Advertisement

Pediatric Brain Tumors: Conformal Radiation Therapy Perspective

  • Thomas E. Merchant

Abstract

Childhood cancer is the most common cause of disease related death among children ages 0 to 19 years.It has not been defined as a public health problem because fewer than 12,500 cases are diagnosed each year. CNS tumors represent 21% of childhood cancers or about 2700 cases per year [1]. This rare group of tumors is composed of astrocytoma, 56% (n = 1510); embryonal tumors including medulloblastoma, supratentorial primitive neuroectodermal tumor, and pineoblastoma, 20% (n = 550); ependymoma, 7% (n = 190); craniopharyngioma, 3% (n = 100); germ cell tumors, 3% (n = 100); and tumors involving the spinal cord, pituitary, and choroid plexus, 11% (n = 300) (Fig. 31-1).
Figure 31-1

Estimated incidence of pediatric CNS tumors in the United States.

Keywords

Plan Target Volume Posterior Fossa Radiat Oncol Biol Phys Gross Tumor Volume Pediatric Brain Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, Bunin GR, eds. Cancer Incidence and Survival among Children and Adolescents: United States SEER Program 1975–1995. National Cancer Institute, SEER Program. NIH Publication No. 99-4649. Bethesda, MD: NIH, 1999.Google Scholar
  2. 2.
    Packer RJ, Goldwein J, Nicholson HS, et al. Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy: a Children’s Cancer Group Study. J Clin Oncol 1999;17:2127–2136.PubMedGoogle Scholar
  3. 3.
    Walter AW, Mulhern RK, Gajjar A, et al. Survival and neurodevelopmental outcome of young children with medulloblastoma at St. Jude Children’s Research Hospital. J Clin Oncol 1999;17:3720–3728.PubMedGoogle Scholar
  4. 4.
    Ris MD, Packer R, Goldwein J, et al. Intellectual outcome after reduced-dose radiation therapy plus adjuvant chemotherapy for medulloblastoma: a Children’s Cancer Group study. J Clin Oncol 2001;19:3470–3476.PubMedGoogle Scholar
  5. 5.
    Merchant TE, Kun LE, Krasin MJ, et al. A multi-institution prospective trial of reduced-dose craniospinal irradiation (23.4 Gy) followed by conformal posterior fossa (36 Gy) and primary site irradiation (55.8 Gy) and dose-intensive chemotherapy for average-risk medulloblastoma. Int J Radiat Oncol Biol Phys 2003;57:S194–195.Google Scholar
  6. 6.
    Mulhern RK, Palmer SL, Merchant TE, et al. Neurocognitive consequences of risk-adapted therapy for childhood medulloblastoma. J Clin Oncol 2005;23:5511–5519.CrossRefPubMedGoogle Scholar
  7. 7.
    National Cancer Institute. Phase III randomized adjuvant study of standard-dose versus reduced-dose craniospinal radiotherapy and posterior fossa boost versus tumor bed boost radiotherapy in combination with chemotherapy comprising vincristine, cisplatin, lomustine, and cyclophosphamide in pediatric patients with newly diagnosed standard-risk medulloblastoma. Available at http://www.cancer.gov/search/ViewClinicalTrials.aspx?cdrid=365506&protocolsearchid=1695050&version=healthprofessional. Accessed August 10, 2006.Google Scholar
  8. 8.
    National Cancer Institute. Phase III study of cyclophosphamide, vincristine, cisplatin, and etoposide followed by second-look surgery and focal conformal radiotherapy in children with nonmetastatic medulloblastoma or posterior fossa primitive neuro ectodermal tumor. Available at http://www.cancer.gov/search/ViewClinicalTrials.aspx?cdrid=68269&version=HealthProfessional&protocolsearchid=1695054. Accessed August 10, 2006.Google Scholar
  9. 9.
    ICRU Report 50. Dose specification for reporting external beam therapy with photons and electrons. No. 9. Washington, DC: International Commission on Radiation Units and Measurements, 1993.Google Scholar
  10. 10.
    ICRU Report 62. Dose specification for reporting external beam therapy with photons and electrons. Washington, DC: International Commission on Radiation Units and Measurements, 1999.Google Scholar
  11. 11.
    Leung W, Rose SR, Merchant TE. In Schwartz C, Hobbie W, Constine L, Ruccione K, eds. Survivors of Childhood Cancer: Assessment and Management, 2nd ed. Heidelberg: Springer-Verlag, 2005:51–80.Google Scholar
  12. 12.
    Shaw EG, Tatter SB, Lesser GJ, et al. Current controversies in the radiotherapeutic management of adult low-grade glioma. Semin Oncol 2004;5:653–658.CrossRefGoogle Scholar
  13. 13.
    Merchant TE, Mulhern RK, Krasin MJ, et al. Preliminary results from a phase II trial of conformal radiation therapy and the evaluation of radiation-related CNS effects for pediatric patients with localized ependymoma. J Clin Oncol 2004;15:3156–3162.CrossRefGoogle Scholar
  14. 14.
    Garvin J, Sposto R, Stanley P, et al. Childhood ependymoma: improved survival for patients with incompletely resected tumors with the use of pre-irradiation chemotherapy. 11th International Symposium on Pediatric Neuro-Oncology, Boston, 2004 (abstract THER 29). Available at http://home.comcast.net/~turne038/abstracts.htm. Accessed August 10, 2006.Google Scholar
  15. 15.
    National Cancer Institute. Phase II study of conformal radiotherapy for pediatric patients with localized ependymoma, chemotherapy prior to second surgery in pediatric patients with incompletely resected ependymoma, and observation only in pediatric patients with completely resected differentiated, supratentorial ependymoma. Available at http://www.cancer.gov/search/ViewClinicalTrials.aspx?cdrid=69086&protocolsearchid=1694995&version=healthprofessional. Accessed August 10, 2006.Google Scholar
  16. 16.
    Merchant TE, Williams T, Smith JM, et al. Pre-irradiation endocrinopathies in pediatric brain tumor patients determined by dynamic tests of endocrine function. Int J Radiat Oncol Biol Phys 2002;54:45–50.CrossRefPubMedGoogle Scholar
  17. 17.
    Merchant TE, Kiehna EN, Li C, et al. Radiation dosimetry predicts IQ after conformal radiation therapy in pediatric patients with localized ependymoma. Int J Radiat Oncol Biol Phys 2005;63:1546–1554.CrossRefPubMedGoogle Scholar
  18. 18.
    Merchant TE, Goloubeva O, Pritchard DL, et al. Radiation dosevolume effects on growth hormone secretion. Int J Radiat Oncol Biol Phys 2002;52:1264–1270.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Thomas E. Merchant
    • 1
  1. 1.Division of Radiation OncologySt. Jude Children’s Research HospitalMemphisUSA

Personalised recommendations