title: Robotically guided radiosurgery for children.
abstract: BACKGROUND
  A robotically guided linear accelerator has recently been developed which provides frameless radiosurgery with high precision. Potential advantages for the pediatric population include the avoidance of the cognitive decline associated with whole brain radiotherapy, the ability to treat young children with thin skulls unsuitable for frame-based methods, and the possible avoidance of general anesthesia. We report our experience with this system (the "Cyberknife") in the treatment of 21 children.
  
  
  METHODS
  Cyberknife radiosurgery was performed on 38 occasions for 21 patients, age ranging from 8 months to 16 years (7.0 +/- 5.1 years), with tumors considered unresectable. Three had pilocytic astrocytomas, two had anaplastic astrocytomas, three had ependymomas (two anaplastic), four had medulloblastomas, three had atypical teratoid/rhabdoid tumors, three had craniopharyngiomas, and three had other pathologies. The mean target volume was 10.7 +/- 20 cm(3), mean marginal dose was 18.8 +/- 8.1 Gy, and mean follow-up is 18 +/- 11 months. Twenty-seven (71%) of the treatments were single-shot and eight (38%) patients did not require general anesthesia.
  
  
  RESULTS
  Local control was achieved in the patients with pilocytic and anaplastic astrocytoma, three of the patients with medulloblastoma, and the three with craniopharyngioma, but not for those with ependymoma. Two of the patients with rhabdoid tumors are alive 16 and 35 months after this diagnosis. There have been no procedure related deaths or complications.
  
  
  CONCLUSIONS
  Cyberknife radiosurgery can be used to achieve local control for some children with CNS tumors without the need for rigid head fixation.
authors.affiliation: Baylor University Medical Center, HTPN, 8080 N. Central Expressway, Ste. 1650, Dallas, TX 75206, USA. ColeG@BaylorHealth.edu
authors.forename: Cole A
authors.initials: CA
authors.lastname: Giller
authors.forename: Brian D
authors.initials: BD
authors.lastname: Berger
authors.forename: David A
authors.initials: DA
authors.lastname: Pistenmaa
authors.forename: Frederick
authors.initials: F
authors.lastname: Sklar
authors.forename: Bradley
authors.initials: B
authors.lastname: Weprin
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shapiro
authors.forename: Naomi
authors.initials: N
authors.lastname: Winick
authors.forename: Arlynn F
authors.initials: AF
authors.lastname: Mulne
authors.forename: Janice L
authors.initials: JL
authors.lastname: Delp
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Gilio
authors.forename: Kenneth P
authors.initials: KP
authors.lastname: Gall
authors.forename: Karel A
authors.initials: KA
authors.lastname: Dicke
authors.forename: Dale
authors.initials: D
authors.lastname: Swift
authors.forename: David
authors.initials: D
authors.lastname: Sacco
authors.forename: Kesha
authors.initials: K
authors.lastname: Harris-Henderson
authors.forename: Daniel
authors.initials: D
authors.lastname: Bowers
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods; D011879:Radiotherapy Dosage; D012371:Robotics; D016896:Treatment Outcome