title: The feasibility of frameless stereotactic radiosurgery in the management of pediatric central nervous system tumors.
abstract: Recurrent malignant primary and metastatic central nervous system (CNS) tumors in pediatric patients are devastating, and efforts to improve outcomes for these patients have been disappointing. Conventional re-irradiation in these patients increases the risk of significant toxicity. We therefore evaluated feasibility and outcomes using frameless radiosurgery (FRS) in children with recurrent primary and metastatic brain tumors. We reviewed five cases of recurrent primary and metastatic brain tumors treated with frameless radiosurgery between 2008 and 2013. We analyzed safety and feasibility, dosimetric data, local control, and adverse effects. Five patients were treated with frameless radiosurgery for palliation. Fifteen target volumes were treated using our institutional FRS system. The volumes of targets ranged from 0.08 to 51.67 cm(3) with doses ranging from 15 to 21 Gy. Radiosurgery was well tolerated, decreased the need for large-volume CNS irradiation, and allowed for effective palliation in this small cohort. Frameless radiosurgery is feasible in this patient population. Frameless radiosurgery should be considered in management of select patients with recurrent primary or metastatic brain tumors.
authors.affiliation: Departments of Radiation Oncology, Winship Cancer Institute at Emory University, 1365 Clifton Road, Atlanta, GA, 30322, USA.
authors.forename: Ronica
authors.initials: R
authors.lastname: Nanda
authors.forename: Anees
authors.initials: A
authors.lastname: Dhabbaan
authors.forename: Anna
authors.initials: A
authors.lastname: Janss
authors.forename: Hui-Kuo
authors.initials: HK
authors.lastname: Shu
authors.forename: Natia
authors.initials: N
authors.lastname: Esiashvili
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010166:Palliative Care; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods*; D011879:Radiotherapy Dosage