Skip to main content

Spinal Radiotherapy for the Pediatric Patient

Indications, Special Technical Considerations, and Long-Term Consequences

  • Chapter
Cancer in the Spine

Part of the book series: Current Clinical Oncology ((CCO))

  • 1113 Accesses

Abstract

Radiation therapy (RT) in the pediatric population presents challenging dilemmas to the clinician. Some of the pediatric malignancies are treated according to multi-institutional multimodality trials that guide the indications and techniques within specific parameters. Because of the extremely low incidence of primary spinal malignancies, multi-institutional trials have not been implemented. Most experience has been gained through the retrospective single institution review of patient management and outcome. The application of RT as a therapeutic modality in the management of pediatric malignancies has to be carefully evaluated because the potential for long-term consequences in this population is significant. The indications for RT are constantly evolving and in a few instances are controversial.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bloom HJG, Glees J, Bell J. The treatment and prognosis of medulloblastoma in children. AJR 1969; 105:43–62.

    CAS  Google Scholar 

  2. Bouffet E, Pierre-Kahn A, Marchal JC, et al. Prognostic factors in pediatric spinal cord astrocytoma. Cancer 1998; 83:2391–2399.

    Article  PubMed  CAS  Google Scholar 

  3. Breslow NE, Norkool PA, Olshan A. Second malignant neoplasms in survivors of Wilms’ tumor:a report from the National Wilms’ tumor study. J Natl Cancer Inst 1998; 80:592–595.

    Article  Google Scholar 

  4. Castleberry RP, Kun LE, Shuster JJ, et al. Radiotherapy improves the outlook for patients older than 1 year with POG stage C neuroblastoma. J Clin Oncol 1991; 9:789–795.

    PubMed  CAS  Google Scholar 

  5. Chacko AG, Chandy MJ. Favorable outcome after radical excision of a “holocord” astrocytoma. Clin Neurol Neurosurg 2000; 102:240–242.

    Article  PubMed  CAS  Google Scholar 

  6. Chang CH, Housepian EM, Herbert C. An operative staging system and a megavoltage radiotherapeutic technique for cerebellar medulloblastoma. J. Neurosurg 1987; 66:80–87.

    Google Scholar 

  7. Cherlow JM, Harland S, Steinherz P, et al. CSI for ALL with CNS disease at diagnosis: a report from the CCG. Int J Radiat Oncol Biol Phys 1996; 36:19–27.

    PubMed  CAS  Google Scholar 

  8. Chun HC, Schmidt-Ullrich RK, Wolfson A, Tercilla OF, Sagerman RH, King GA.. External beam radiotherapy for spinal cord tumors. J Neurooncol 1990; 9:211–217.

    Article  PubMed  CAS  Google Scholar 

  9. Constantini S, Houten J, Miller DC, et al. Intramedullary spinal cord tumors in children under the age of three years. J Neurosurg 1996; 85:1036–1043.

    PubMed  CAS  Google Scholar 

  10. Crist W, Gehan EA, Ragab AH, et al: The third IRS. J Clin Oncol 1995; 13:610–630.

    PubMed  CAS  Google Scholar 

  11. D’Angio GJ, Breslow N, Beckwith JB, et al. Treatment of Wilms’ tumor: results of the third NWTS. Cancer 1989; 64:349–360.

    Article  PubMed  CAS  Google Scholar 

  12. D’Angio GJ, Tefft M, Breslow NE, et al. Radiation therapy of Wilms’ tumor: results according to dose, field, postoperative timing and histology. Int J Radiat Oncol Biol Phys 1978; 4:769.

    PubMed  CAS  Google Scholar 

  13. David KM, Casey ATH, Hayward RD, Harkness WF, Phipps K, Wade AM. Medulloblastoma: is the 5-year survival rate improving? J Neurosurg 1997; 86:13–21.

    PubMed  CAS  Google Scholar 

  14. DeSousa AL, Kalsbeck JE, Mealey J, Campbell RL, Hockey A. Intraspinal tumors in children. A review of 81 cases. J Neurosurg 1979; 51:437–445.

