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Updated: Jun 10, 2025
Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
Pediatric cranial stereotactic radiosurgery: Meta-analysis and international stereotactic radiosurgery society
Erin S Murphy1, Arjun Sahgal2, Jean Regis3
1Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA.
Insights
Stereotactic radiosurgery (SRS) shows promising local control rates for pediatric brain tumors and arteriovenous malformations (AVMs). This systematic review provides evidence to guide consensus guidelines for pediatric cranial SRS applications.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Radiation Oncology
Background:
- Limited data exists on stereotactic radiosurgery (SRS) efficacy in pediatric populations.
- Pediatric cranial SRS indications and outcomes require summarization to inform clinical practice.
Purpose of the Study:
- To systematically review and summarize indications and outcomes of cranial stereotactic radiosurgery (SRS) in pediatric patients.
- To inform the development of consensus guidelines for the International Stereotactic Radiosurgery Society (ISRS) regarding pediatric cranial SRS.
Main Methods:
- Systematic review of English-language articles (1989-2021) on cranial SRS in pediatric patients (minimum 5 patients per study).
- MEDLINE database search using radiosurgical, age-specific, and tumor-related terms.
- Meta-regressions performed for specific conditions including medulloblastoma, craniopharyngioma, ependymoma, glioma, and arteriovenous malformation (AVM).
Main Results:
- 68 of 113 articles met inclusion criteria, describing ~400 pediatric patients with brain tumors and 5119 with AVMs.
- Local control rates: 89% for benign tumors, 71% for malignant tumors, and 65% for AVMs.
- No significant associations found between local control and patient-, tumor-, or treatment-related variables.
Conclusions:
- This is the first review to consolidate SRS outcomes for pediatric brain tumors and AVMs.
- Despite limited data, SRS demonstrates acceptable local control rates in pediatric patients.
- Consensus guidelines are presented to support the judicious application of cranial SRS in pediatric cases.
Background:
There are limited data on the use of stereotactic radiosurgery (SRS) for pediatric patients. The aim of this systematic review was to summarize indications and outcomes specific to pediatric cranial SRS to inform consensus guidelines on behalf of the International Stereotactic Radiosurgery Society.
Methods:
A systematic review, using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses, analyzed English-language articles on SRS, published between 1989 and 2021, that included outcomes for at least 5 pediatric patients. MEDLINE database terms included tumor types and locations, and radiosurgical and age-specific terms. We excluded nonclinical reports, expert opinions, commentaries, and review articles. Meta-regressions for associations with local control were performed for medulloblastoma, craniopharyngioma, ependymoma, glioma, and arteriovenous malformation (AVM).
Results:
Of the 113 articles identified for review, 68 met the inclusion criteria. These articles described approximately 400 pediatric patients with benign and malignant brain tumors and 5119 with AVMs who underwent cranial SRS. The rates of local control for benign tumors, malignant tumors, and AVMs were 89% (95% CI, 82%-95%), 71% (95% CI, 59%-82%), and 65% (95% CI, 60%-69%), respectively. No significant associations were identified for local control with the patient-, tumor-, or treatment-related variables.
Conclusions:
This review is the first to summarize outcomes specific to SRS for pediatric brain tumors and AVMs. Although data reporting is limited for pediatric patients, SRS appears to provide acceptable rates of local control. We present ISRS consensus guidelines to inform the judicious use of cranial SRS for pediatric patients.
