title: Pediatric craniospinal irradiation with conventional technique or helical tomotherapy: impact of age and body volume on integral dose.
abstract: OBJECTIVE
  The use of helical tomotherapy (HT) for craniospinal irradiation (CSI) in pediatric patients remains an issue of discussion. In this study, we evaluated the integral dose (ID) to organs at risk (OARs) and to the whole body delivered with conventional 3-dimensional conformal radiotherapy (3D-CRT) and HT for pediatric patients and made a comparison according to different whole body volumes.
  
  
  METHODS
  We selected 10 pediatric patients with different body volumes and of different ages undergoing CSI. Plans for 3D-CRT and HT were developed for each patient. The ID to OARs and to the whole body were compared and statistical analyses were performed to determine differences.
  
  
  RESULTS
  We noticed that variations of ID depend on the different anatomical location of the organs relatively to the target, with lower ID to OARs opposed to the target and increased ID to lateral organs: ID tomotherapy/3D-CRT ratio was higher in lungs, kidneys, and mammary region, while it was lower in heart, liver, thyroid, and esophagus. The ID of the body increased with large volumes both in HT and in 3D-CRT plans, but in tomotherapy plans ID increased significantly more with large volumes than with small ones.
  
  
  CONCLUSIONS
  While there are no differences in using tomotherapy or 3D-CRT with small body volumes, we found a difference with large volumes (≥20,000 mL vs ≤20,000 mL). Therefore, for very small patients, the use of intensity-modulated radiotherapy provided with tomotherapy to reduce the dose to OARs can be reconsidered.
authors.affiliation: Department of Radiation Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova - Italy.
authors.forename: Salvina
authors.initials: S
authors.lastname: Barra
authors.affiliation: Department of Medical Physics, IRCCS Azienda Ospedaliera Universitaria San Martino- IST Istituto Nazionale per la Ricerca sul Cancro, Genova - Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gusinu
authors.affiliation: School of Radiation Oncology, University of Genova, Genova - Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Timon
authors.affiliation: Department of Radiation Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova - Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Giannelli
authors.affiliation: Department of Medical Physics, IRCCS Azienda Ospedaliera Universitaria San Martino- IST Istituto Nazionale per la Ricerca sul Cancro, Genova - Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Vidano
authors.affiliation: Department of Oncology, Istituto Giannina Gaslini, Genova - Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Garrè
authors.affiliation: Department of Radiation Oncology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova - Italy.|Department of Medical Physics, IRCCS Azienda Ospedaliera Universitaria San Martino- IST Istituto Nazionale per la Ricerca sul Cancro, Genova - Italy.|School of Radiation Oncology, University of Genova, Genova - Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Corvò
mesh_terms: D000367:Age Factors; D049628:Body Size; D002648:Child; D002675:Child, Preschool; D061888:Craniospinal Irradiation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D058958:Organs at Risk; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods