[Radiotherapy of childhood brain stem tumours]

STUDY OBJECTIVE: Description and evaluation of radiotherapy of inoperable brain stem tumours. Possibilities of improving therapeutic results. MATERIALS AND METHODS: Between 1987 and 2000 43 patients (23 boys and 20 girls, mean age 8.5+/-4.4 years) with brain stem tumours were treated with 6 MV and 9 MV X-ray. The doses administered ranged from 30 to 66 Gy; mean 50.41+/-7.67 Gy. Treatment in each case was performed according to CT- and /or MR-based radiotherapy plan. Since 2000 3D conformal radiotherapy plans have been prepared by using image fusion. RESULTS: All patients were followed. The mean follow-up period was 19.4 months (range: 1 to 112 months). For survival statistics the 2 to 3-year overall and symptom-free survivals were taken into account, the former ones in the function of tumour localisations. The gender of children did not affect the survival (p>0.74). No significant difference was found as to survival in the function of tumour localisation either (p>0.87). CONCLUSION: According to the literature data the results expected were not achieved by hyperfractionation and by delivering an overall focal dose of 72 to 78 Gy. Results can be improved by precise patient fixation and the routine application of 3D conformal radiotherapy plans prepared by CT- and MR-based image fusion. These together can result the correctly reproducible patient fixation, the homogenous radiation delivery in the target volume and the reduction of injury in the surrounding tissues. Irradiation should be performed also in histologically not verified tumours since a 24.6 month transitory improvement could be achieved in 60.5% of our patients.