Аннотация:PO-1018 Current status of pediatric image-guided radiation therapy in Europe: An international survey C. Windmeijer1, A. Bel1, R. De Jong1, B. Balgobind1, G. Collaboration2, C. Rasch1, I. Van Dijk1
1Amsterdam UMC- location AMC, Radiation Oncology, Amsterdam, The Netherlands ; 2Participating institutions, Radiation Oncology, Various Europe, The Netherlands
Purpose or Objective
Image-guided radiotherapy (IGRT) enables high precision tumor treatment while sparing healthy tissues. Particularly in pediatric radiotherapy the value of IGRT is widely acknowledged, but there is no consensus on the ‘best practice’. With this survey we aim to evaluate clinical pediatric IGRT patterns in European radiotherapy institutes.
Material and Methods
An eight-domain survey based on seven treatment sites was sent to members of the Pediatric Radiation Oncology Society and/or our IGRT project-based consortium in 70 European institutes. The domains include items on radiotherapy preparation, planning and delivery. Responses were collected from June-September 2018.
Results
In total, 42/70 institutes (60%) responded; 33/42 (79%) treat children, one of which focuses exclusively on total body irradiation. The number of children treated annually varies between institutes and per site from 1 to 130 (Figure 1). Photon/electron therapy is used in 26/33 (79%) centers, and 3/33 (9%) use photon therapy only. Proton therapy (PT) is available in 5/33 (15%) institutes, whereas 7/28 (25%) of photon centers refer to proton centers; 2/33 (6%) use both photon and proton therapy. To immobilize patients, facial masks are used in 100% of brain, craniospinal axis (CSA) and head-and-neck (H&N) radiotherapy (all devices in Table 1). Most institutes (89% (thorax), 93% (abdomen), 96% (extremities) and 100% for other sites) use 3DCT scans to define the treatment target. Also MRI (range, 79% for thorax to 97% for brain), PET (range, 21% for CSA to 79% for H&N), and, for thorax and abdomen, 4DCT scans (by respectively 43% and 31% of institutes) are used. IMRT/VMAT is the most common treatment technique (range, 71% for CSA to 87% for brain), followed by 3DCRT (range, 36% for H&N to 69% for extremities). Averaged over all sites, 3D conformal PT is used in 60% and IMPT in 80% of the proton centers. Averaged over all enquired indications, 70% of institutes follow (inter)national clinical treatment protocols, although varying protocols are used depending on indication and institute. Most institutes treat patients in supine position (range, 82% for CSA to 94% for brain). Regarding image guidance during treatment delivery, in- room 3D CBCT (kV) is used most frequently (range, 57% for CSA to 86% for thorax, Table 1). Daily online imaging is used by the majority (range, 85% for extremities to 90% for abdomen and pelvis), and offline imaging protocols (eNAL) are used by 14% (H&N) to 21% (thorax) of institutes.
Conclusion
Our results show moderate agreement in clinical pediatric IGRT use in European institutes. The findings from this survey can help to define internationally acceptable standard quality criteria for ‘best practice’ guidelines for pediatric IGRT.