Pediatric Brain Tumors: Radiation Therapy for the Treatment of Brain Tumors in Children

Pediatric brain tumors (TCP) are the second most common cancer in childhood. Radiation therapy uses x-rays and small particles that destroy cancer cells. Radiation therapy is an aggressive way of treating PCTs and should be avoided in younger children.
Pediatric brain tumors (TCP) are the second most common cancer in childhood.


The typical signs of brain tumors in children are:

  • Headaches that may be worse in the morning and improve during the day.
  • Nausea or vomiting in the morning.
  • Problems with motor skills, such as clumsiness or poor calligraphy.
  • Fatigue.
  • Tilt the head to one side.
  • Difficulty walking and balance problems.

In general, pediatric brain tumors are treated with surgery, chemotherapy for brain tumors in children or radiation therapy, or through a combination of all three.

One of the most extreme ways to treat brain tumors in children is through the use of radiation therapy, which uses high-energy x-rays and small particles that penetrate the skull and destroy cancer cells.
In general, there is a specific type of oncologist, known as a radiation oncologist, who performs this therapy. Radiation is given on several occasions, which is left to the discretion of the physician. For pediatric brain tumors, it can be used in three scenarios:

  • First, it can be used to destroy the remaining cells that exist after resection or removal of the tumor.
  • Secondly, surgery is usually not the ideal choice if the tumor is located in a part of the brain that is too sensitive to be touched and therefore radiotherapy can be administered.
  • Finally, it can be used to help prevent the symptoms that would result from a tumor.
  • Radiation therapy may have aggressive long-term side effects, particularly in the developing brain of young children. Radiation can lead to long-term neurocognitive deficits, even in older children. While the doctor will try to administer enough radiation to affect the tumor and not the rest of the brain, it can be difficult and there is often overflow in the normal areas of the brain.

Therefore, patients who are younger than three years usually are not given radiation, but are treated with surgery and if that is insufficient, chemo.
Prior to the initiation of any radiotherapy treatment regimen, the radiation equipment gathers to measure the appropriate angles that are required for the beam's perfect target as well as the correct dose. Often, children can be installed for a body mold in order to keep them still during the procedure so that there are no accidents at the angle of the radiation beam. Usually, radiation therapy sessions only last 15-30 minutes, but much of that time can be spent adjusting the children in position and the actual radiation takes much less time. The radiation is carried out when the child is on a table with a machine directed at the head. Radiation therapy is given on a weekly schedule, usually from Monday to Friday.

Radiation therapy is not a painful procedure, however, some young children may need to be sedated so they do not make any movement during radiation.

There are some different types of radiation therapy with their own advantages and disadvantages. It is at the discretion of the oncologist for whom radiation is appropriate.

One of the most common types of radiation therapy is 3D-CRT or three-dimensional conformal radiotherapy. This technique uses imaging tests such as magnetic resonance imaging to determine the correct location of the tumor. Upon recognition of the location, many X-ray beams are directed at the tumor from several directions, with each beam being relatively weak. This technique has the advantage of causing less damage to normal tissue, but since the individual beams converge on the tumor, they are able to provide intense radiation in place.

Another type of radiation therapy is intensity modulated radiation therapy, which is a more innovative form of the previously mentioned 3D-CRT. While the basic technique remains the same with several weak beams converging on the tumor, its individual intensities can be adjusted so that there is less radiation affecting the more sensitive brain tissue. This technique has become increasingly popular and is now used in most hospitals.

Another method of radiotherapy is called conformal proton beam radiation therapy. This technique is similar to 3D-CRT, however, instead of using X-rays, this technique uses proton beams in the tumor. The advantage of this therapy, unlike 3D-CRT, is that the X-rays release energy before and after hitting their target, which causes normal brain tissue damage along the way. However, protons only release their energy after having traveled a specified distance and therefore cause little damage to normal tissue. This allows oncologists to send more radiation directly to the tumor with less damage along the way.

However, while theoretically more advantageous, many tumors have no distinct borders and can be mixed with normal tissue, making it difficult to estimate the correct distance to administer proton therapy. Therefore, it is useful for tumors such as chordomas, but not for tumors such as glioblastomas.

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Stereotactic radiotherapy is a technique that uses a large dose of radiation and delivery to the tumor in few sessions of radiotherapy. This is used only in some specific scenarios, such as if a child is too weak to undergo surgery.

Another method is brachytherapy, which is different from others, because it puts the source of radiation directly into or near the tumor, and therefore the radiation only goes a small distance. This is often used together with a low dose of external radiation.

Finally, there is brain and spinal cord radiotherapy, which is performed if MRIs show that the tumor has spread to the spinal cord sheath, and therefore the radiation has to be extended enough to cover those Areas.

Radiation therapy is an aggressive way of treating patients with pediatric brain tumors, but it is sometimes an unavoidable method. There has been innovation in recent years in this area and radiation has become less harmful to surrounding tissues, but unfortunately, it remains dangerous to the developing brain and should be avoided in children under three years of age.
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