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Endocrine Sequelae of Central Nervous System Irradiation

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Radiation Oncology for Pediatric CNS Tumors

Abstract

Children with central nervous system (CNS) tumors who are treated with irradiation are uniquely at risk for the development of endocrinopathies due to acquired anterior pituitary and thyroid dysfunction, which can in turn negatively affect linear growth, pubertal development, metabolism, skeletal health, and quality of life. The risk for anterior pituitary dysfunction increases with the dose of radiation delivered to the hypothalamic-pituitary axis (HPA) and with the duration of follow-up. Concomitant spinal irradiation also increases the risk of primary hypothyroidism and thyroid neoplasia. Endocrine sequelae may take years to manifest, and their clinical symptoms may be indolent and nonspecific. Early recognition and treatment should lead to better long-term health outcomes and improvements in the quality of life of childhood brain tumor survivors. The radiation oncologist can help reduce the impact of long-term endocrine sequelae by understanding the HPA and thyroid dose tolerance and facilitating the early referral and timely diagnosis of at-risk patients.

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References

  • Armstrong GT, Chow EJ, Sklar CA (2009a) Alterations in pubertal timing following therapy for childhood malignancies. Endocr Dev 15:25–39. doi:10.1159/000207616

    Article  PubMed  Google Scholar 

  • Armstrong GT, Whitton JA, Gajjar A, Kun LE, Chow EJ, Stovall M, Leisenring W, Robison LL, Sklar CA (2009b) Abnormal timing of menarche in survivors of central nervous system tumors: a report from the Childhood Cancer Survivor Study. Cancer 115(11):2562–2570. doi:10.1002/cncr.24294

    Article  PubMed  PubMed Central  Google Scholar 

  • Beckers D, Thomas M, Jamart J, Francois I, Maes M, Lebrethon MC, De Waele K, Tenoutasse S, De Schepper J (2010) Adult final height after GH therapy for irradiation-induced GH deficiency in childhood survivors of brain tumors: the Belgian experience. Eur J Endocrinol 162(3):483–490. doi:10.1530/EJE-09-0690

    Article  CAS  PubMed  Google Scholar 

  • Brauner R, Czernichow P, Rappaport R (1984) Precocious puberty after hypothalamic and pituitary irradiation in young children. N Engl J Med 311(14):920

    CAS  PubMed  Google Scholar 

  • Brauner R, Czernichow P, Rappaport R (1986) Greater susceptibility to hypothalamopituitary irradiation in younger children with acute lymphoblastic leukemia. J Pediatr 108(2):332

    Article  CAS  PubMed  Google Scholar 

  • Brignardello E, Felicetti F, Castiglione A, Chiabotto P, Corrias A, Fagioli F, Ciccone G, Boccuzzi G (2013) Endocrine health conditions in adult survivors of childhood cancer: the need for specialized adult-focused follow-up clinics. Eur J Endocrinol 168(3):465–472. doi:10.1530/EJE-12-1043

    Article  CAS  PubMed  Google Scholar 

  • Chemaitilly W, Sklar CA (2010) Endocrine complications in long-term survivors of childhood cancers. Endocr Relat Cancer 17(3):R141–R159. doi:10.1677/ERC-10-0002

    Article  CAS  PubMed  Google Scholar 

  • Chemaitilly W, Li Z, Huang S, Ness KK, Clark KL, Green DM, Barnes N, Armstrong GT, Krasin MJ, Srivastava DK, Pui CH, Merchant TE, Kun LE, Gajjar A, Hudson MM, Robison LL, Sklar CA (2015a) Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy: a report from the St Jude Lifetime Cohort study. J Clin Oncol 33(5):492–500. doi:10.1200/JCO.2014.56.7933

    Article  PubMed  PubMed Central  Google Scholar 

  • Chemaitilly W, Merchant TE, Li Z, Barnes N, Armstrong GT, Ness KK, Pui CH, Kun LE, Robison LL, Hudson MM, Sklar CA, Gajjar A (2015b) Central precocious puberty following the diagnosis and treatment of paediatric cancer and central nervous system tumours: presentation and long-term outcomes. Clin Endocrinol 84(3):361–371. doi:10.1111/cen.12964

