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Modern Radiation Treatment Planning Parameters and Outcomes in Pediatric Tectal Gliomas
Qateeb Khan1, Breann Bowar1, Heba Ismael1
1Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Insights
Pediatric low-grade tectal gliomas are slow-growing brain tumors. Radiation therapy (RT) for progressing tumors shows excellent outcomes with few side effects.
Area of Science:
- Neuro-oncology
- Pediatric oncology
- Radiation oncology
Background:
- Pediatric low-grade tectal gliomas are rare, slow-growing brain stem tumors.
- Understanding their behavior and treatment outcomes is crucial for effective patient management.
Purpose of the Study:
- To review the outcomes of pediatric patients diagnosed with low-grade tectal gliomas.
- To report dosimetric parameters for patients receiving radiation therapy (RT).
Main Methods:
- Retrospective review of pediatric patients (<18 years) diagnosed with low-grade gliomas (1993-2020).
- Identified 23 patients with tectal gliomas; detailed dosimetric analysis for 8 patients receiving RT.
- Reviewed doses to critical structures and toxicities, with a minimum 2-year follow-up.
Main Results:
- All 23 patients survived the study period (median follow-up 7.4 years).
- Upfront RT (n=3) showed no local failure; 26% of observed patients (n=5) progressed and received salvage RT.
- Modern photon RT demonstrated excellent oncologic control with minimal late effects.
Conclusions:
- Pediatric low-grade tectal gliomas generally exhibit indolent behavior.
- For progressing tumors, modern radiation therapy offers effective treatment with minimal adverse effects.
Purpose:
Pediatric low-grade tectal gliomas are rare, indolent tumors of the brain stem. We reviewed outcomes of pediatric patients who received a diagnosis of low-grade tectal gliomas and report dosimetric parameters for those receiving radiation therapy (RT).
Methods And Materials:
We retrospectively reviewed all pediatric patients (age <18 years) at our institution diagnosed with a low-grade glioma between 1993 and 2020 (n = 288). Twenty-three patients with tectal gliomas were identified. Patients who received RT (n = 8) had detailed dosimetric analyses performed. Doses to critical structures and any resulting toxicities were reviewed. Minimum follow-up was 2 years and complete follow-up was available for all patients.
Results:
Twenty-three patients, with a median age of 8.9 years, were included (range, 0.5-16.2 years). At a median follow-up of 7.4 years (range, 2-24 years), all were alive at the end of the study period. Three patients (13%) were treated with upfront RT; none of these patients developed local failure (LF) after a median follow-up of 10.6 years. One patient was treated with upfront chemotherapy with no evidence of progression afterward. Nineteen patients were initially observed after diagnosis and 26% of them (n = 5) experienced local progression. All 5 were treated with salvage RT, with 1 patient requiring further treatment with chemotherapy. Fractionation schedules for patients undergoing upfront or salvage RT included 50.4 Gy in 28 fractions (n = 4), 54 Gy in 30 fractions (n = 2), and 51 Gy in 30 fractions (n = 2). For patients treated after 2007, the gross tumor volume was delineated on a T2 magnetic resonance imaging with an average gross tumor volume-to-planning target volume expansion of 4.5 mm (range, 3-5 mm). Detailed dosimetric parameters were available for all patients treated with RT.
Conclusions:
Our review supports the indolent behavior for most tectal gliomas. For the subset of tumors with evidence of progression, modern photon RT results in excellent oncologic outcomes with minimal late effects.
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