Fractionated Stereotactic Radiotherapy in Pediatric Diffuse Intrinsic Brain Stem Gliomas

Choi, Woo Jin; Yee, Gi Taek; Han, Seong Rok; Yoon, Sang Won; Lee, Dong Joon; Whang, Choong Jin

Abstract

OBJECTIVE
We treated 10 pediatric diffuse intrinsic brain stem glioma(BSG) patients with Novalis system (linac based radiotherapy unit, Germany) and examined the efficacy of the Fractionated Stereotactic Radiotherapy(FSRT).
METHODS
A retrospective review was conducted on 10 pediatric diffuse intrinsic BSG patients who were treated with FSRT between May, 2001 and August, 2004. The mean age of the patient group was 7.7 years old. Male to female ratio was 4 to 1. The mean dose of FSRT was 38.7Gy, mean fractionated dose was 2.6Gy, mean fractionation size was 16.6, and target volume was 42.78cm3. The mean follow up period was 14 months.
RESULTS
Four weeks after completion of FSRT, improvements on neurological status and Karnofsky performance scale(KPS) score were recorded in 9/10 (90%) patients and magnetic resonance imaging(MRI) showed decrease in target tumor volume in 8 pediatric patients. The median survival period was 13.5 months after FSRT and treatment toxicity was mild.
CONCLUSION
It is difficult for surgeons to choose surgical treatment for diffuse intrinsic BSG due to its dangerous anatomical structures. FSRT made it possible to control the tumor volume to improve neurological symptoms with minimal complications. We expect that FSRT is a feasible treatment modality for pediatric diffuse intrinsic BSG with tolerable toxicities.