    Article  PubMed  CAS  Google Scholar 

  15. Deutsch M. Medulloblastoma: staging and treatment outcome. Int J Radiat Oncol Biol Phys 1988; 14:1103–1107.

    PubMed  CAS  Google Scholar 

  16. Deutsch M, Thomas PRM, Krischer J, et al. Results of a prospective randomized trail comparing standard dose neuraxis irradiation (3,600 cGy/20) with reduced neuraxis irradiation (2,340 cGy/13) in patients with low-stage medulloblastoma: a combined Children’s Cancer Group-Pediatric Oncology Group Study. Pediatr Neurosurg 1996; 24:167–177.

    Article  PubMed  CAS  Google Scholar 

  17. Dunbar S, Barnes P, Tarbell NJ. Radiographic determination of the caudal border of the spinal field in craniospinal irradiation. Int J Radiat Oncol Biol Phys 1993; 26:669–673.

    PubMed  CAS  Google Scholar 

  18. Epstein F. Intraaxial tumors of the cervicomedullary junction in children. Pediatr Neurosurg 1987; 7:117.

    Google Scholar 

  19. Evans AE, Jenkin RDT, Sposto R, et al. The treatment of medulloblastoma: results of a prospective randomized trial of radiation therapy with and without CCNU, vincristine, and prednisone. J Neurosurg 1990; 72:572–582.

    PubMed  CAS  Google Scholar 

  20. Evans AE, Norkool P, Evans I. Late effects for Wilm’s tumor. A report from the National Wilms tumor study group. Cancer 1991; 67:331–336.

    Article  PubMed  CAS  Google Scholar 

  21. Garcia DM, Marks JE, Latifi HR, Kliefoth AB. Childhood cerebellar astrocytomas: is there a role for postoperative irradiation? Int J Radiat Oncol Biol Phys 1990; 8:815–818.

    Google Scholar 

  22. Garrett PG, Simpson WJK. Ependymomas: results of radiation treatment. Int J Radiat Oncol Biol Phys 1983; 9:1121–1124.

    PubMed  CAS  Google Scholar 

  23. Gaspar LE, Dawson DJ, Tilley-Gulliford SA, Banerjee P. Medulloblastoma. Long-term follow-up of patients treated with electron irradiation of the spinal field. Radiology 1991; 180:867–870.

    PubMed  CAS  Google Scholar 

  24. Goh KY, Velasquez L, Epstein FJ. Pediatric intramedullary spinal cord tumors: is surgery alone engough? Pediatr Neurosurg 1997; 271:34–39.

    Article  Google Scholar 

  25. Goldwein JW, Corn BW, Finlay JL, Packer RJ, Rorke LB, Schut L. Is craniospinal irradiation required to cure children with malignant (anaplastic) intracranial ependymomas? Cancer 1991; 67:2766–2771.

    Article  PubMed  CAS  Google Scholar 

  26. Gurney JG, Davis S, Severson RK, Fang JY, Ross JA, Robison LL. Trends in cancer incidence among children in the U.S. Cancer 1996; 78:532–541.

    Article  PubMed  CAS  Google Scholar 

  27. Halperin BC. Impact of radiation technique upon the outcome of treatment for medulloblastoma. Int J Radiat Oncol Biol Phys 1996; 36:233–239.

    Article  PubMed  CAS  Google Scholar 

  28. Heaston DK, Libshitz HI, Chan RC. Skeletal effects of megavoltage irradiation in survivors of Wilm’s tumor. AJR 1979; 133:389–395.

    PubMed  CAS  Google Scholar 

  29. Heyn R, Haeberlen V, Newton WA, et al. Second malignant neoplasms in children treated for rhabdomyosarcoma. J Clin Oncol 1993; 11:262–270.

