BJR
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
British Journal of Radiology (2008) 81, 872-880
© 2008 British Institute of Radiology
doi: 10.1259/bjr/14878999
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by PLOWMAN, P N
Right arrow Articles by WALSH, N
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by PLOWMAN, P N
Right arrow Articles by WALSH, N
British Journal of Radiology 81 (2008),872-880 ©2008 The British Institute of Radiology

Full paper

Indications for tomotherapy/intensity-modulated radiation therapy in paediatric radiotherapy: extracranial disease

P N PLOWMAN, MD 1 K COOKE, MA 2 and N WALSH, BSc 2

1 St. Bartholomew's Hospital and the Hospital for Sick Children and 2 Cromwell Hospital, London, UK

Correspondence: P N Plowman, St. Bartholomew's Hospital and the Hospital for Sick Children, West Smithfield, London EC1A 7BE, UK. E-mail: nick.plowman{at}bartsandthelondon.nhs.uk

The potential conformality advantages of intensity-modulated radiation therapy (IMRT; TomoTherapy Hi ArtTM system) over conventional linear accelerator based therapy was assessed in six consecutive children referred for extracranial radiotherapy. IMRT/tomotherapy was considered advantageous for (i) small abdominal tumours, compared with parallel opposed or single portal technology using a conventional linear accelerator, and (ii) re-treatment of an ethmoidal sarcoma, but not for palliation of a small spinal metastasis, or therapy for a whole deep cervical node chain or a pelvic side wall tumour in a young child. Considerations integral to the treatment decision included target volume dose conformality, "low-dose bath" effects (oncogenic and late growth sequelae) and treatment delivery time. IMRT/tomotherapy was the selected modality for therapy when the conformality advantages were perceived to outweigh any disadvantages in three out of the six cases. The dose conformality advantages of IMRT/tomotherapy are sufficient to selectively recommend its availability to the paediatric practice in accordance to the following criteria: (i) where conformality of radiation therapy to the target/tumour is critical and where the margin of safety (from gross/clinical target volume to planning target volume (PTV)) around the tumour is narrow; (ii) where adjacent organs at risk of radiation damage have a low threshold for damage; and (iii) where the "low-dose bath" phenomenon, which occurs between the upper and lower axial limits of the PTV, is not sufficiently disadvantageous (with regard to late oncogenesis or growth retardation) to outweigh the more confined (non-tumour) integral doses received in higher dose corridors through the body when utilizing conventional radiation techniques.




This article has been cited by other articles:


Home page
 Br. J. Radiol.Home page
BJR review of the year - 2008.
Br. J. Radiol., March 1, 2009; 82(975): 180 - 182.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
BJR DMFR IMAGING  ALL BIR JOURNALS 
Copyright © 2008 by the British Institute of Radiology.