This survey study aimed to assess current practice patterns regarding the vertebral bodies (VB) coverage for pediatric patients undergoing CSI. With the 28 responses, 23 physicians sometimes treat the entire VB and five physicians report always treating the entire VB. Most common responses regarding anterior CTV expansion for uncertainty were no expansion (n=9) and 3-4 mm (n=8).

Most physicians modify the anterior CTV margin to protect normal structures, most commonly esophagus (n=15), thyroid (n=6), heart (n=5), bowel (n=4), and pharynx (n=2). The practice varies amongst radiation oncologists in respect to target delineation, CTV expansions and modifications for organs at risk. These data suggest the radiation oncology community may benefit from a standardized approach to pediatric proton based CSI.