Abstract
Cancer is a leading cause of death in children with tumors of the central nervous system, the most commonly encountered solid malignancies in this population. Radiotherapy (RT) is an integral part of managing brain tumors, with excellent long-term survival overall. The tumor histology will dictate the volume of tissue requiring treatment and the dose. However, radiation in developing children can yield functional deficits and/or cosmetic defects and carries a risk of second tumors. In particular, children receiving RT are at risk for neurocognitive effects, neuroendocrine dysfunction, hearing loss, vascular anomalies and events, and psychosocial dysfunction. The risk of these late effects is directly correlated with the volume of tissue irradiated and dose delivered and is inversely correlated with age. To limit the risk of developing these late effects, improved conformity of radiation to the target volume has come from adopting a volumetric planning process. Radiation beam characteristics have also evolved to achieve this end, as exemplified through development of intensity modulated photons and the use of protons. Understanding dose limits of critical at-risk structures for different RT modalities is evolving. In this review, we discuss the physical basis of the most common RT modalities used to treat pediatric brain tumors (intensity modulated radiation therapy and proton therapy), the RT planning process, survival outcomes for several common pediatric malignant brain tumor histologies, RT-associated toxicities, and steps taken to mitigate the risk of acute and late effects from treatment.
Highlights
Cancer is the second leading cause of death in children aged 1–14 years, with approximately11,000 diagnoses anticipated in 2020 [1]
We summarize the major radiation therapy (RT) modalities available to treat pediatric brain tumors, describe the modern treatment planning process, and discuss the successes achieved and challenges encountered in treating several of the most common pediatric brain cancers
The dose distributions achieved using either passive scatter (PS) or pencil beam scanning (PBS) proton radiation are superior to those seen with photon delivery techniques, with the benefit of less entrance and no exit dose compared with photon beams (Figure 2)
Summary
Cancer is the second leading cause of death in children aged 1–14 years, with approximately. Radiation exposure to the brain can predispose one to hearing loss, impaired neurocognition, and neuroendocrine dysfunction [3,4,5], among other functional deficits. These toxicities can detract from a Cancers 2020, 12, 1533; doi:10.3390/cancers12061533 www.mdpi.com/journal/cancers. To maximize the therapeutic window between efficacy and toxicity, RT has undergone revolutionary changes in recent decades like the development of intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and proton beam radiation therapy (PBRT). We summarize the major RT modalities available to treat pediatric brain tumors, describe the modern treatment planning process, and discuss the successes achieved and challenges encountered in treating several of the most common pediatric brain cancers
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