TY - JOUR
T1 - The need for consensus on delineation and dose constraints of dentofacial structures in paediatric radiotherapy
T2 - Outcomes of a SIOP Europe survey
AU - Davey, Angela
AU - Pan, Shermaine
AU - Bryce-Atkinson, Abigail
AU - Mandeville, Henry
AU - Janssens, Geert O.
AU - Kelly, Sarah M.
AU - Hol, Marinka
AU - Tang, Vivian
AU - Davies, Lucy Siew Chen
AU - SIOP-Europe Radiation Oncology Working Group, null
AU - Aznar, Marianne
N1 - Funding Information: This research and Dr Angela Davey’s work was supported by Friends of Rosie. Dr Marianne Aznar and Dr Angela Davey are supported by Research England under the Engineering and Physical Sciences Research Council fellowship funding stream [EP/T028017/1]. Dr Marianne Aznar is also supported by NIHR Manchester Biomedical Research Centre, Cancer Research UK via funding to the Cancer Research Manchester Centre [C147/A25254], and by the Cancer Research UK RadNet Manchester [C1994/A28701]. Dr. Abigail Bryce-Atkinson was supported by a SU2C-CRUK Pediatric Cancer New Discoveries Challenge Team Grant [SU2C#RT6186]. The QUARTET Project and Sarah Kelly’s work as a fellow at European Organisation of Research and Treatment of Cancer (EORTC) headquarters are supported by a grant from Fondatioun Kriibskrank Kanner (SIOP Europe Grant). Dr Henry Mandeville is supported by the National Institute for Health and Care Research (NIHR) Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London. Funding Information: The authors acknowledge the support of Radiation Oncology Working Group and the QUARET Project of the European Society for Paediatric Oncology (SIOP Europe), European Paediatric Soft Tissue Sarcoma Study Group (EpSSG) radiotherapy committee, and all centres who participated in the survey for their contribution to this manuscript. Publisher Copyright: © 2023
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Background and purpose: Children receiving radiotherapy for head-and-neck tumours often experience severe dentofacial side effects. Despite this, recommendations for contouring and dose constraints to dentofacial structures are lacking in clinical practice. We report on a survey aiming to understand current practice in contouring and dose assessment to dentofacial structures. Methods: A digital survey was distributed to European Society for Paediatric Oncology members of the Radiation Oncology Working Group, and member-affiliated centres in Europe, Australia, and New Zealand. The questions focused on clinical practice and aimed to establish areas for future development. Results: Results from 52 paediatric radiotherapy centres across 27 countries are reported. Only 29/52 centres routinely delineated some dentofacial structures, with the most common being the mandible (25 centres), temporo-mandibular joint (22), dentition (13), orbit (10) and maxillary bone (eight). For most bones contoured, an ‘As Low As Reasonably Achievable’ dose objective was implemented. Only four centres reported age-adapted dose constraints. The largest barrier to clinical implementation of dose constraints was firstly, the lack of contouring guidance (49/52, 94%) and secondly, that delineation is time-consuming (33/52, 63%). Most respondents who routinely contour dentofacial structures (25/27, 90%) agreed a contouring atlas would aid delineation. Conclusion: Routine delineation of dentofacial structures is infrequent in paediatric radiotherapy. Based on survey findings, we aim to 1) define a consensus-contouring atlas for dentofacial structures, 2) develop auto-contouring solutions for dentofacial structures to aid clinical implementation, and 3) carry out treatment planning studies to investigate the importance of delineation of these structures for planning optimisation.
AB - Background and purpose: Children receiving radiotherapy for head-and-neck tumours often experience severe dentofacial side effects. Despite this, recommendations for contouring and dose constraints to dentofacial structures are lacking in clinical practice. We report on a survey aiming to understand current practice in contouring and dose assessment to dentofacial structures. Methods: A digital survey was distributed to European Society for Paediatric Oncology members of the Radiation Oncology Working Group, and member-affiliated centres in Europe, Australia, and New Zealand. The questions focused on clinical practice and aimed to establish areas for future development. Results: Results from 52 paediatric radiotherapy centres across 27 countries are reported. Only 29/52 centres routinely delineated some dentofacial structures, with the most common being the mandible (25 centres), temporo-mandibular joint (22), dentition (13), orbit (10) and maxillary bone (eight). For most bones contoured, an ‘As Low As Reasonably Achievable’ dose objective was implemented. Only four centres reported age-adapted dose constraints. The largest barrier to clinical implementation of dose constraints was firstly, the lack of contouring guidance (49/52, 94%) and secondly, that delineation is time-consuming (33/52, 63%). Most respondents who routinely contour dentofacial structures (25/27, 90%) agreed a contouring atlas would aid delineation. Conclusion: Routine delineation of dentofacial structures is infrequent in paediatric radiotherapy. Based on survey findings, we aim to 1) define a consensus-contouring atlas for dentofacial structures, 2) develop auto-contouring solutions for dentofacial structures to aid clinical implementation, and 3) carry out treatment planning studies to investigate the importance of delineation of these structures for planning optimisation.
KW - Contouring
KW - Dentofacial
KW - Dose-volume constraints
KW - Late adverse effects
KW - Paediatrics
KW - Radiotherapy
UR - http://www.scopus.com/inward/record.url?scp=85173443703&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.ctro.2023.100681
DO - https://doi.org/10.1016/j.ctro.2023.100681
M3 - Article
C2 - 37790584
SN - 2405-6308
VL - 43
JO - Clinical and Translational Radiation Oncology
JF - Clinical and Translational Radiation Oncology
M1 - 100681
ER -