Pediatric brain stem tumors: patterns of treatment failure and their implications for radiotherapy

摘要: There have been conflicting opinions regarding the correct volume to be used in radiotherapy fields for brain stem tumors of childhood. Whereas many clinicians recommend limited designed cover tumor with a margin, some advocated whole radiotherapy. Using our clinical experience at Duke University Medical Center, we made an attempt determine proper irradiation this group tumors. We evaluated 38 patients children less than 18 years age. The most common presenting symptoms were headache, ataxia, and hemiparesis. Thirteen had histologic diagnosis prior treatment or post-mortem. All either anaplastic astrocytoma glioblastoma multiforme. Tumors located thalamus, hypothalamus, midbrain 9 pons medulla oblongata remaining 29 patients. received course mean minimum dose was 52.6 +/- 5 Gy given 1.7 2.0 Gy/fraction. Twenty-three radiation field 14 irradiation. In one patient, size could not ascertained. five year survival total 39%. thalamic, hypothalamic, 73% compared 28% those (p = 0.0159). Eighty-eight percent recurrences evaluable (22/25) occurred within fields. Patients stratified location no difference observed relapse-free among individuals treated When results are examined conjunction previously published data, bulk existing evidence supports use