Current and Future Strategies in Radiotherapy of
Childhood Low-Grade Glioma of the Brain

Kortmann, Rolf Dieter; Timmermann, Beate; Taylor, Roger; Scarzello, Giovanni; Plaßwilm, Ludwig; Paulsen, Frank; Jeremić, Branislav; Gnekow, Astrid; Dieckmann, Karin; Kay, Sylvia; Bamberg, M.

doi:10.1007/s00066-003-9104-9

Cited by 111 publications

(66 citation statements)

References 74 publications

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“…Some 50% of long-term survivors develop latedelayed cognitive deficits due to radiation-induced injury of normal brain tissue (1,2). Age is an important risk factor for the development and severity of cognitive dysfunction following WBI, with pediatric and elderly patients appearing to be more vulnerable to WBI-induced brain injury than young adults (3)(4)(5)(6). There is a paucity of experimental data regarding the effects of old age on the radiation response in the brain despite evidence that the average age for developing the cancers that require treatment with WBI is > 50 years old, making middle-aged and older adults a commonly treated patient population (7).…”

Section: Introductionmentioning

confidence: 99%

Aging-Dependent Changes in the Radiation Response of the Adult Rat Brain

Schindler¹,

Forbes²,

Robbins³

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To assess the impact of aging on the radiation response in the adult rat brain.Methods and Materials-Male rats 8, 18, or 28 months of age received a single 10Gy dose of whole brain irradiation (WBI). The hippocampal dentate gyrus (DG) was analyzed one and ten weeks later for sensitive neurobiological markers associated with radiation-induced damage: changes in the density of proliferating cells, immature neurons, total microglia, and activated microglia.Results-A significant reduction in basal levels of proliferating cells and immature neurons and increased microglial activation occurred with normal aging. WBI induced a transient increase in proliferation that was greater in older animals. This proliferation response did not increase the number of immature neurons, which decreased following WBI in young rats but not in old rats. Total microglial number decreased following WBI at all ages but microglial activation increased markedly, particularly in older animals.Conclusions-Age is an important factor to consider when investigating the radiation response of the brain. In contrast to young adults, older rats show no sustained decrease in the number of immature neurons following WBI but have a greater inflammatory response. The latter may play an enhanced role in the development of radiation-induced cognitive dysfunction in older individuals.

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Section: Introductionmentioning

confidence: 99%

Aging-Dependent Changes in the Radiation Response of the Adult Rat Brain

Schindler¹,

Forbes²,

Robbins³

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…For this reason the risk of post-radiation damage to the brain tissue should be significantly lower than with standard fractionated EBRT. [10][11][12]14,16,23,27 The recommended radiation dose for fractionated EBRT is in the range of 40-54 Gy (depending on the age of the patient). Clinical trials have not confirmed the benefit of radiation dose escalation above this range.…”

Section: 20mentioning

confidence: 99%

“…Other treatment modalities include fractionated external beam radiation therapy (EBRT), chemotherapy, stereotactic radiotherapy (using an optimal fractionation scheme), and radiosurgery (a single radiation fraction). 5,6,9,11,12,14,16,17,19,20,23,27 Radiation therapy is not recommended for very young children (under the age of 3 years) because it is associated with a high risk of serious postradiation damage. 25,29 Depending on the patients' age and future prospects and treatment methods, 3 groups of patients could be defined: 1) patients with completely resected tumors, 2) patients with subtotally resected tumors, and 3) patients who have undergone biopsy but not resection (i.e., those with unresectable tumors).…”

mentioning

confidence: 99%

“…Subtotal neurosurgical resections are often combined with postoperative fractionated radiotherapy, and over the past 3 decades stereotactic radiation methods have become increasingly used for the treatment of residual tumors. [9][10][11][12][13][14][15][16][17]28 Pilocytic astrocytomas tend to proliferate very slowly, and the evaluation of treatment results requires prolonged follow-up (at least 10 years) after total resection. 3,8,13,18,25,29 Malignant transformation of pilocytic astrocytomas and meningeal infiltration has only rarely been described.…”

mentioning

confidence: 99%

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Leksell Gamma Knife treatment for pilocytic astrocytomas: long-term results

