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, Marianne Aznar

Research output: Contribution to journalArticlepeer-review


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.

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 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.

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.
Original languageEnglish
Article number100681
JournalClinical and translational radiation oncology
Early online date24 Sept 2023
Publication statusE-pub ahead of print - 24 Sept 2023


  • Dentofacial
  • radiotherapy
  • paediatrics
  • late adverse effects
  • contouring
  • dose-volume constraints


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