Radiosurgery in the management of pediatric brain tumors

Objective: To describe the outcome of pediatric brain tumor patients follow ing stereotactic radiosurgery (SRS), and factors associated with progressio n-free survival. Methods: We reviewed the outcome of 90 children treated with SRS for recurr ent (n = 62) or residual (n = 28) brain tumors over a 10 year period. Media n follow-up from SRS was 24 months for all patients and 55.5 months for the 34 patients currently alive. Results: The median progression-free survival (PFS) for all patients was 13 months. Median PFS according to tumor histology was medulloblastoma = 11 m onths, ependymoma 8.5 months, glioblastoma and anaplastic astrocytoma = 12 months. Median PFS in patients treated to a single lesion was 15.4 months. No patient undergoing SRS to more than 1 lesion survived disease free beyon d 2 years. After adjusting for histology and other clinical factors, SRS fo r tumor recurrence (RR = 2.49) and the presence of > 1 lesion (RR = 2.3) we re associated with a significantly increased rate of progression (p < 0.05) . Three-year actuarial local control (LC) was as follows: medulloblastoma = 57%, ependymoma = 29%, anaplastic astrocytoma/glioblastoma = 60%, other hi stologies = 56%. Nineteen patients with radionecrosis and progressive neuro logic symptoms underwent reoperation after an interval of 0.6-62 months fol lowing SRS. Pathology revealed necrosis with no evidence of tumor in 9 of t hese cases. Conclusion: SRS can be given safely to selected children with brain tumors. SRS appears to reduce the proportion of first failures occurring locally a nd is associated with better outcome when given as a part of initial manage ment. Some patients with unresectable relapsed disease can be salvaged with SRS. SRS to multiple lesions does not appear to be curative. Serious neuro logic symptoms requiring reoperation is infrequently caused by radionecrosi s alone. (C) 2001 Elsevier Science Inc.