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Fractionated stereotactic radiotherapy for pediatric brain tumors: the Chicago children's experience
J A Kalapurakal1, A Kepka, T Bista
1Division of Radiation Oncology, Northwestern Memorial Hospital, Chicago, Illinois, USA. j-kalapurakal@nwu.edu
Insights
Fractionated stereotactic radiotherapy effectively treats pediatric brain and eye tumors. The Laitinen stereoadapter ensures accurate delivery, leading to good local control in most children.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neurosurgery
Background:
- Pediatric brain and eye neoplasms require precise treatment.
- Fractionated stereotactic radiotherapy offers targeted radiation delivery.
- Immobilization techniques are crucial for accurate radiotherapy in children.
Purpose of the Study:
- To evaluate the efficacy and tolerance of fractionated stereotactic radiotherapy in children with brain and eye neoplasms.
- To assess the impact of the Laitinen stereoadapter on treatment accuracy and outcomes.
- To determine local control rates and identify potential complications.
Main Methods:
- Retrospective analysis of 35 pediatric cases (brain/eye neoplasms).
- Treatment involved fractionated stereotactic radiotherapy with noncoplanar beams.
- Immobilization used plaster casts/masks initially, then the Laitinen stereoadapter.
- Dose fractionation varied for curative intent (50.4-60 Gy) and reirradiation (10-32 Gy).
Main Results:
- High local control rate: 22 of 25 children (treated with curative intent) achieved local control.
- Excellent accuracy: Daily treatment accuracy was consistently < 2 mm.
- Good tolerance: Fractionated stereotactic radiotherapy with the Laitinen stereoadapter was well-tolerated.
- One case of progressive brain necrosis noted, etiology unclear.
Conclusions:
- Fractionated stereotactic radiotherapy, particularly with the Laitinen stereoadapter, is a safe and effective treatment for pediatric brain and eye neoplasms.
- The Laitinen stereoadapter facilitates accurate and well-tolerated radiotherapy delivery in pediatric patients.
- This technique demonstrates promising local control rates for challenging pediatric tumors.
Abstract:
Thirty-three children with a total of 35 benign/malignant brain and eye neoplasms were treated with fractionated stereotactic radiotherapy. In the first 11 children immobilization for treatment was achieved with plaster of Paris casts or aquaplast masks. In the remaining 22 children the Laitinen stereoadapter was used. Radiation was delivered with noncoplanar static or rotational beams. The dose fractionation used was 50.4-60 Gy in 28-30 fractions in patients receiving treatment with curative intent, and 10-32 Gy at 2-4 Gy/fraction for reirradiation. The accuracy of daily treatment was < 2 mm. After a median follow-up of 27 months, 22 of the 25 children treated with curative intent achieved local control. One child had progressive brain necrosis following 54 Gy in 30 fractions for a pontine astrocytoma. The exact etiology of this complication is unknown. This series demonstrates that in children fractionated stereotactic radiotherapy using the Laitinen stereoadapter is well tolerated and accurate and results in good local control.