    PubMed  CAS  Google Scholar 

  30. Holupka EJ, Humm JL, Tarbell NJ, Svensson GK. Effect of set-up error on the dose across the junction of matching cranial-spinal fields in the treatment of medulloblastoma. Int J Radiat Oncol Biol Phys 1993; 27:345–352

    PubMed  CAS  Google Scholar 

  31. Houten JK, Cooper PR. Spinal cord astrocytomas: presentation, management and outcome. J Neurooncol 2000; 47:219–224.

    Article  PubMed  CAS  Google Scholar 

  32. Houten JK, Weiner HL. Pediatric intramedullary spinal cord tumor: special considerations. J Neurooncol 2000; 473:225–230.

    Article  Google Scholar 

  33. Innocenzi G, Raco A, Cantore G, Raimondi AJ. Intrmedullary astrocytomas and ependymomas in the pediatric age group: a retrospective study. Childs Nerv Syst 1996; 12:776–780.

    Article  PubMed  CAS  Google Scholar 

  34. Jenkin D, Goddard K, Armstrong D, et al. Posterior fossa medulloblastoma in childhood: treatment results and a proposal for a new staging system. Int J Radiat Oncol Biol Phys 1990; 19:265–274.

    PubMed  CAS  Google Scholar 

  35. Kopelson G, Linggood RM, Kleinman GM, Doucette J, Wang CC. Management of intramedullary spinal cord tumors. Radiology 1980; 135:473–479.

    PubMed  CAS  Google Scholar 

  36. Linstadt DE, Wara WM, Leibel SA, Gutin PH, Wilson CB, Sheline GE. Postoperative radiotherapy of spinal cord tumors. Int J Radiat Oncol Biol Phys 1989; 16:1397–1403

    PubMed  CAS  Google Scholar 

  37. Mandell LR, Ghavimi F, Exelby P, Fuks Z. Preliminary results of alternating combination chemotherapy and hyperfractionated radiotherapy in advanced rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 1988; 15:197–203.

    PubMed  CAS  Google Scholar 

  38. Maor MH, Fields RS, Hogstrom KR, van Eys J. Improving the therapeutic ratio of craniospinal irradiation in medulloblastoma. Int J Radiat Oncol Biol Phys 1985; 11:687–697.

    PubMed  CAS  Google Scholar 

  39. Matthay KK, Sather HN, Seeger RC, Haase GM, Hammond GD. Excellent outcome of stage II Neuroblastoma is independent of residual disease and radiation therapy. J Clin Oncol 1993; 7:233–244.

    Google Scholar 

  40. Maurer HM, Beltangady M, Gehan EA, et al. The IRS-I: A final report. Cancer 1988; 61:209–220.

    Article  PubMed  CAS  Google Scholar 

  41. Maurer HM, Gehan EA, Beltangady M, et al. The IRS-II. Cancer 1993; 71:1904–1922.

    Article  PubMed  CAS  Google Scholar 

  42. Mayfield JK, Riseborough EJ, Jaffe N, Nehme ME. Spinal deformity in children treated for neuroblastoma. J Bone Joint Surg Am 1981; 63:183–193.

    PubMed  CAS  Google Scholar 

  43. McCormick PC, Torres R, Post KD, Stein BM. Intramedullary ependymoma of the spinal cord. J Neurosurg 1990; 72:523–532.

    PubMed  CAS  Google Scholar 

  44. Meadows AT, D’Angio GJ. Incidence of second malignant neoplasms in children: results of an international study. Lancet 1982; 2:1326–1331.

    PubMed  Google Scholar 

  45. Merchant TE, Haida T, Wang M-H, Finlay JL, Leibel SA. Anaplastic ependymoma: treatment of pediatric patients with or without craniospinal radiation therapy. J Neurosurg 1997; 86:943–949.

    PubMed  CAS  Google Scholar 

  46. Merchant TE, Kiehna EN, Thompson SJ, Heideman R, Sanford RA, Kun LE. Pediatric low-grade and ependymal spinal cord tumors. Pediatr Neurosurg 2000; 32:30–36.

