Department of Radiation Oncology, University of Utah, Salt Lake City, Utah.
Department of Radiation Oncology, Emory University, Atlanta, Georgia.
Int J Radiat Oncol Biol Phys. 2021 Dec 1;111(5):1155-1164. doi: 10.1016/j.ijrobp.2021.07.1715. Epub 2021 Aug 2.
The aim of this study was to examine current practice patterns in pediatric total body irradiation (TBI) techniques among COG member institutions.
Between November 2019 and February 2020, a questionnaire containing 52 questions related to the technical aspects of TBI was sent to medical physicists at 152 COG institutions. The questions were designed to obtain technical information on commonly used TBI treatment techniques. Another set of 9 questions related to the clinical management of patients undergoing TBI was sent to 152 COG member radiation oncologists at the same institutions.
Twelve institutions were excluded because TBI was not performed in their institutions. A total of 88 physicists from 88 institutions (63% response rate) and 96 radiation oncologists from 96 institutions (69% response rate) responded. The anterior-posterior/posterior-anterior (AP/PA) technique was the most common technique reported (49 institutions [56%]); 44 institutions (50%) used the lateral technique, and 14 (16%) used volumetric modulated arc therapy or tomotherapy. Midplane dose rates of 6 to 15 cGy/min were most commonly used. The most common specification for lung dose was the midlung dose for both AP/PA techniques (71%) and lateral techniques (63%). Almost all physician responders agreed with the need to refine current TBI techniques, and 79% supported the investigation of new TBI techniques to further lower the lung dose.
There was no consistency in the practice patterns, methods for dose measurement, and reporting of TBI doses among COG institutions. The lack of standardization precludes meaningful correlation between TBI doses and clinical outcomes including disease control and normal tissue toxicity. The COG radiation oncology discipline is currently undertaking several steps to standardize the practice and dose reporting of pediatric TBI using detailed questionnaires and phantom-based credentialing for all COG centers.
本研究旨在检查 COG 成员机构中儿科全身照射（TBI）技术的当前实践模式。
在 2019 年 11 月至 2020 年 2 月期间，向 152 家 COG 机构的医学物理学家发送了一份包含 52 个与 TBI 技术方面相关问题的问卷。这些问题旨在获取常用 TBI 治疗技术的技术信息。同时，向同一机构的 152 名 COG 成员放射肿瘤学家发送了另一组 9 个与接受 TBI 治疗的患者临床管理相关的问题。
由于有 12 家机构未开展 TBI 治疗，因此被排除在外。共有 88 名来自 88 家机构的物理学家（响应率为 63%）和 96 名来自 96 家机构的放射肿瘤学家（响应率为 69%）做出了回应。最常报告的技术是前后/后前（AP/PA）技术（49 家机构[56%]）；44 家机构（50%）使用侧位技术，14 家机构（16%）使用容积调强弧形治疗或断层调强放疗。中平面剂量率最常使用 6 至 15 cGy/min。AP/PA 技术（71%）和侧位技术（63%）中最常用的肺部剂量规范是中肺剂量。几乎所有的医生都认为需要改进当前的 TBI 技术，79%的医生支持调查新的 TBI 技术，以进一步降低肺部剂量。
COG 机构之间在实践模式、剂量测量方法和 TBI 剂量报告方面没有一致性。缺乏标准化使得 TBI 剂量与包括疾病控制和正常组织毒性在内的临床结果之间无法进行有意义的关联。COG 放射肿瘤学学科目前正在采取几个步骤，使用详细的问卷和基于体模的认证来为所有 COG 中心标准化儿科 TBI 的实践和剂量报告。
