{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:53:59Z","timestamp":1791986039337,"version":"4.4.0"},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82001813"],"award-info":[{"award-number":["82001813"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Craniospinal irradiation (CSI) is essential for treating pediatric medulloblastoma (MB) but causes significant long\u2010term toxicities. Existing dose\u2010reduction or partial\u2010sparing strategies improve neurocognitive outcomes but may compromise survival or fail to address other late effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A new functional preservation CSI (FP\u2010CSI) technique was developed to spare the hippocampus, hypothalamic\u2010pituitary axis (HPA), cochlea, and scalp while ensuring homogeneous vertebral coverage. Eight pediatric patients with average\u2010risk MB were retrospectively planned with volumetric modulated arc therapy (VMAT) using both FP\u2010CSI and standard CSI (S\u2010CSI). Dosimetric parameters for the planning target volume (PTV) and organs at risk (OARs), radiobiological effects, plan robustness, plan complexity, and plan quality assurance (QA) were compared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      FP\u2010CSI significantly reduced mean doses to the hippocampus (12.4 vs. 23.9 Gy), hypothalamus (14.7 vs. 23.9 Gy), and pituitary gland (15.4 vs. 24.1 Gy, all\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01). Vertebral dose gradients were halved (4.7 vs. 8.7 Gy). Moderate dose reductions were also achieved for the cochlea and scalp. Compared with S\u2010CSI, FP\u2010CSI exhibited slightly inferior PTV homogeneity (HI: 0.16 vs. 0.07) and conformity (CI: 0.88 vs. 0.93), but coverage remained clinically acceptable. Normal tissue complication probability (NTCP) modeling showed pronounced decreases in predicted neurocognitive and endocrine toxicity risks, with probability of neurocognitive impairment reduced from 84.5% to 24.9% and probability of endocrine dysfunction from 44.7% to 27.3%. FP\u2010CSI increased modulation complexity and produced slightly lower gamma passing rates for cranial beams, while spinal beam deliverability remained similar to S\u2010CSI. Robustness analysis indicated greater sensitivity of FP\u2010CSI to setup and rotational errors. Nevertheless, 3D dose reconstruction confirmed accurate delivery, with volumetric dose deviations generally below 1 Gy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>FP\u2010CSI effectively spares critical functional structures while maintaining clinically acceptable target coverage, and offers a promising strategy to reduce long\u2010term radiotherapy\u2010induced toxicities in pediatric MB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70474","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T11:38:32Z","timestamp":1769513912000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A feasibility study of functional preservation in craniospinal irradiation with photon for pediatric medulloblastoma"],"prefix":"10.1002","volume":"27","author":[{"given":"Keqiang","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Tianjin Medical University General Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Tianjin Medical University General Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianbo","family":"Jian","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Tianjin Medical University General Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Tianjin Medical University General Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Tianjin Medical University General Hospital  Tianjin China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenxue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Tianjin Medical University General Hospital  Tianjin 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