    Article  Google Scholar 

  • Chen M, Eugster EA (2015) Central precocious puberty: update on diagnosis and treatment. Paediatr Drugs 17(4):273–281. doi:10.1007/s40272-015-0130-8

    Article  PubMed  Google Scholar 

  • Chieng PU, Huang TS, Chang CC, Chong PN, Tien RD, Su CT (1991) Reduced hypothalamic blood flow after radiation treatment of nasopharyngeal cancer: SPECT studies in 34 patients. AJNR Am J Neuroradiol 12(4):661–665

    CAS  PubMed  Google Scholar 

  • Children’s Oncology Group (2013) Long-term follow-up guidelines for survivors of childhood, adolescent and young adult cancers, Version 4.0. Children’s Oncology Group. http://www.survivorshipguidelines.org

  • Chow EJ, Friedman DL, Yasui Y, Whitton JA, Stovall M, Robison LL, Sklar CA (2008) Timing of menarche among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer 50(4):854–858. doi:10.1002/pbc.21316

    Article  PubMed  Google Scholar 

  • Chrousos GP, Kino T, Charmandari E (2009) Evaluation of the hypothalamic-pituitary-adrenal axis function in childhood and adolescence. Neuroimmunomodulation 16(5):272–283. doi:10.1159/000216185

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ciaccio M, Gil S, Guercio G, Vaiani E, Alderete D, Palladino M, Warman DM, Rivarola MA, Belgorosky A (2010) Effectiveness of rhGH treatment on adult height in GH-deficient childhood survivors of medulloblastoma. Horm Res Paediatr 73(4):281–286. doi:10.1159/000284393

    Article  CAS  PubMed  Google Scholar 

  • Clayton PE, Shalet SM (1991) The evolution of spinal growth after irradiation. Clin Oncol 3(4):220–222

    Article  CAS  Google Scholar 

  • Constine LS, Woolf PD, Cann D, Mick G, McCormick K, Raubertas RF, Rubin P (1993) Hypothalamic-pituitary dysfunction after radiation for brain tumors. N Engl J Med 328(2):87–94. doi:10.1056/NEJM199301143280203

    Article  CAS  PubMed  Google Scholar 

  • Darzy KH (2009) Radiation-induced hypopituitarism after cancer therapy: who, how and when to test. Nat Clin Pract Endocrinol Metab 5(2):88–99. doi:10.1038/ncpendmet1051

    Article  CAS  PubMed  Google Scholar 

  • Diller L, Chow EJ, Gurney JG, Hudson MM, Kadin-Lottick NS, Kawashima TI, Leisenring WM, Meacham LR, Mertens AC, Mulrooney DA, Oeffinger KC, Packer RJ, Robison LL, Sklar CA (2009) Chronic disease in the Childhood Cancer Survivor Study cohort: a review of published findings. J Clin Oncol 27(14):2339–2355. doi:10.1200/JCO.2008.21.1953

    Article  PubMed  PubMed Central  Google Scholar 

  • Edgar AB, Morris EM, Kelnar CJ, Wallace WH (2009) Long-term follow-up of survivors of childhood cancer. Endocr Dev 15:159–180. doi:10.1159/000207614

    Article  PubMed  Google Scholar 

  • Gan HW, Spoudeas HA (2014) Long-term follow-up of survivors of childhood cancer (SIGN Clinical Guideline 132). Arch Dis Child Educ Pract Ed 99(4):138–143. doi:10.1136/archdischild-2013-305452

    Article  PubMed  PubMed Central  Google Scholar 

  • Gan HW, Phipps K, Aquilina K, Gaze MN, Hayward R, Spoudeas HA (2015) Neuroendocrine morbidity after pediatric optic gliomas: a longitudinal analysis of 166 children over 30 years. J Clin Endocrinol Metab 100(10):3787–3799. doi:10.1210/jc.2015-2028