    Article  PubMed  CAS  Google Scholar 

  47. Merchant TE, Nguyen D, Thompson SJ, Reardon DA, Kun LE, Sanford RA. High-grade pediatric spinal cord tumors. Pediatr Neurosurg 2000; 32:1–5.

    Article  Google Scholar 

  48. Merchant TE, Wang M-E, Haida T, et al. Medulloblastoma: long-term results for patients treated with definitive radiation therapy during the computed tomography era. Int J Ratiat Oncol Biol Phys 1996; 36:29–35.

    Article  CAS  Google Scholar 

  49. Nadkarni TD, Rekate HL. Pediatric intramedullary spinal cord tumors. Critical review of the literature. Childs Nerv Syst 1999; 15:17–28.

    Article  PubMed  CAS  Google Scholar 

  50. Neuhauser, EBD, Wittenborg MH, Berman CZ, Cohen J. Irradiation effects of roentgen therapy on the growing spine. Radiology 1952; 59:637–650.

    PubMed  CAS  Google Scholar 

  51. Nitschke R, Smith EI, Altshuler G, et al. Postoperative treatment of non metastatic visible residual neuroblastoma: a POG study. J Clin Oncol 1991; 9:1181–1188.

    PubMed  CAS  Google Scholar 

  52. Nitschke R, Smith EI, Shochat S, et al. Localized Neuroblastoma treated by surgery: a POG study. J Clin Oncol 1988; 6:1271–1279.

    PubMed  CAS  Google Scholar 

  53. O’Sullivan C, Jenkin RD, Doherty MA, Hoffman HJ, Greenberg ML. Spinal cord tumors in children: long-term results of combined surgical and radiation treatment. J Neurosurg 1994; 81:507–512.

    PubMed  CAS  Google Scholar 

  54. Packer RJ, Sutton LN, Elterman R, et al. Outcome for children with medulloblastoma treated with radiation and cisplatin, CCNU, and vincristine chemotherapy. J Neurosurg 1994; 81:690–698.

    PubMed  CAS  Google Scholar 

  55. Pollack IF, Hurtt M, Pang D, Albright AL. Dissemination of low grade intracranial astro-cytomas in children. Cancer 1994; 73:2869–2878.

    Article  PubMed  CAS  Google Scholar 

  56. Prados M, Mamelak AN. Metastasizing low grade gliomas in children. Redefining an old disease. Cancer 1994; 73:2671–2673.

    Article  PubMed  CAS  Google Scholar 

  57. Probert JC, Parker BR. The effects of radiation therapy on bone growth. Radiology 1975; 114:155–162.

    PubMed  CAS  Google Scholar 

  58. Probert JC, Parker BR, Kaplan HS. Growth retardation in children after megavoltage irradiation of the spine. Cancer 1973; 32:634–639.

    Article  PubMed  CAS  Google Scholar 

  59. Reimer R, Onofrio BM. Astrocytomas of the spinal cord in children and adolescents. J Neurosurg 1985; 63:669–675.

    PubMed  CAS  Google Scholar 

  60. Rezai AR, Woo HH, Lee M, Cohen H, Zagzag D, Epstein FJ. Disseminated ependymomas of the central nervous system. J Neurosurg 1996; 85:618–624

    PubMed  CAS  Google Scholar 

  61. Riseborough EJ, Grabias SL, Burton RI. Skeletal alterations following irradiation for Wilms’ tumor. J Bone Joint Surg Am 1976; 58:526–536.

    PubMed  CAS  Google Scholar 

  62. Rousseau P, Habrand JL, Ssarrazin D, et al. Treatment of intracranial ependymomas of children: review of a 15-year experience. Int J Radiat Oncol Biol Phys 1994; 28:381–386.

    PubMed  CAS  Google Scholar 

  63. Salazar OM. A better understanding of CNS seeding and brighter outlook for postoperatively irradiated patients with ependymomas. Int J Radiat Oncol Biol Phys 1983; 9:1231–1234.

