Cover to cover.

Top Line: If anyone benefits from proton therapy, it’s gotta be a child receiving craniospinal irradiation (CSI), but how much do proton CSI techniques vary among institutions?

The Study: Fortunately we have the Pediatric Proton/Photon Consortium Registry (PPCR) to help us understand how this technique is being used for pediatric CSI cases across the US. Among 384 evaluable cases treated from 2015-2020, clinical coverage varied significantly across institutions. While the majority of plans achieved coverage with 95% of prescription dose of spinal (96%) and sacral (88%) nerves, only 69% covered cranial foramina and 48% covered optic nerves. Check out figure 1 to appreciate just how different these plans can be. The method of vertebral body sparing has increased over time, employed in roughly one of five cases of immature skeletons. The discussion really delves into the various points of contention for whether or not to routinely include all of the above.

TBL: This dosimetric look at poroton CSI plans across the US throughout the past half-decade highlights a gaping need for guidelines on the finer details of target coverage. | Connor, Int J Radiat Oncol Biol 2021