Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Colak O, Ozcan F, Gundem E, Elcim Y, Dirican B, Beyzadeoglu M. Concise review of stereotactic irradiation for pediatric glial neoplasms: Current concepts and future directions. World J Methodol 2021; 11(3): 61-74 [PMID: 34026579 DOI: 10.5662/wjm.v11.i3.61]
Corresponding Author of This Article
Omer Sager, MD, Associate Professor, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Gn.Tevfik Saglam Cad, Ankara 06018, Turkey. omersager@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Methodol. May 20, 2021; 11(3): 61-74 Published online May 20, 2021. doi: 10.5662/wjm.v11.i3.61
Concise review of stereotactic irradiation for pediatric glial neoplasms: Current concepts and future directions
Omer Sager, Ferrat Dincoglan, Selcuk Demiral, Bora Uysal, Hakan Gamsiz, Onurhan Colak, Fatih Ozcan, Esin Gundem, Yelda Elcim, Bahar Dirican, Murat Beyzadeoglu
Omer Sager, Ferrat Dincoglan, Selcuk Demiral, Bora Uysal, Hakan Gamsiz, Onurhan Colak, Fatih Ozcan, Esin Gundem, Yelda Elcim, Bahar Dirican, Murat Beyzadeoglu, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Ankara 06018, Turkey
Author contributions: Sager O, Dincoglan F, Demiral S, Uysal B, Gamsiz H, Colak O and Ozcan F played significant role in data acquisition, interpretation of data, reviewing and writing of the manuscript; Gundem E, Elcim Y and Dirican B worked on checking the manuscript for important intellectual content; Beyzadeoglu M took part in designing, reviewing and writing of the manuscript and checking the manuscript for important intellectual content; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors state that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Omer Sager, MD, Associate Professor, Department of Radiation Oncology, Gulhane Medical Faculty, University of Health Sciences, Gn.Tevfik Saglam Cad, Ankara 06018, Turkey. omersager@gmail.com
Received: November 17, 2020 Peer-review started: November 17, 2020 First decision: March 31, 2021 Revised: April 7, 2021 Accepted: April 14, 2021 Article in press: April 14, 2021 Published online: May 20, 2021
Abstract
Brain tumors, which are among the most common solid tumors in childhood, remain a leading cause of cancer-related mortality in pediatric population. Gliomas, which may be broadly categorized as low grade glioma and high grade glioma, account for the majority of brain tumors in children. Expectant management, surgery, radiation therapy (RT), chemotherapy, targeted therapy or combinations of these modalities may be used for management of pediatric gliomas. Several patient, tumor and treatment-related characteristics including age, lesion size, grade, location, phenotypic and genotypic features, symptomatology, predicted outcomes and toxicity profile of available therapeutic options should be considered in decision making for optimal treatment. Management of pediatric gliomas poses a formidable challenge to the physicians due to concerns about treatment induced toxicity. Adverse effects of therapy may include neurological deficits, hemiparesis, dysphagia, ataxia, spasticity, endocrine sequelae, neurocognitive and communication impairment, deterioration in quality of life, adverse socioeconomic consequences, and secondary cancers. Nevertheless, improved understanding of molecular pathology and technological advancements may pave the way for progress in management of pediatric glial neoplasms. Multidisciplinary management with close collaboration of disciplines including pediatric oncology, surgery, and radiation oncology is warranted to achieve optimal therapeutic outcomes. In the context of RT, stereotactic irradiation is a viable treatment modality for several central nervous system disorders and brain tumors. Considering the importance of minimizing adverse effects of irradiation, radiosurgery has attracted great attention for clinical applications in both adults and children. Radiosurgical applications offer great potential for improving the toxicity profile of radiation delivery by focused and precise targeting of well-defined tumors under stereotactic immobilization and image guidance. Herein, we provide a concise review of stereotactic irradiation for pediatric glial neoplasms in light of the literature.
Core Tip: Pediatric gliomas comprise the majority of brain tumors in children. Radiotherapeutic management of pediatric gliomas poses a formidable challenge considering the adverse effects of irradiation for this vulnerable patient population. In this context, efforts have been focused on improving the toxicity profile of radiation delivery. Stereotactic irradiation with stereotactic radiosurgery or stereotactic radiotherapy in a single or few treatment fractions may serve as a viable radiotherapeutic approach to achieve this goal given the high conformality along with steep dose gradients around the target volume allowing for reduced normal tissue exposure under precise immobilization and image guidance.
