Pediatric brain cancers

Primary brain tumors are the most common solid tumor malignancy in children. The majority of pediatric brain tumors are treated with maximal safe surgical resection. Adjuvant treatments include conventionally fractionated radiation therapy and systemic therapies. Radiation therapy is an effective treatment modality for many pediatric primary brain tumors but can cause significant neurologic, neuroendocrine, and neurocognitive sequelae. Stereotactic radiosurgery (SRS) is an attractive option in pediatric patients as it allows for the delivery of ablative, high-dose radiation with steep dose gradients allowing for greater sparing of the developing brain. SRS has been used in the definitive, adjuvant, and salvage settings to treat primary pediatric brain tumors. This chapter will examine the use of SRS in the treatment of pediatric low-grade glioma, medulloblastoma, ependymoma, and craniopharyngioma with a focus on technique, oncologic outcomes, and toxicity.