The spleen as an organ at risk in paediatric radiotherapy: A SIOP-Europe Radiation Oncology Working Group report

Arunagiri, Niruthiga; Kelly, Sarah; Dunlea, Cathy; Dixon, Olivia; Cantwell, Jessica; Bhudia, P.; Boterberg, Tom; Janssens, Geert O.; Gains, J.; Chang, Yen-Ching; Gaze, Mark

doi:10.1016/j.ejca.2020.10.025

Cited by 15 publications

(15 citation statements)

References 13 publications

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“…Recent childhood cancer survivor studies have provided evidence of a dose-response relationship between radiation exposure of the pancreas and the risk of diabetes, especially when the tail of the pancreas receives a mean dose of 10 Gy [8,9]. Also, the SIOP-Europe Radiation Oncology Working Group now recommends antibiotic prophylaxis or (re)vaccination in children receiving a mean dose above 10 Gy to the spleen, because this is associated with an increased rate of late infection-related mortality [10,11]. In patients with tumor extension in major blood vessels, VMAT may contribute to a risk reduction of cardiac disease or invasive breast cancer in later life by sparing or decreasing the dose to the heart and mammary buds [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Locoregional control using highly conformal flank target volumes and volumetric-modulated arc therapy in pediatric renal tumors: Results from the Dutch national cohort

Mul

Grotel

Seravalli

et al. 2021

Radiotherapy and Oncology

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Background and purpose: In pediatric renal tumors, conventional two opposing photon beams have been used to cover the postoperative flank target volume for decades. This single center study describes the locoregional outcome using highly conformal flank target volumes adjusted for postoperative changes and intra-fraction motion combined with Volumetric-Modulated Arc Therapy (VMAT). Materials and methods: Between 01-2015 and 12-2019, 36/161 newly diagnosed patients with renal tumors underwent flank only irradiation (n = 30) or flank + whole lung irradiation (n = 6) using highly conformal target volumes in line with the SIOP-RTSG consensus statement. VMAT consisted of full-arc 10MV photon beams optimized for constraints of the organs at risk. In case of locoregional relapses, image co-registration and dose reconstruction was performed. Each relapse was classified as either 'infield' (V95% relapse : 99.0%), 'marginal' (V95% relapse : 20.0-98.9%) or 'outfield' (V95% relapse : 0-19.9%). Results: At a median follow-up from diagnosis of 3.1 years (range:0.4-5.7), the estimated 2-year Locoregional Control Rate, Disease-Free Interval and Overall Survival were 94%, 91% and 94%, respectively. Locoregional relapse was observed in two patients. One patient had a combined tumor bed and regional recurrence, classified as infield (V95% relapse : 100%) and outfield (V95% relapse : 1.2%). The second patient had a regional relapse in the inferior vena cava classified as marginal recurrence (V95% relapse : 93%). Relapses would not have been adequately covered by conventional beams. Conclusions: This single center analysis provides encouraging evidence that excellent locoregional control can be obtained by using highly conformal flank target volumes with VMAT in pediatric renal tumors. The safety of this approach will be validated in a prospective multicenter study.

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Section: Discussionmentioning

confidence: 99%

Locoregional control using highly conformal flank target volumes and volumetric-modulated arc therapy in pediatric renal tumors: Results from the Dutch national cohort

Mul

Grotel

Seravalli

et al. 2021

Radiotherapy and Oncology

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“…The following supporting information can be downloaded at: , Supplementary Table S1: (DVCs for emerging OaRs), Supplementary Table S2: (DVCs for RT of Hodgkin’s lymphoma), Supplementary Table S3: (DVCs for RT of breast cancers), Supplementary Table S4: (DVCs for RT of pediatric tumors), Supplementary Table S5: (DVCs for stereotactic ablative RT of ventricular arrythmia) [ 6 , 8 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 35 , 40 , 68 , 79 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 ].…”

mentioning

confidence: 99%

Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

et al. 2022

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Background: The safe use of radiotherapy (RT) requires compliance with dose/volume constraints (DVCs) for organs at risk (OaRs). However, the available recommendations are sometimes conflicting and scattered across a number of different documents. Therefore, the aim of this work is to provide, in a single document, practical indications on DVCs for OaRs in external beam RT available in the literature. Material and Methods: A multidisciplinary team collected bibliographic information on the anatomical definition of OaRs, on the imaging methods needed for their definition, and on DVCs in general and in specific settings (curative RT of Hodgkin’s lymphomas, postoperative RT of breast tumors, curative RT of pediatric cancers, stereotactic ablative RT of ventricular arrythmia). The information provided in terms of DVCs was graded based on levels of evidence. Results: Over 650 papers/documents/websites were examined. The search results, together with the levels of evidence, are presented in tabular form. Conclusions: A working tool, based on collected guidelines on DVCs in different settings, is provided to help in daily clinical practice of RT departments. This could be a first step for further optimizations.

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“…In the current study, 80% of the left-sided cases using AP/PA had a spleen dose ≥10 Gy compared to 30% using VMAT. Therefore, VMAT might lower the risk of functional asplenia and, subsequently, may restrict the need for immunization or prophylactic antibiotics in patients with a left-sided renal tumor [21].…”

Section: Discussionmentioning

confidence: 99%

“…right-sided) or lymph node involvement (LN+ vs. LN-). Fulfillment of the dose constraints of one or more OARs in favor of one technique was considered to be of potential clinical relevance based on the evidence summarized in Table 1 [13,[15][16][17][18][19][20][21][22][23][24][25].…”

Section: Plan Evaluationmentioning

confidence: 99%

Estimated clinical benefit of combining highly conformal target volumes with Volumetric-Modulated Arc Therapy (VMAT) versus conventional flank irradiation in pediatric renal tumors

Mul¹,

Seravalli²,

Bosman³

et al. 2021

Clinical and Translational Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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The spleen as an organ at risk in paediatric radiotherapy: A SIOP-Europe Radiation Oncology Working Group report

Cited by 15 publications

References 13 publications

Locoregional control using highly conformal flank target volumes and volumetric-modulated arc therapy in pediatric renal tumors: Results from the Dutch national cohort

Locoregional control using highly conformal flank target volumes and volumetric-modulated arc therapy in pediatric renal tumors: Results from the Dutch national cohort

Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

Estimated clinical benefit of combining highly conformal target volumes with Volumetric-Modulated Arc Therapy (VMAT) versus conventional flank irradiation in pediatric renal tumors

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