Novel technique for craniospinal radiotherapy with patient supine

A simple procedure to plan, verify and implement craniospinal irradiation（CSI） with patients supine is presented. Treatment is conducted with a single posterior spinal field abutting two lateral cranial fields. The opposed lateral fields are half-blocked and the inferior line is perpendicular. The posterior field uses some fixed field parameters so that the cephalad edge of the posterior field is coplanar with the caudal edges of the lateral fields and it is independent of the height of the couch. A steel-shot ball is used to measure the size of overlap or gap at the junction using portal images of an electron portal image device or portal films. The results of analyzing the portal images show that the errors of the junction are within ± 1 mm. The dose-volume histograms （DVHs）show that there are not unbearable hot or cold spots in the clinic target volumes （CTVs）. Supine craniospinal treatment is a reliable and convenient alternative to treatment in the prone position and avoids the technical difficulties of the latter. The use of fixed field geometry greatly facilitates treatment planning and effectively reduces the amount of time of setup, verification and treatment.

Recombinant human vascular endostatin injection to synchronize craniospinal radiotherapy for the treatment of recurrent medulloblastoma in children:A retrospective clinical study

Objective Medulloblastoma(MB)is the most common primary central nervous system malignancy in children.Nonetheless,there is no standard treatment for recurrent MB.The purpose of this study was to investigate the clinical value and toxicity of recombinant human endostatin injection(Endostar~?)combined with craniospinal radiotherapy for the treatment of recurrent MB in children.Methods This study retrospectively analyzed 13 patients with recurrent MB aged 5–18 years.Endostar?7.5 mg/m~2/d was synchronized during craniospinal radiotherapy for 7 children with a portable micro uniform speed infusion pump.Endostar~?was applied 3 days prior to the initiation of radiotherapy.The drug was in continuous use for 7 days.Similarly,the withdrawal of the drug took place over 7 days.This represented a cycle.During radiotherapy,the application was repeated until the end of radiotherapy(experimental group).In the other 6 cases,only craniospinal radiotherapy was used(control group).Results The complete remission rate was 71.4%in the experimental group and 16.7%in the control group.The median progression-free survival(PFS)was 14 months(95%CI:0.0–29.60)and 19 months(95%CI:0.0–39.53)in the experimental and control groups,respectively.The median overall survival(OS)was 19 months(95%CI:0.0–38.20)and 23 months(95%CI:2.47–43.53)in the experimental and control groups,respectively.The most common adverse events included grade 1 thrombocytopenia(7.7%),grade 3 neutropenia(38.5%),and grade 1 anemia(30.8%).Conclusion Endostar~?synchronizing craniospinal radiotherapy significantly improved the complete response rate of children with recurrent MB.It did not increase the side effects of radiation therapy.However,it did not improve the PFS or OS.