title: High precision conformal radiotherapy employing conservative margins in childhood benign and low-grade brain tumours.
abstract: OBJECTIVE
  To report local control and follow up outcome data of high precision conformal radiotherapy in childhood brain tumours.
  
  
  METHODS
  Between December 1999 and December 2002, 26 children (17 boys and 9 girls, median age 11.5 years) with incompletely excised or recurrent benign and low-grade brain tumours [13 craniopharyngiomas, 11 low-grade gliomas (LGG) and 2 others] were treated with three-dimensional (3D) conformal radiotherapy (CRT) (12 patients) and stereotactic conformal radiotherapy (SCRT) (14 patients). Gross tumour volume (GTV) included neuro-imaging based visible tumour and/or resected tumour bed. Clinical target volume (CTV) consisted of GTV+ 5 mm margin and planning target volume (PTV) consisted of additional 5 mm margin for CRT and 2 mm for SCRT. Treatment was delivered with 3-9 conformal fixed fields to a median dose of 54 Gy/30 fractions.
  
  
  RESULTS
  The actuarial 2 and 3 year disease free and overall survival was 96 and 100%, respectively (median follow up: 25 months, range 12-47 months). Radiological follow up available in 25 patients revealed complete response in 1, partial regression in 10, stable disease in 13 and progression in 1 patient (within the CTV). One patient with craniopharyngioma on a routine imaging revealed a mild asymptomatic cyst enlargement, which resolved with conservative management. A patient with chiasmatic glioma developed cystic degeneration and hydrocephalus 9 months after SCRT requiring cyst drainage and placement of a ventriculoperitoneal shunt.
  
  
  CONCLUSIONS
  High-precision conformal techniques delivering irradiation to a computer generated target volume employing 7-10 mm 3D margins beyond the visible tumour and/or resected tumour bed appear to be safe in children with incompletely resected or recurrent benign and low-grade brain tumours, based on these data.
authors.affiliation: Department of Radiation Oncology, 113 Tata Memorial Hospital, Parel, Mumbai, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Jalali
authors.forename: Ashwini
authors.initials: A
authors.lastname: Budrukkar
authors.forename: Rajiv
authors.initials: R
authors.lastname: Sarin
authors.forename: Dayananda S
authors.initials: DS
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D001927:Brain Diseases / Q000209:etiology; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003397:Craniopharyngioma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D003560:Cysts / Q000209:etiology; D019583:Dose Fractionation, Radiation; D005260:Female; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D011832:Radiation Injuries; D020266:Radiotherapy, Conformal; D016019:Survival Analysis; D016896:Treatment Outcome