@article{8614508,
  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.}},
  author       = {{Hoeben, Bianca A and Carrie, Christian and Timmermann, Beate and Mandeville, Henry C and Gandola, Lorenza and Dieckmann, Karin and Ramos Albiac, Monica and Magelssen, Henriette and Lassen-Ramshad, Yasmin and Ondrová, Barbora and Ajithkumar, Thankamma and Alapetite, Claire and Balgobind, Brian V and Bolle, Stephanie and Cameron, Alison L and Davila Fajardo, Raquel and Dietzsch, Stefan and Dumont Lecomte, Delphine and van den Heuvel-Eibrink, Marry M and Kortmann, Rolf D and Laprie, Anne and Melchior, Patrick and Padovani, Laetitia and Rombi, Barbara and Scarzello, Giovanni and Schwarz, Rudolf and Seiersen, Klaus and Seravalli, Enrica and Thorp, Nicola and Whitfield, Gillian A and Boterberg, Tom and Janssens, Geert O}},
  issn         = {{1470-2045}},
  journal      = {{LANCET ONCOLOGY}},
  keywords     = {{LONG-TERM SURVIVORS,GROWTH-HORMONE TREATMENT,BONE-MINERAL DENSITY,RADIATION-THERAPY,WILMS-TUMOR,MEGAVOLTAGE IRRADIATION,ADJUVANT CHEMOTHERAPY,ROENTGEN RAYS,CELL-KINETICS,LATE TOXICITY}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{e155--e166}},
  title        = {{Management of vertebral radiotherapy dose in paediatric patients with cancer : consensus recommendations from the SIOPE radiotherapy working group}},
  url          = {{http://doi.org/10.1016/s1470-2045(19)30034-8}},
  volume       = {{20}},
  year         = {{2019}},
}

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