Šimonová¹,

Kozubíková

Novotný

2016

PED

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OBJECTIVE The purpose of this study was to evaluate long-term treatment results, radiation-related toxicity, and prognostic factors for the progression-free survival (PFS) of patients with pilocytic astrocytomas treated by means of stereotactic radiosurgery with a Leksell Gamma Knife. METHODS A total of 25 patients with pilocytic astrocytomas underwent Gamma Knife surgery during the period 1992–2002. The median target volume was 2700 mm3 (range 205–25,000 mm3). The 18 patients treated with 5 daily fractions received a median minimum target dose of 25 Gy. Doses for the 2 patients treated with 10 fractions over 5 days (2 fractions delivered on the same day at least 6 hours apart) were 23 and 28 Gy. For the 5 patients treated with a single fraction, the minimum target dose ranged from 13 to 20 Gy (median 16 Gy). RESULTS Complete regression occurred in 10 patients (40%) and partial regression in 10 patients (40%). The 10-year overall survival rate was 96% and the 10-year PFS rate was 80%. Target volume appeared to be a significant prognostic factor for PFS (p = 0.037). Temporary Grade 3 toxicity appeared in 2 patients (8%), and these patients were treated with corticosteroids for 2 months. Permanent Grade 4 toxicity appeared in 2 patients (8%) and was associated with neurocognitive dysfunction. In these 2 individuals, the neurocognitive dysfunction was also felt to be in part the result of the additional therapeutic interventions (4 in one case and 6 in the other) required to achieve durable control of their tumors. CONCLUSIONS Radiosurgery represents an alternative treatment modality for small residual or recurrent volumes of pilocytic astrocytomas and provides long-term local control. Target volume appears to be the most important factor affecting PFS.

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“…41 Newer modalities of delivering radiotherapy, such as stereotactic radiotherapy and the Gamma Knife, may lessen side effects and preserve effectiveness. 42,43 Three of our patients continued to show tumour progression after their first course of chemotherapy, and received a second, non-protocol course of chemotherapy that was individualized to each patient.…”

Section: Treatmentmentioning

confidence: 99%

Optic glioma warranting treatment in children

Kaufman

Doroftei

2006

Eye

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Purpose To describe cases of optic pathway glioma (OPG) warranting treatment in children. Methods This is a retrospective review of pediatric patients treated for OPG. The clinical data and imaging studies were obtained from the medical records and radiology files of patients seen at the Pediatric NeuroOphthalmology Clinic at the University of Illinois, Chicago and the private office of the author (LMK). Results A total of seven cases with an age range of 3-48 months at presentation were reviewed. Three of the patients were also ultimately diagnosed with neurofibromatosis type 1. Presenting symptoms included proptosis, decreased vision, gaze deficit, and nystagmus. Four patients underwent biopsies that confirmed OPG. Six of the patients were treated with intravenous chemotherapy, with three patients requiring a second chemotherapy cycle. One patient was successfully treated with an en-bloc optic nerve excision. Two patients underwent unilateral enucleation owing to globe complications. Conclusion Although benign tumours, OPG can behave very aggressively in young children. Both chemotherapy and en-bloc excision can be employed for treatment.

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Current and Future Strategies in Radiotherapy of Childhood Low-Grade Glioma of the Brain

Cited by 111 publications

References 74 publications

Aging-Dependent Changes in the Radiation Response of the Adult Rat Brain

Aging-Dependent Changes in the Radiation Response of the Adult Rat Brain

Leksell Gamma Knife treatment for pilocytic astrocytomas: long-term results

Optic glioma warranting treatment in children

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