What radiation dose constraints should be used for the spinal cord in pediatrics?

As part of the PENTEC project (Constine et al., PMID 37999712), I had the privilege of finding all of the cases of pediatric radiation myelitis in the literature. This is modified from our published findings, I encourage you to read the full manuscript if you would like further details (Cooper et al...

I have been going to 50.4-52.2 Gy for large volumes and 54 Gy for small volumes (1.8 Gy per day).

I would be more careful with radiosensitizing chemotherapy – busulfan, cisplatin, etc.

I have not been modifying doses based on histology or location (intramedullary vs extramedullary).