Alejandra P. Zárate-Gómez, Servicio de Radioterapia, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México
Heynar J. Pérez-Villanueva, Servicio de Radioterapia, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México
Aida A. López-Azcárraga, Servicio de Radioterapia, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México
Juan M. Vázquez-Peralta, Servicio de Radioterapia, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Ciudad de México, México
Gabriel A. Sánchez-Marín, Servicio de Oncología, Hospital Juárez de México. Secretaría de Salud, Ciudad de México, México
Background: Craniospinal irradiation (CSI) has a decisive impact on the control of pediatric tumors with a high probability of dissemination through cerebrospinal fluid, but is associated with developmental defects in the spinal column during growth. Objective: To analyze spinal alterations after CSI, and to compare dosimetric techniques of conformal radiotherapy (CR) and volumetric intensity-modulated arc (VMAT). Method: An institutional series of 101 cases is presented, with clinical results at 5 years. Results: In the analyzed cases (n = 12), a mean achieved height of 136.1 cm was observed with a projected mean height of 147.7 cm (p < 0.001) and a growth velocity (GV) of 3.2 cm/year with a projected mean GV of 7.1 cm/year (p < 0.001). There was a difference of 11.6 cm between the current and projected mean height and of 3.9 cm/year between the achieved and expected GV, with a 58% increase in the incidence of short stature. The VMAT technique showed better homogeneity in exchange for a greater distribution of low doses to peripheral tissues. Conclusions: Alterations in spinal development are multifactorial, resulting from genetic, nutritional and treatment factors. Age and dose are the greatest predictors of effects.
Keywords: Craniospinal irradiation. Pediatric tumors. Growth deficit.
