Low-Dose Image-Guided Pediatric CNS Radiation Therapy: Final Analysis From a Prospective Low-Dose Cone-Beam CT Protocol From a Multinational Pediatrics Consortium

Autor: Sara R. Alcorn MD, MPH, PhD, Xian Chiong Zhou MS, Casey Bojechko PhD, Rodrigo A. Rubo BS, Michael J. Chen MD, Karin Dieckmann MD, Ralph P. Ermoian MD, Eric C. Ford PhD, Daria Kobyzeva MD, Shannon M. MacDonald MD, Todd R. McNutt PhD, Alexey Nechesnyuk MD, Kristina Nilsson MD, PhD, Hakan Sjostrand BS, Koren S. Smith MS, Markus Stock PhD, Erik J. Tryggestad PhD, Rosangela C. Villar MD, Brian A. Winey PhD, Stephanie A. Terezakis MD
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Technology in Cancer Research & Treatment, Vol 19 (2020)
Druh dokumentu: article
ISSN: 1533-0338
15330338
25499289
DOI: 10.1177/1533033820920650
Popis: Background: Lower-dose cone-beam computed tomography protocols for image-guided radiotherapy may permit target localization while minimizing radiation exposure. We prospectively evaluated a lower-dose cone-beam protocol for central nervous system image-guided radiotherapy across a multinational pediatrics consortium. Methods: Seven institutions prospectively employed a lower-dose cone-beam computed tomography central nervous system protocol (weighted average dose 0.7 mGy) for patients ≤21 years. Treatment table shifts between setup with surface lasers versus cone-beam computed tomography were used to approximate setup accuracy, and vector magnitudes for these shifts were calculated. Setup group mean, interpatient, interinstitution, and random error were estimated, and clinical factors were compared by mixed linear modeling. Results: Among 96 patients, with 2179 pretreatment cone-beam computed tomography acquisitions, median age was 9 years (1-20). Setup parameters were 3.13, 3.02, 1.64, and 1.48 mm for vector magnitude group mean, interpatient, interinstitution, and random error, respectively. On multivariable analysis, there were no significant differences in mean vector magnitude by age, gender, performance status, target location, extent of resection, chemotherapy, or steroid or anesthesia use. Providers rated >99% of images as adequate or better for target localization. Conclusions: A lower-dose cone-beam computed tomography protocol demonstrated table shift vector magnitude that approximate clinical target volume/planning target volume expansions used in central nervous system radiotherapy. There were no significant clinical predictors of setup accuracy identified, supporting use of this lower-dose cone-beam computed tomography protocol across a diverse pediatric population with brain tumors.
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