Irradiation of Intracranial Gliomas in Children.

Attainment of local control is a cornerstone in the management of brain tumors in children. Treatment of progressive low-grade and all high-grade gliomas traditionally includes resection followed by fractionated radiotherapy (FRT) or FRT alone in neoplasms not amenable to surgical removal. While in younger children chemotherapy is typically used as a first-line non-surgical management option, FRT in such patients remains the standard of salvage therapy. Recent improvements in techniques for radiation treatment planning and delivery allow conformal and selective coverage of the target volume with a prescribed dose, sparing adjacent normal tissues to assure maximal tumor control and minimal toxicity. Implementation of novel functional and metabolic neuroimaging allows better delineation of the lesion margins and organs at risk, which also reduces the incidence of adverse effects. Further improvements of outcome after radiation treatment of pediatric gliomas may be expected with wider application of intensity-modulated radiation therapy (IMRT), proton therapy, and stereotactic techniques, including brachytherapy.