Radiation therapy in the management of childhood brain tumors

Radiation therapy (RT) still plays a major role in the management of intracranial malignancies, together with surgical resection and, more recently, chemotherapy. This is a review of the experience with fractionated external beam RT. In medulloblastomas, combined modalities currently achieve a 5-year survival in excess of 70% in low-risk subgroups and 40% in the subgroups considered to be high risk. For the past decade, the emphasis has been on the quality of life in cured children. Recent advances have mainly aimed at limiting the toxicity of the "prophylactic" craniospinal irradiation by testing dose reductions and altered fractionations. Technical innovations have also greatly benefited gliomas: modern techniques dealing with 3D CT and MRI-based treatment combined with stereotactic positioning of the patients, achieve a high degree of conformity that might improve both local control and longterm neurocognitive and growth sequelae.