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Paediatric medulloblastoma: patterns of care and radiotherapy quality assurance in Australia
1Department of Radiation Oncology, Westmead Hospital, Sydney, New South Wales, Australia. verity.ahern@swahs.health.nsw.gov.au
Insights
Radiotherapy for Australian children with medulloblastoma showed variable quality. Improved immobilization, critical structure dose documentation, and shielding accuracy are needed for reduced craniospinal irradiation doses.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Medical Physics
Background:
- Medulloblastoma is a common pediatric brain tumor.
- Craniospinal irradiation (CSI) is a standard treatment for medulloblastoma.
- Reducing radiation dose while maintaining efficacy is a key challenge.
Purpose of the Study:
- To assess the quality of radiotherapy (RT) delivered to Australian children with medulloblastoma.
- To document current treatment practices for pediatric medulloblastoma patients.
- To identify areas for improvement in RT delivery for this population.
Main Methods:
- Utilized the Australian and New Zealand Children's Haematology and Oncology Group Radiotherapy Database.
- Identified 46 pediatric patients (<15 years) treated with radical intent CSI (1997-1999).
- Analyzed treatment immobilization, planning, dose to critical structures, and shielding accuracy.
Main Results:
- Significant variability in immobilization and planning methods was observed.
- Dose to critical structures was documented for only 15% of patients.
- Shielding errors (e.g., overshielding posterior orbit) and inadequate thecal sac coverage were common.
Conclusions:
- Current radiotherapy practices for pediatric medulloblastoma require enhancement.
- Increased focus on patient immobilization and accurate shielding is crucial.
- Improved documentation of radiation dose to critical structures is necessary, especially with dose reductions.
Abstract:
The purpose of this study was to document how children in Australia with medulloblastoma are being treated and to evaluate the quality of radiotherapy (RT) delivered. The Radiotherapy Database of the Australian and New Zealand Children's Haematology and Oncology Group was used to identify 46 children with medulloblastoma younger than the age of 15 years treated with radical intent by craniospinal irradiation between 1997 and 1999 inclusively. Twenty-six patients had completely resected disease without evidence of disease spread. Of these, 16 patients received a craniospinal RT dose of <25 Gy in addition to chemotherapy. RT treatment immobilization methods varied, as did planning methods. RT dose to critical structures was recorded on treatment plans for only 15% of patients. The average systematic error in shield placement at the posterior orbit was 5.2 mm, and two-thirds of patients were 'overshielded' at this site. Adequate coverage of the distal end of the thecal sac was achieved in fewer than 50% of on-treatment verification films for 21 of 45 patients. With a reduction in RT dose to the craniospinal axis for paediatric medulloblastoma, greater attention is needed for patient immobilization, documentation of RT dose to critical structures and the placement and reproducibility of shielding.
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