title: The cranial-spinal junction in medulloblastoma: does it matter?
abstract: OBJECTIVE
  Late effects of treatment in children and young adults with medulloblastoma can be influenced by the technique employed in radiating the craniospinal axis. The purpose of this study is to determine whether the placement of the cranial-spinal junction has an impact on dose to the cervical spinal cord and surrounding organs.
  
  
  METHODS
  Five patients underwent computed tomography (CT) simulation in the prone position for craniospinal irradiation. A dose of 36 Gy was prescribed to the entire neuraxis. The doses to the cervical spinal cord and surrounding organs were calculated using a cranial-spinal junction at the C1-C2 vertebral interspace (high junction) or at the lowest point in the neck, with exclusion of the shoulders in the lateral cranial fields (low junction). The volume of critical organs at risk, as well as dose to these structures using the cranial and spinal field(s) were outlined and calculated using the CMS FOCUS 3-dimensional treatment planning system.
  
  
  RESULTS
  The average dose to the cervical spinal cord was 11.9% higher than the prescribed dose with the low junction, and 6.7% higher with the high junction. However, doses to the thyroid gland, mandible, pharynx, and larynx were increased by an average of 29.6%, 75.8%, 70.6%, and 227.7%, respectively, by the use of the high junction compared to the low junction.
  
  
  CONCLUSIONS
  A higher dose to the cervical spinal cord can be minimized by using a high junction. However, this would be at the cost of substantially increased doses to surrounding organs such as the thyroid gland, mandible, pharynx, and larynx. This can be critical in children and young adults, where hypothyroidism, mandibular hypoplasia, and development of second malignancies may be a late sequela of radiation therapy.
authors.affiliation: Department of Radiotherapy, Loyola University of Chicago, Maywood, IL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Narayana
authors.forename: S
authors.initials: S
authors.lastname: Jeswani
authors.forename: A C
authors.initials: AC
authors.lastname: Paulino
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000033:anatomy & histology*; D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007830:Larynx / Q000528:radiation effects; D008297:Male; D008334:Mandible / Q000528:radiation effects; D008527:Medulloblastoma / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D010306:Parotid Gland / Q000528:radiation effects; D010614:Pharynx / Q000528:radiation effects; D011829:Radiation Dosage; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted; D013116:Spinal Cord / Q000033:anatomy & histology* / Q000528:radiation effects; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D013961:Thyroid Gland / Q000528:radiation effects