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 - Publisher Copyright:
© 2023
PY - 2023/11
Y1 - 2023/11
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 - 10.1016/j.ctro.2023.100681
DO - 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 -