Search

AIM: The aim of the study is to analyse radiotherapy quality assurance (RTQA) processes in the treatment of paediatric central nervous system (CNS) tumours across Europe. METHODS: The RTQA aspects of major past and current European trials for paediatric CNS tumours were reviewed based on study protocols and publications. A survey among radiation oncologists and paediatric oncologists about the practices of RTQA in paediatric CNS tumours across European countries was also performed. RESULTS: Several (inter)national initiatives to implement RTQA are being developed across Europe, with an apparent paradigm shift from retrospective to prospective RTQA. Experts from 21 of 29 contacted countries responded to the survey. National consensus guidelines for paediatric CNS tumours are available in 10 of 21 countries. Twenty-one of 33 experts believe that the level of involvement of paediatric radiation oncologists in the meetings and activities of the national paediatric oncology societies is adequate. Central storage of radiotherapy data is available in France, Germany and Denmark. RTQA programmes for paediatric brain tumours are available in 7 countries. Twelve of 21 experts believe that there is a well-established national referral network for the radiation treatment of paediatric patients in their respective countries. CONCLUSION: As a result of the review and survey, the following measures are proposed: (1) developing international RT guidelines for paediatric CNS tumours, (2) improving the collaboration between paediatric oncologists and paediatric radiation oncologists, (3) building a central storage system for RT data, (4) implementing international prospective RTQA platforms and (5) promoting European referral networks to reduce inequality.

ispartof: European Journal of Cancer Care vol:24 issue:2 pages:143-6 ispartof: location:England status: published

x

The aim of this study was to evaluate the usefulness of visual and semiquantitative [¹⁸F]fluorodeoxy-glucose (FDG) positron emission tomography-computed tomography (PET-CT) data for the diagnosis of peri-anastomotic colorectal cancer recurrence, taking into account the time period between surgery and [¹⁸F]FDG PET-CT scanning.The study population consisted of 70 patients who had prior preoperative radiochemotherapy and surgical resection of the primary tumor and who underwent whole body [¹⁸F]FDG PET-CT scanning for the detection of recurrent disease. Visual and semiquantitative (SUV(max)) analysis of [¹⁸F]FDG uptake at the peri-anastomosis was performed. The final diagnosis was based on pathological proof or clinical and/or imaging follow-up data.On visual reading, 27 patients exhibited increased [¹⁸F]FDG uptake at the peri-anastomosis. Of these, 11 (41%) patients had a local tumor recurrence and 16 (59%) had no recurrent tumor. Among the 43 patients without increased [¹⁸F]FDG uptake at the peri-anastomosis, none had local tumor recurrence. On semiquantitation, SUV(max) in patients with and without a local recurrence overlapped. However, when the time period between surgery and [¹⁸F]FDG PET-CT scanning was taken into account, overlap of SUV(max) was mainly observed within a postoperative period of ≤12 months; thereafter, a threshold SUV(max) of 3.2 discriminated between benign and malignant lesions in all but one patient.In our series, visually increased [¹⁸F]FDG uptake at the peri-anastomosis was 100% sensitive but non-specific (73% specificity) for the diagnosis of local tumor recurrence. On the other hand, normal [¹⁸F]FDG uptake at the peri-anastomosis precluded a local tumor recurrence (a negative predictive value of 100%). In addition, semiquantitative (SUV(max)) analysis of [¹⁸F]FDG uptake at the peri-anastomosis may increase specificity (up to 97%), while preserving maximum sensitivity, if the postoperative period is12 months.

Item does not contain fulltext Inhomogeneities in radiotherapy dose distributions covering the vertebrae in children can produce long-term spinal problems, including kyphosis, lordosis, scoliosis, and hypoplasia. In the published literature, many often interrelated variables have been reported to affect the extent of potential radiotherapy damage to the spine. Articles published in the 2D and 3D radiotherapy era instructed radiation oncologists to avoid dose inhomogeneity over growing vertebrae. However, in the present era of highly conformal radiotherapy, steep dose gradients over at-risk structures can be generated and thus less harm is caused to patients. In this report, paediatric radiation oncologists from leading centres in 11 European countries have produced recommendations on how to approach dose coverage for target volumes that are adjacent to vertebrae to minimise the risk of long-term spinal problems. Based on available information, it is advised that homogeneous vertebral radiotherapy doses should be delivered in children who have not yet finished the pubertal growth spurt. If dose fall-off within vertebrae cannot be avoided, acceptable dose gradients for different age groups are detailed here. Vertebral delineation should include all primary ossification centres and growth plates, and therefore include at least the vertebral body and arch. For partial spinal radiotherapy, the number of irradiated vertebrae should be restricted as much as achievable, particularly at the thoracic level in young children (