title: Comparison of supine and prone craniospinal irradiation in children with medulloblastoma.
abstract: OBJECTIVE
  To compare port film rejection and treatment outcome according to craniospinal irradiation (CSI) position for medulloblastoma.
  
  
  METHODS
  We retrospectively searched for patients ≤19 years treated with CSI for medulloblastoma at 1 department. We collected the following data: age; sex; risk group; need for general anesthesia; radiation therapy (RT) dose and fractionation; and the acceptance or rejection of weekly port films during treatment. We also collected data on outcomes, including neuraxis recurrence and possible complications such as myelitis.
  
  
  RESULTS
  Of 46 children identified, 23 were treated prone (median age, 8.1 years) and 23 supine (median age, 7.2 years). High-risk disease was seen in 26% of prone and 35% of supine patients (P = .25). There was no difference in use of general anesthesia between those treated prone versus supine (57% vs 61%). The rejection rate of cranial port films in the prone position was 35%, which was significantly higher than the rate of 8% in patients treated supine (P < .0001). The 5-year progression-free (P = .37) and overall survival (P = .18) rates were 62% and 67% for prone and 76% and 84% for supine patients. There were no isolated junctional failures or radiation myelitis in either CSI position.
  
  
  CONCLUSIONS
  The supine position for CSI was found to have similar survival outcomes compared with the prone position. A higher proportion of rejected cranial port films was seen in children treated in the prone position.
authors.affiliation: Department of Radiation Oncology, The Methodist Hospital, Houston, Texas.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Verma
authors.affiliation: Department of Radiation Oncology, The Methodist Hospital, Houston, Texas.
authors.forename: Ali
authors.initials: A
authors.lastname: Mazloom
authors.affiliation: Department of Radiation Oncology, The Methodist Hospital, Houston, Texas.
authors.forename: Bin S
authors.initials: BS
authors.lastname: Teh
authors.affiliation: Department of Radiation Oncology, The Methodist Hospital, Houston, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: South
authors.affiliation: Department of Radiation Oncology, The Methodist Hospital, Houston, Texas.
authors.forename: E Brian
authors.initials: EB
authors.lastname: Butler
authors.affiliation: Department of Radiation Oncology, The Methodist Hospital, Houston, Texas; Department of Pediatrics, Division of Pediatric Hematology/Oncology, Texas Children's Hospital, Houston, Texas. Electronic address: apaulino@mdanderson.org.
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Paulino
mesh_terms: D000293:Adolescent; D002528:Cerebellar Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D061888:Craniospinal Irradiation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000532:radiotherapy*; D016684:Prone Position; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016683:Supine Position; D016896:Treatment Outcome