The Clinical Results of Pediatric Brain Tumors Treated with Linac-Based Stereotactic Radiosurgery and Radiotherapy
Putipun Puataweepong MD*, Mantana Dhanachai MD*, Somjai Dangprasert MD*, Ladawan Narkwong MD*, Chomporn Sitathanee MD*, Taweesuk Junwityanujit MD**
Affiliation : * Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok Thailand ** Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok Thailand
Objective : Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for brain tumor is increasingly
acceptable worldwide. In Thailand, the first Linac-based stereotactic radiation machine was implemented at the Radiosurgery
Center, Ramathibodi Hospital since 1997. This is the first study in Thailand to report the results of pediatric brain tumor
patients treated with SRS and FSRT.
Material and Method: The clinical outcome of 39 pediatric patients treated with SRS/FSRT between 1998 and 2010 was
retrospectively reviewed.
Results : The median follow-up time was 26 months (range, 1 to 154 months). The local progression free survival (LPFS)
at one and five years after SRS/FSRT for all patients was 87.5% and 54.2%, respectively. The 5-year LPFS by tumor histology
was as follow, pituitary adenoma 100%, meningioma 100%, ependymoma, and low-grade astrocytoma 75%, and
craniopharyngioma 68.6%. High-grade tumor had the worst LPFS and the median LPFS of this group was only 12 months.
On univariate analysis, low-grade tumor (pituitary adenoma and menigioma) and small tumor volume (< 10 ml) were the
factors that correlated significantly with good local control. After multivariate analysis, small tumor volume was the only
factor associated with good LPFS (HR = 2.35, p = 0.042). No other radiation complication except panhypopituitarism was
reported.
Conclusion : SRS/FSRT in pediatric brain tumor is technically feasible, with minimal acute side effects. SRS/FSRT plays
an important role for the small low-grade tumor.
Keywords : Stereotactic radiation, SRS, FSRT, Pediatrics, Brain tumors
