The need for consensus on delineation and dose constraints of dentofacial structures in paediatric radiotherapy: Outcomes of a SIOP Europe survey

Angela Davey; Shermaine Pan; Abigail Bryce-Atkinson; Henry Mandeville; Geert O Janssens; Sarah M Kelly; Marinka Hol; Vivian Tang; Lucy Siew Chen Davies; Siop-Europe Radiation Oncology Working Group; Marianne Aznar

doi:10.1016/j.ctro.2023.100681

The need for consensus on delineation and dose constraints of dentofacial structures in paediatric radiotherapy: Outcomes of a SIOP Europe survey

Clin Transl Radiat Oncol. 2023 Sep 24:43:100681. doi: 10.1016/j.ctro.2023.100681. eCollection 2023 Nov.

Authors

Affiliations

¹ Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
² Department of Proton Therapy, The Christie NHS Foundation Trust, Manchester, UK.
³ The Royal Marsden NHS Foundation Trust, London, UK.
⁴ Princess Maxima Center for Paediatric Oncology, Utrecht, The Netherlands.
⁵ Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁶ European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, Brussels, Belgium.
⁷ The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium.
⁸ Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁹ Department of Otorhinolaryngology, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁰ Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, UK.
¹¹ Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK.

Abstract

Background and purpose: Children receiving radiotherapy for head-and-neck tumours often experience severe dentofacial side effects. Despite this, recommendations for contouring and dose constraints to dentofacial structures are lacking in clinical practice. We report on a survey aiming to understand current practice in contouring and dose assessment to dentofacial structures.

Methods: A digital survey was distributed to European Society for Paediatric Oncology members of the Radiation Oncology Working Group, and member-affiliated centres in Europe, Australia, and New Zealand. The questions focused on clinical practice and aimed to establish areas for future development.

Results: Results from 52 paediatric radiotherapy centres across 27 countries are reported. Only 29/52 centres routinely delineated some dentofacial structures, with the most common being the mandible (25 centres), temporo-mandibular joint (22), dentition (13), orbit (10) and maxillary bone (eight). For most bones contoured, an 'As Low As Reasonably Achievable' dose objective was implemented. Only four centres reported age-adapted dose constraints.The largest barrier to clinical implementation of dose constraints was firstly, the lack of contouring guidance (49/52, 94%) and secondly, that delineation is time-consuming (33/52, 63%). Most respondents who routinely contour dentofacial structures (25/27, 90%) agreed a contouring atlas would aid delineation.

Conclusion: Routine delineation of dentofacial structures is infrequent in paediatric radiotherapy. Based on survey findings, we aim to 1) define a consensus-contouring atlas for dentofacial structures, 2) develop auto-contouring solutions for dentofacial structures to aid clinical implementation, and 3) carry out treatment planning studies to investigate the importance of delineation of these structures for planning optimisation.

Keywords: Contouring; Dentofacial; Dose-volume constraints; Late adverse effects; Paediatrics; Radiotherapy.

Grants and funding

28701/CRUK_/Cancer Research UK/United Kingdom