Inter-clinician variability in making dosimetric decisions in pediatric treatment: A balance between efficacy and late effects

A review of dosimetric and toxicity modeling of proton versus photon craniospinal irradiation for pediatrics medulloblastoma

“…A historical study concluded that doses below 10 Gy failed to cause permanent vertebral deformity [33]. Stature loss was weakly related to heterogeneous vertebral body dose [34]. Thus, the advantage of reduced stature loss with PrT (6.8 cm) compared with 3DCRT (23.2 cm), predicted by vertebral dose, may not exist as both modalities delivered vertebral doses heterogeneously [18].…”

Potential benefit of MRI-guided IMRT for flank irradiation in pediatric patients with Wilms’ tumor

“…Furthermore, as mentioned previously, the systematic target delineation uncertainty was not included in the PTV margin calculation in this study. Estimating inter-observer delineation variability for pediatric cases is even more difficult than for adults as a result of the small number of patients treated in each center, the broad spectrum of pediatric tumors, the lack of common guidelines and the individual patient's specific needs [39,40]. Thus, for the assessment of the exact PTV expansion, an estimation of the delineation uncertainty and a larger patient cohort would be necessary for both workflows.…”

Reassessing dose constraints of organs at risk in children with abdominal neuroblastoma treated with definitive radiation therapy: A correlation with late toxicity

“…Equally important is the accurate characterization of RT dose-volume constraints and toxicity risk specific to the kidney(s) and liver, which represent the primary OARs constrained in RT planning. As demonstrated in Tables II and V [9,15,17,[19][20][21][22][23], there remains significant variability in OAR constraint parameters across recent protocols and institutions. These constraints appreciably influence the delivery and design of RT, yet are not based on toxicity data specific to children with neuroblastoma.…”