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Volume 15, Number 1, 2010

Craniospinal radiotherapy in children: Electron- or photon-based technique of spinal irradiation

Marzanna Chojnacka, Anna Skowrońska-Gardas, Marzena Morawska-Kaczyńska,
Anna Zygmuntowicz-Piętka, Katarzyna Pędziwiatr, Anna Semaniak


Background: The prone position and electron-based technique for craniospinal irradiation
(CSI) have been standard in our department for many years. But this immobilization is
difficult for the anaesthesiologist to gain airway access. The increasing number of children
treated under anaesthesia led us to reconsider our technique.
Aim: The purpose of this study is to report our new photon-based technique for CSI which
could be applied in both the supine and the prone position and to compare this technique
with our electron-based technique.
Materials and methods: Between November 2007 andMay 2008, 11 children with brain tumours were treated in the prone position with CSI. For 9 patients two treatment planswere created: the first one using photons and the second one using electron beams for spinal irradiation.
We prepared seven 3D-conformal photon plans and four forward planned segmented field
plans. We compared 20 treatment plans in terms of target dose homogeneity and sparing
of organs at risk.
Results: In segmented field plans better dose homogeneity in the thecal sac volume was
achieved than in electron-based plans. Regarding doses in organs at risk, in photon-based
plans we obtained a lower dose in the thyroid but a higher one in the heart and liver.
Conclusions: Our technique can be applied in both the supine and prone position and it seems to be more feasible and precise than the electron technique. However, more homogeneous target coverage and higher precision of dose delivery for photons are obtained at the cost of slightly higher doses to the heart and liver.

Signature: Rep Pract Oncol Radiother, 2010; 15(1) : 21-24

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