title: Inter-clinician variability in making dosimetric decisions in pediatric treatment: a balance between efficacy and late effects.
abstract: OBJECTIVE
  To investigate variability of clinical target volume (CTV) delineation and deviations according to doses delivered in normal tissue for abdominal tumor irradiation in children.
  
  
  METHODS
  For a case of nephroblastoma six French pediatric radiation oncologists outlined post-operative CTV, on the same dosimetric CT scan according to the International Society for Pediatric Oncology 2001 protocol. On a reference CTV and organs at risk (OAR), we performed dosimetric planning with the constraints as 25.2 Gy for CTV, V(20 max) to 50% for liver, V(12) <15% for kidney. Data were analyzed with Aquilab software.
  
  
  RESULTS
  Final CTVs showed inter-clinician variability: 44.85-120.78 cm(3). The recommended liver doses were not respected in four cases: V(20) from 74% to 88% of the volume; for kidney, in two cases: V(12) of 17.6% and 25%, respectively. For vertebral bodies, no deviations were noted.
  
  
  CONCLUSIONS
  Variability not only affected CTV delineation but also dose distribution to OAR with different compromises. This practice training demonstrates the hudge lack of data about correlation between dose, volume and risk of late effects in pediatric radiotherapy. We intend to record prospectively the dose/volume histogram of each OAR in a national database in order to characterize late effects occurring in relation to treatment modalities.
authors: CHU La Timone Marseille, France. laetitia.padovani@ap-hm.fr
authors: Laetitia
authors: L
authors: Padovani
authors: Aymeri
authors: A
authors: Huchet
authors: Line
authors: L
authors: Claude
authors: Valerie
authors: V
authors: Bernier
authors: Philippe
authors: P
authors: Quetin
authors: Marc
authors: M
authors: Mahe
authors: Anne
authors: A
authors: Laprie
authors: Christine
authors: C
authors: Kerr
authors: Pierre Yves
authors: PY
authors: Bondiau
authors: Arnaud
authors: A
authors: Delarue
authors: Carole
authors: C
authors: Coze
authors: David
authors: D
authors: Gibon
authors: Clarisse
authors: C
authors: Barteau
authors: Jean Philippe
authors: JP
authors: Maire
authors: Christian
authors: C
authors: Carrie
authors: Xavier
authors: X
authors: Muracciole
mesh_terms: D000293:Adolescent; D001842:Bone and Bones / Q000528:radiation effects; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000528:radiation effects; D008099:Liver / Q000528:radiation effects; D009369:Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D014057:Tomography, X-Ray Computed