STEREOTAXIC RADIOSURGERY IN PEDIATRIC-PATIENTS

Although stereotactic radiosurgery has been studied extensively in adu lts, the data demonstrating its efficacy in children is limited. Medic al records were reviewed to identify the indications for and outcomes of patients treated with this modality. Linear accelerator-based radio surgery was used to treat 11 recurrent brain tumors and one posterior fossa arteriovenous malformation over 3 years. The mean and median age of those treated was 10 and 8 years, respectively (range 1-20 years), Patients received 700 to 3,000 cGy delivered to the 50-90% isodose li ne in a single fraction. The mean and median follow-up was 15 and 17 m onths, respectively. Three of the four children with malignant disease died 6 to 9 months after treatment. One patient died of recurrence ou tside the treatment field. Another child died of complications related to radiation injury, and the third died of disease progression. All c hildren with low-grade tumors remain alive without complications. Six of eight (75%) children exhibit substantial radiographic reductions in tumor size. The child with a vascular malformation has been followed for 26 months, without hemorrhage and with a radiographically proved d ecrease in size. Our series suggests that radiosurgery has limited use fulness in malignant disease. Therapeutic response is influenced by le sion size and/or location. Stereotactic radiosurgery appears to be eff ective in children,vith low-grade intracranial tumors or arteriovenous malformations. Further experience is required to establish the role a nd long term side effects of radiosurgery in pediatric patients. (C) 1 996 by Elsevier Science Inc. All rights reserved.