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Pediatric Radiotherapy: Surgical Considerations, Sequelae, and Future Directions

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Textbook of Pediatric Neurosurgery

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Abstract

Radiation therapy is a critical component in the treatment of children with central nervous system tumors. As the use of this modality continues to increase in complexity and sophistication, it is imperative for the neurosurgeon to understand the additional challenges that the use of radiotherapy may pose in both surgical and nonsurgical management. Operating after radiation to the surgical site may increase infection rate, decrease probability of wound healing, increase rate of intraoperative complications, distort typical anatomy, and alter operative approach. Radiation therapy can also result in many long-term sequelae, including radiation necrosis, vasculopathy, neurocognitive deficits, and secondary malignancies, many of which may require additional workup and surgical intervention. Such risks must be understood by all members of the team when developing management strategies in these patients, and a multidisciplinary approach is vital. This chapter discusses these topics and also reviews future directions for radiation therapy, including technologic advances, image guidance, and large-scale informatics efforts. Also promising is the role of next-generation sequencing in better understanding nuances in tumor biology and thus radiation sensitivity. Advanced sequencing efforts may also help predict susceptibility to sequelae of radiotherapy in individual patients.

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Authors and Affiliations

  1. University of Tennessee Health Science Center, Memphis, TN, USA

    Ryan P. Lee

  2. Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    John T. Lucas Jr, Christopher L. Tinkle & Thomas E. Merchant

  3. Department of Neurosurgery, Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN, USA

    Frederick A. Boop

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  1. Ryan P. Lee
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  2. John T. Lucas Jr
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  3. Christopher L. Tinkle
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  4. Thomas E. Merchant
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  5. Frederick A. Boop
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Correspondence to Thomas E. Merchant .

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Editors and Affiliations

  1. Pediatric Neurosurgery, International Neuroscience Institute, Hannover, Germany

    Concezio Di Rocco

  2. Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Trust, London, UK

    Dachling Pang

  3. Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON, Canada

    James T. Rutka

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  1. Director of Pediatric Neurosurgery, International Neuroscience Institute, Hannover, Germany

    Concezio Di Rocco

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Lee, R.P., Lucas, J.T., Tinkle, C.L., Merchant, T.E., Boop, F.A. (2020). Pediatric Radiotherapy: Surgical Considerations, Sequelae, and Future Directions. In: Di Rocco, C., Pang, D., Rutka, J. (eds) Textbook of Pediatric Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-72168-2_152

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