背景:中枢神经系统肿瘤是儿童期最常见的实体瘤。小儿中枢神经系统恶性肿瘤的治疗模式取决于包括肿瘤组织学在内的因素,病人的年龄,和疾病的阶段。放射治疗是许多小儿中枢神经系统恶性肿瘤的重要治疗方式。
结论:虽然辐射有助于许多患者的总体生存率,辐射还具有长期副作用的重大风险,包括神经认知能力下降,听力损失,增长减值,神经内分泌功能障碍,笔画,和继发性恶性肿瘤。近几十年来,临床试验表明,随着更好的成像和分期以及更复杂的辐射计划和治疗设置验证,可以利用较小的处理量而不会降低存活率。此外,调强放射治疗和质子束放射治疗的发展大大提高了辐射的保形性。
结论:最近放射治疗模式的变化降低了常见组织学和不同年龄组的短期和长期毒性的风险。未来的研究将继续开发新的放疗方案,以改善侵袭性中枢神经系统肿瘤的预后。整合分子亚型来定制放射治疗,并降低长期幸存者的辐射相关毒性。
BACKGROUND: Central nervous system tumors are the most common solid tumors in childhood. Treatment paradigms for pediatric central nervous system malignancies depend on elements including tumor histology, age of patient, and stage of disease. Radiotherapy is an important modality of treatment for many pediatric central nervous system malignancies.
CONCLUSIONS: While radiation contributes to excellent overall survival rates for many patients, radiation also carries significant risks of long-term side effects including neurocognitive decline, hearing loss, growth impairment, neuroendocrine dysfunction, strokes, and secondary malignancies. In recent decades, clinical trials have demonstrated that with better imaging and staging along with more sophisticated radiation planning and treatment set-up verification, smaller treatment volumes can be utilized without decrement in survival. Furthermore, the development of intensity-modulated radiotherapy and proton-beam radiotherapy has greatly improved conformality of radiation.
CONCLUSIONS: Recent changes in radiation treatment paradigms have decreased risks of short- and long-term toxicity for common histologies and in different age groups. Future studies will continue to develop novel radiation regimens to improve outcomes in aggressive central nervous system tumors, integrate molecular subtypes to tailor radiation treatment, and decrease radiation-associated toxicity for long-term survivors.