Scientific publications

Clinical practice in European centres treating paediatric posterior fossa tumours with pencil beam scanning proton therapy. Scientific Publication

Jun 26, 2024 | Magazine: Radiotherapy and Oncology

Laura Toussaint  1 , Witold Matysiak  2 , Claire Alapetite  3 , Javier Aristu  4 , Agata Bannink-Gawryszuk  2 , Stephanie Bolle  5 , Alessandra Bolsi  6 , Felipe Calvo  4 , Fernando Cerron Campoo  7 , Frances Charlwood  8 , Charlotte Demoor-Goldschmidt  9 , Jérôme Doyen  10 , Katarzyna Drosik-Rutowicz  11 , Pauline Dutheil  12 , Anna Embring  13 , Jacob Engellau  14 , Anneleen Goedgebeur  15 , Farid Goudjil  3 , Semi Harrabi  16 , Renata Kopec  17 , Ingrid Kristensen  14 , Peter Lægsdmand  18 , Carola Lütgendorf-Caucig  19 , Arturs Meijers  6 , Alfredo Mirandola  20 , Fernand Missohou  12 , Marta Montero Feijoo  7 , Ludvig P Muren  18 , Barbora Ondrova  21 , Ester Orlandi  22 , Erik Pettersson  23 , Alessia Pica  6 , Sandija Plaude  24 , Roberto Righetto  25 , Barbara Rombi  26 , Beate Timmermann  27 , Karen Van Beek  15 , Anthony Vela  12 , Sabina Vennarini  28 , Anne Vestergaard  29 , Marie Vidal  10 , Vladimir Vondracek  21 , Damien C Weber  6 , Gillian Whitfield  30 , Jens Zimmerman  31 , John H Maduro  2 , Yasmin Lassen-Ramshad  29


Background and purpose: As no guidelines for pencil beam scanning (PBS) proton therapy (PT) of paediatric posterior fossa (PF) tumours exist to date, this study investigated planning techniques across European PT centres, with special considerations for brainstem and spinal cord sparing.

Materials and methods: A survey and a treatment planning comparison were initiated across nineteen European PBS-PT centres treating paediatric patients. The survey assessed all aspects of the treatment chain, including but not limited to delineations, dose constraints and treatment planning. Each centre planned two PF tumour cases for focal irradiation, according to their own clinical practice but based on common delineations. The prescription dose was 54 Gy(RBE) for Case 1 and 59.4 Gy(RBE) for Case 2. For both cases, planning strategies and relevant dose metrics were compared.

Results: Seventeen (89 %) centres answered the survey, and sixteen (80 %) participated in the treatment planning comparison. In the survey, thirteen (68 %) centres reported using the European Particle Therapy Network definition for brainstem delineation. In the treatment planning study, while most centres used three beam directions, their configurations varied widely across centres. Large variations were also seen in brainstem doses, with a brainstem near maximum dose (D2%) ranging from 52.7 Gy(RBE) to 55.7 Gy(RBE) (Case 1), and from 56.8 Gy(RBE) to 60.9 Gy(RBE) (Case 2).

Conclusion: This study assessed the European PBS-PT planning of paediatric PF tumours. Agreement was achieved in e.g. delineation-practice, while wider variations were observed in planning approach and consequently dose to organs at risk. Collaboration between centres is still ongoing, striving towards common guidelines.

CITATION  Radiother Oncol. 2024 Jun 26:198:110414.  doi: 10.1016/j.radonc.2024.110414