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Modern Radiotherapy for Pediatric Brain Tumors

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 t...

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Detalles Bibliográficos
Autores principales: DeNunzio, Nicholas J., Yock, Torunn I.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352417/
https://www.ncbi.nlm.nih.gov/pubmed/32545204
http://dx.doi.org/10.3390/cancers12061533
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author DeNunzio, Nicholas J.
Yock, Torunn I.
author_facet DeNunzio, Nicholas J.
Yock, Torunn I.
author_sort DeNunzio, Nicholas J.
collection PubMed
description 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.
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spelling pubmed-73524172020-07-15 Modern Radiotherapy for Pediatric Brain Tumors DeNunzio, Nicholas J. Yock, Torunn I. Cancers (Basel) Review 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. MDPI 2020-06-11 /pmc/articles/PMC7352417/ /pubmed/32545204 http://dx.doi.org/10.3390/cancers12061533 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
DeNunzio, Nicholas J.
Yock, Torunn I.
Modern Radiotherapy for Pediatric Brain Tumors
title Modern Radiotherapy for Pediatric Brain Tumors
title_full Modern Radiotherapy for Pediatric Brain Tumors
title_fullStr Modern Radiotherapy for Pediatric Brain Tumors
title_full_unstemmed Modern Radiotherapy for Pediatric Brain Tumors
title_short Modern Radiotherapy for Pediatric Brain Tumors
title_sort modern radiotherapy for pediatric brain tumors
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7352417/
https://www.ncbi.nlm.nih.gov/pubmed/32545204
http://dx.doi.org/10.3390/cancers12061533
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