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Modern radiation treatment planning parameters and outcomes in pediatric tectal gliomas
Journal article   Open access   Peer reviewed

Modern radiation treatment planning parameters and outcomes in pediatric tectal gliomas

Qateeb Khan, Breann Bowar, Heba Ismael, Jordan Gainey, Bryn Myers, Brian Dlouhy, Daniel Hyer, Amanda Grafft, Maryam Khan, John M. Buatti, …
Advances in radiation oncology, Vol.9(4), 101440
04/2024
DOI: 10.1016/j.adro.2024.101440
PMCID: PMC11110028
PMID: 38778828
url
https://doi.org/10.1016/j.adro.2024.101440View
Published (Version of record) Open Access

Abstract

Purpose/Objective(s) Pediatric low-grade tectal gliomas are rare, indolent tumors of the brainstem. We reviewed outcomes of pediatric patients diagnosed with low-grade tectal gliomas and report dosimetric parameters for those receiving radiotherapy (RT). Material/Methods We retrospectively reviewed all pediatric patients (age <18) at our institution diagnosed with a low-grade glioma between 1993 and 2020 (n=288). Twenty-three patients with tectal gliomas were identified. Patients who received RT (n=8) had detailed dosimetric analyses performed. Doses to critical structures and any resulting toxicities were reviewed. Minimum follow-up was 2 years and complete follow-up was available for all patients. Results Twenty-three patients, with a median age of 8.9 years, were included (range 0.5 – 16.2 years). At a median follow-up of 7.4 years (range: 2 – 24 yrs), all were alive at the end of the study period. Three patients (13%) were treated with upfront RT; none of these patients developed local failure (LF) after a median follow-up of 10.6 years. One patient was treated with upfront chemotherapy with no evidence of progression afterwards. Nineteen patients were initially observed after diagnosis and 26% of them (n=5) experienced local progression. All 5 were treated with salvage RT, with one patient requiring further treatment with chemotherapy. Fractionation schedules for patients undergoing upfront or salvage RT included 50.4 Gy in 28 fractions (n = 4), 54 Gy in 30 fractions (n=2), and 51 Gy in 30 fractions (n=2). For patients treated after 2007, the gross tumor volume (GTV) was delineated on a T2 MRI with an average GTV-to-PTV expansion of 4.5 mm (range: 3-5 mm). Detailed dosimetric parameters were available for all patients treated with RT. Conclusion Our review supports the indolent behavior for most tectal gliomas. For the subset of tumors with evidence of progression, modern photon RT results in excellent oncologic outcomes with minimal late effects.

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