Pediatric Tumors
Pediatric malignancies are uncommon, representing less than 1% of all cancers diagnosed each year. Significant advances in the last 30 years have led to significantly improved survival rates of childhood cancers. Despite these advances, cancer remains the
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Paul B. Romesser, Nelly Ju, Chin-Cheng Chen, Kevin Sine, Oren Cahlon, and Suzanne L. Wolden
Contents 24.1 I ntroduction 24.2 C raniospinal Irradiation 24.2.1 Simulation, Setup, and Planning 24.3 Medulloblastoma 24.3.1 Simulation, Setup, and Planning 24.4 Retinoblastoma 24.4.1 Simulation, Setup, and Planning 24.5 Pediatric Sarcomas 24.6 Rhabdomyosarcoma 24.6.1 Simulation, Setup, and Planning 24.7 Ewing Sarcoma 24.7.1 Simulation, Setup, and Planning References
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24.1 Introduction Pediatric malignancies are uncommon, representing less than 1% of all cancers diagnosed each year. Significant advances in the last 30 years have led to significantly improved survival rates of childhood cancers. Despite these advances, cancer remains the second leading cause of death in children after accidents.
P.B. Romesser • O. Cahlon • S.L. Wolden (*) Memorial Sloan Kettering Cancer Center, New York, NY, USA e-mail: [email protected] N. Ju • C.-C. Chen • K. Sine Procure Proton Therapy Center, Somerset, NJ, USA
© Springer International Publishing Switzerland 2018 N. Lee et al. (eds.), Target Volume Delineation and Treatment Planning for Particle Therapy, Practical Guides in Radiation Oncology, https://doi.org/10.1007/978-3-319-42478-1_24
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Of the approximate 12,000 new cases of pediatric cancer each year in the United States, about 3000 will require radiation therapy in the frontline management [1]. Given the improved outcomes, secondary to well-designed and well-conducted clinical trials, the pediatric community is committed to the design of new trials that not only increase cure rates but that also maximize health-related quality of life in the developing child and adult survivor [2]. A shift from two-dimensional to three-dimensional radiation plans and later to intensity-modulated radiation therapy (IMRT) resulted in increased conformality of treatment plans with a reduction of the treated volume. As organs at risk could be easily identified on computerized tomographic (CT) images, constraints were applied a priori to limit the dose of radiation delivered to the normal tissue while maximizing the dose to the target of interest; this is known as inverse planning. In order to achieve high conformality, the number of beams utilized increased. While inversely planned IMRT increased the conformality of the high-dose regions, it came at the expense of an expansion of the low-dose volume to achieve the optimal constraints. Proton beam radiotherapy (PBRT) represents yet another stride forward in radiation therapy. The principle advantage of proton therapy over photon or X-ray therapy is the ability to reduce dose to normal tissues given inherent differences in the dose deposition of the proton as compared to the photon, discussed in Chaps. 1–3. Yet questions remain whether the dosimetric advantage of proton therapy actually improves clinical outcomes for patients. In addition, optimal management of un
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