Pediatric craniospinal irradiation. Growth deficit and dosimetric aspects.

Abstract

Background:

Craniospinal irradiation (CSI) has a decisive impact on the control of pediatric tumors with a high probability of dissemination through cerebrospinal fluid, but it is associated with developmental defects of the spine during growth.

Objective:

To analyze spinal alterations following CRT and to compare the dosimetry of conformal radiotherapy (CRT) and volumetric modulated arc therapy (VMAT) techniques.

Method:

An institutional series of 101 cases is presented, with 5-year clinical results.

Results:

In the cases analyzed (n = 12), a mean height of 136.1 cm was observed with a mean projected height of 147.7 cm (p < 0.001) and a growth velocity (GV) of 3.2 cm/year with a projected average GV of 7.1 cm/year (p < 0.001). There was a difference of 11.6 cm between the current and projected average height and 3.9 cm/year between the achieved and expected GS, with a 58% increase in the incidence of short stature. The VMAT technique showed better homogeneity in exchange for a greater distribution of low doses to peripheral tissues.

Conclusions:

Spinal development abnormalities are multifactorial, resulting from genetic, nutritional, and treatment factors. Age and dose are the strongest predictors of effects.

Alejandra P. Zárate-Gómez 1 , Heynar J. Pérez-Villanueva 1 , Aida A. López-Azcárraga 1 , Juan M. Vázquez-Peralta 1 , Gabriel A. Sánchez-Marín 2

1 Radiotherapy Department, Federico Gómez Children’s Hospital of Mexico;

2 Oncology Department, Juárez Hospital of Mexico. Ministry of Health, Mexico City, Mexico

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