PDF(Sci-hub)
Abstract：
Inhomogeneities in radiotherapy dose distributions covering the vertebrae in children can produce long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. In the published literature, many often interrelated variables have been reported to affect the extent of potential radiotherapy damage to the spine. Articles published in the 2D and 3D radiotherapy era instructed radiation oncologists to avoid dose inhomogeneity over growing vertebrae. However, in the present era of highly conformal radiotherapy, steep dose gradients over at-risk structures can be generated and thus less harm is caused to patients. In this report, paediatric radiation oncologists from leading centres in 11 European countries have produced recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimise the risk of long-term spinal problems. Based on available information, it is advised that homogeneous vertebral radiotherapy doses should be delivered in children who have not yet finished the pubertal growth spurt. If dose fall-off within vertebrae cannot be avoided, acceptable dose gradients for different age groups are detailed here. Vertebral delineation should include all primary ossification centres and growth plates, and therefore include at least the vertebral body and arch. For partial spinal radiotherapy, the number of irradiated vertebrae should be restricted as much as achievable, particularly at the thoracic level in young children (<6 years old). There is a need for multicentre research on vertebral radiotherapy dose distributions for children, but until more valid data become available, these recommendations can provide a basis for daily practice for radiation oncologists who have patients that require vertebral radiotherapy.
摘要：
覆盖儿童椎骨的放疗剂量分布的不均匀性会产生长期的脊柱问题，包括脊柱后凸,脊柱前凸,脊柱侧弯,和发育不全。在已发表的文献中,据报道，许多相互关联的变量会影响脊柱潜在的放射治疗损伤程度。在2D和3D放射治疗时代发表的文章指示放射肿瘤学家避免在生长的椎骨上剂量不均匀。然而,在当今高度适形放射治疗的时代，可以在风险结构上产生陡峭的剂量梯度，因此对患者造成的伤害较小。在这份报告中,来自11个欧洲国家主要中心的儿科放射肿瘤学家就如何接近椎骨附近目标体积的剂量覆盖率提出了建议,以最大程度地降低长期脊柱问题的风险.根据现有信息，建议尚未完成青春期生长突增的儿童应接受均匀的椎体放射治疗剂量。如果无法避免椎骨内的剂量下降，此处详细介绍了不同年龄组可接受的剂量梯度。椎体轮廓应包括所有主要骨化中心和生长板，因此至少包括椎体和牙弓。对于部分脊柱放射治疗，应尽可能限制受辐照的椎骨的数量，特别是在幼儿（<6岁）的胸部水平。需要对儿童椎体放射治疗剂量分布进行多中心研究，但是在更多有效数据可用之前，这些建议可以为需要进行椎体放射治疗的放射肿瘤学家的日常实践提供依据.