    PubMed  CAS  Google Scholar 

  64. Salazar OM, Castro-Vita H, VanHoutte P, Rubin P, Aygun C. Improved survival in cases of intracranial ependymoma after radiation therapy. Late report and recommendations. J. Neurosurg 1983; 59:652–653.

    PubMed  CAS  Google Scholar 

  65. Scaradavou A, Heller G, Sklar CA. Second malignant neoplasms in long-term survivors of childhood rhabdomyosarcoma. Cancer 1995; 76:1860–1867.

    Article  PubMed  CAS  Google Scholar 

  66. Scharf CB, Paulino AC, Goldberg KN. Determination of the inferior border of the thecal sac using magnetic resonance imaging: implications on radiation therapy treatment planning. Int J Radiat Oncol Biol Phys 1998; 41:621–624.

    Article  PubMed  CAS  Google Scholar 

  67. Schiffer D, Chio A, Giordana MT, et al. Histologic prognostic factors in ependymoma. Childs Nerv Syst 1991; 7:177–182.

    Article  PubMed  CAS  Google Scholar 

  68. Silber JH, Littman PS, Meadows AT. Stature loss following skeletal irradiation for childhood cancer. J Clin Oncol 1990; 8:304–312.

    PubMed  CAS  Google Scholar 

  69. Silverman CL, Simpson JR. Cerebellar medulloblastoma: the importance of posterior fossa dose to survival and patterns of failure. Int J Radiat Oncol Biol Phys 1982; 8:1869–1876.

    PubMed  CAS  Google Scholar 

  70. Tatcher M, Glicksman AS. Field matching considerations in craniospinal irradiation. Int J Radiat Oncol Biol Phys 1989; 17:865–869.

    PubMed  CAS  Google Scholar 

  71. Thomas PRM, Deutsch M, Mulhern, R, et al. Reduced dose neuraxis irradiation in low stage medulloblastoma: the POG and CCG study. SIPO XXVII meeting-abstracts. Med Pediatr Oncol 1995; 25:277–287.

    Google Scholar 

  72. Thomas PRM, Tefft M, Farewell VT, Norkool P, Storer B, D’Angio GJ. Abdominal relapses in irradiated second NWTS patients. J Clin Oncol 1984; 2:1098–1101.

    PubMed  CAS  Google Scholar 

  73. Trigg ME, Makuch R, Glaubiger D. Actuarial risk of isolated CNS involvement in Ewing’s sarcoma following prophylactic cranial irradiation and intrathecal methotrexate. Int J Radiat Oncol Biol Phys 1985; 11:699–702.

    PubMed  CAS  Google Scholar 

  74. Vanuytsel LJ, Bessell EM, Ashley SE, Bloom HJ, Brada M. Intracranial ependymoma: long-term results of a policy of surgery and radiotherapy. Int J Radiat Oncol Biol Phys 1992; 23:313–319.

    PubMed  CAS  Google Scholar 

  75. Wara WM, Le QT, Sneed PK, et al. Pattern of recurrence of medulloblastoma after low-dose craniospinal radiotherapy. Int J Radiat Oncol Biol Phys 1994; 30:551–556.

    PubMed  CAS  Google Scholar 

  76. Whitaker SJ, Bessel EM, Ashley SE, et al. Postoperative radiotherapy in the management of spinal cord ependymoma. J Neurosurg 1991; 74:720–728.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Humana Press, Inc., Totowa, NJ

About this chapter

Cite this chapter

Ludin, A. (2006). Spinal Radiotherapy for the Pediatric Patient. In: McLain, R.F., Lewandrowski, KU., Markman, M., Bukowski, R.M., Macklis, R., Benzel, E.C. (eds) Cancer in the Spine. Current Clinical Oncology. Humana Press. https://doi.org/10.1007/978-1-59259-971-4_23

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-971-4_23

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-074-8

  • Online ISBN: 978-1-59259-971-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics