Department of Radiation Oncology, Northwestern University, Chicago, Illinois. 9. Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon. 10. Department of Radiation Oncology, Stanford University, Stanford, California. 11. Department of Radiation Oncology, City of Hope, Los Angeles, California. 12. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York. 13. Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. Electronic address: Jose.Penagaricano@Moffitt.org. 14. Medical Physics division, Princess Margaret Cancer Center, Toronto, Ontario, Canada. 15. Department of Radiation Oncology, Children's Hospital of Pittsburgh, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 16. Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York. 17. Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York. 18. Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California. 19. Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio. 20. Department of Radiation Oncology, University of Massachusetts, Worcester, Massachusetts.
Abstract
PURPOSE: The aim of this study was to examine current practice patterns in pediatric total body irradiation (TBI) techniques among COG member institutions. METHODS AND MATERIALS: Between November 2019 and February 2020, a questionnaire containing 52 questions related to the technical aspects of TBI was sent to medical physicists at 152 COG institutions. The questions were designed to obtain technical information on commonly used TBI treatment techniques. Another set of 9 questions related to the clinical management of patients undergoing TBI was sent to 152 COG member radiation oncologists at the same institutions. RESULTS: Twelve institutions were excluded because TBI was not performed in their institutions. A total of 88 physicists from 88 institutions (63% response rate) and 96 radiation oncologists from 96 institutions (69% response rate) responded. The anterior-posterior/posterior-anterior (AP/PA) technique was the most common technique reported (49 institutions [56%]); 44 institutions (50%) used the lateral technique, and 14 (16%) used volumetric modulated arc therapy or tomotherapy. Midplane dose rates of 6 to 15 cGy/min were most commonly used. The most common specification for lung dose was the midlung dose for both AP/PA techniques (71%) and lateral techniques (63%). Almost all physician responders agreed with the need to refine current TBI techniques, and 79% supported the investigation of new TBI techniques to further lower the lung dose. CONCLUSIONS: There was no consistency in the practice patterns, methods for dose measurement, and reporting of TBI doses among COG institutions. The lack of standardization precludes meaningful correlation between TBI doses and clinical outcomes including disease control and normal tissue toxicity. The COG radiation oncology discipline is currently undertaking several steps to standardize the practice and dose reporting of pediatric TBI using detailed questionnaires and phantom-based credentialing for all COG centers.
PURPOSE: The aim of this study was to examine current practice patterns in pediatric total body irradiation (TBI) techniques among COG member institutions. METHODS AND MATERIALS: Between November 2019 and February 2020, a questionnaire containing 52 questions related to the technical aspects of TBI was sent to medical physicists at 152 COG institutions. The questions were designed to obtain technical information on commonly used TBI treatment techniques. Another set of 9 questions related to the clinical management of patients undergoing TBI was sent to 152 COG member radiation oncologists at the same institutions. RESULTS: Twelve institutions were excluded because TBI was not performed in their institutions. A total of 88 physicists from 88 institutions (63% response rate) and 96 radiation oncologists from 96 institutions (69% response rate) responded. The anterior-posterior/posterior-anterior (AP/PA) technique was the most common technique reported (49 institutions [56%]); 44 institutions (50%) used the lateral technique, and 14 (16%) used volumetric modulated arc therapy or tomotherapy. Midplane dose rates of 6 to 15 cGy/min were most commonly used. The most common specification for lung dose was the midlung dose for both AP/PA techniques (71%) and lateral techniques (63%). Almost all physician responders agreed with the need to refine current TBI techniques, and 79% supported the investigation of new TBI techniques to further lower the lung dose. CONCLUSIONS: There was no consistency in the practice patterns, methods for dose measurement, and reporting of TBI doses among COG institutions. The lack of standardization precludes meaningful correlation between TBI doses and clinical outcomes including disease control and normal tissue toxicity. The COG radiation oncology discipline is currently undertaking several steps to standardize the practice and dose reporting of pediatric TBI using detailed questionnaires and phantom-based credentialing for all COG centers.
Authors: Bianca A W Hoeben; Jeffrey Y C Wong; Lotte S Fog; Christoph Losert; Andrea R Filippi; Søren M Bentzen; Adriana Balduzzi; Lena Specht Journal: Front Pediatr Date: 2021-12-03 Impact factor: 3.418