Radiosurgery in the management of pediatric brain tumors

A total of 114 patients with benign and malignant intracranial tumors were treated by Valentine at the Flaminia Radiosurgical Center using a Philips 6 -MeV linear accelerator between 1987 and 1995. The tumor locations break do wn as follows: 36 in the cerebral hemispheres, 14 in the region of the hypo thalamus/optic chiasm, 21 in the III ventricle/pineal region, 3 in the basa l ganglia, 27 in the posterior fossa, 13 in the brain stem. Seventy-nine pa tients had multivariate/combined treatment consisting of surgery or biopsy followed by chemotherapy, radiotherapy and/or radiosurgery. Thirty-five wer e not operated on or biopsied but were treated primarily by radiosurgery, w hich was associated with chemotherapy and conventional radiotherapy. The sh ort- and long-term results were evaluated separately for each pathology in an attempt to derive guidelines for future treatment. For tumors of the pin eal region, we are of the opinion that radiosurgery is the treatment of cho ice in children and that more than one-third of patients can be cured by th is means. The remaining patients require surgery and/or chemotherapy in add ition. For medulloblastomas radiosurgery may be useful to control local rec urrence if coupled with chemotherapy. In the case of ependymomas, partly be cause of the extreme malignancy of the lesions in our series, radiosurgery did not succeed in controlling local recurrence. We fear that limiting trea tment to radiosurgery, rather than prescribing conventional radiotherapy wh en indicated, could permit CNS seeding. For craniopharyngiomas radiosurgery proved useful for controlling solid remnants. In glial tumors radiosurgery helped either to "sterilize" the tumor bed after removal or to treat remna nts of the lesions in critical areas; for diffuse brain stem gliomas it sho uld be considered the treatment of choice.