    Article  CAS  PubMed  Google Scholar 

  • Gleeson HK, Shalet SM (2004) The impact of cancer therapy on the endocrine system in survivors of childhood brain tumours. Endocr Relat Cancer 11(4):589–602. doi:10.1677/erc.1.00779

    Article  CAS  PubMed  Google Scholar 

  • Gleeson HK, Stoeter R, Ogilvy-Stuart AL, Gattamaneni HR, Brennan BM, Shalet SM (2003) Improvements in final height over 25 years in growth hormone (GH)-deficient childhood survivors of brain tumors receiving GH replacement. J Clin Endocrinol Metab 88(8):3682–3689. doi:10.1210/jc.2003-030366

    Article  CAS  PubMed  Google Scholar 

  • Growth Hormone Research Society (2000) Consensus guidelines for the diagnosis and treatment of growth hormone (GH) deficiency in childhood and adolescence: summary statement of the GH Research Society. GH Research Society. J Clin Endocrinol Metab 85(11):3990–3993. doi:10.1210/jcem.85.11.6984

  • Gurney JG, Kadan-Lottick NS, Packer RJ, Neglia JP, Sklar CA, Punyko JA, Stovall M, Yasui Y, Nicholson HS, Wolden S, McNeil DE, Mertens AC, Robison LL, Childhood Cancer Survivor S (2003a) Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: Childhood Cancer Survivor Study. Cancer 97(3):663–673. doi:10.1002/cncr.11095

    Article  PubMed  Google Scholar 

  • Gurney JG, Ness KK, Stovall M, Wolden S, Punyko JA, Neglia JP, Mertens AC, Packer RJ, Robison LL, Sklar CA (2003b) Final height and body mass index among adult survivors of childhood brain cancer: childhood cancer survivor study. J Clin Endocrinol Metab 88(10):4731–4739. doi:10.1210/jc.2003-030784

    Article  CAS  PubMed  Google Scholar 

  • Gurney JG, Ness KK, Sibley SD, O’Leary M, Dengel DR, Lee JM, Youngren NM, Glasser SP, Baker KS (2006) Metabolic syndrome and growth hormone deficiency in adult survivors of childhood acute lymphoblastic leukemia. Cancer 107(6):1303–1312. doi:10.1002/cncr.22120

    Article  CAS  PubMed  Google Scholar 

  • Hobbie WL, Mostoufi SM, Carlson CA, Gruccio D, Ginsberg JP (2011) Prevalence of advanced bone age in a cohort of patients who received cis-retinoic acid for high-risk neuroblastoma. Pediatr Blood Cancer 56(3):474–476. doi:10.1002/pbc.22839

    Article  PubMed  Google Scholar 

  • Lam KS, Wang C, Yeung RT, Ma JT, Ho JH, Tse VK, Ling N (1986) Hypothalamic hypopituitarism following cranial irradiation for nasopharyngeal carcinoma. Clin Endocrinol 24(6):643–651

    Article  CAS  Google Scholar 

  • Langsenlehner T, Stiegler C, Quehenberger F, Feigl GC, Jakse G, Mokry M, Langsenlehner U, Kapp KS, Mayer R (2007) Long-term follow-up of patients with pituitary macroadenomas after postoperative radiation therapy: analysis of tumor control and functional outcome. Strahlenther Onkol 183(5):241–247. doi:10.1007/s00066-007-1706-1

    Article  PubMed  Google Scholar 

  • Lannering B, Jansson C, Rosberg S, Albertsson-Wikland K (1997) Increased LH and FSH secretion after cranial irradiation in boys. Med Pediatr Oncol 29(4):280–287. doi:10.1002/(SICI)1096-911X(199710)29:4<280::AID-MPO8>3.0.CO;2-I. [pii]

    Article  CAS  PubMed  Google Scholar 

  • Laughton SJ, Merchant TE, Sklar CA, Kun LE, Fouladi M, Broniscer A, Morris EB, Sanders RP, Krasin MJ, Shelso J, Xiong Z, Wallace D, Gajjar A (2008) Endocrine outcomes for children with embryonal brain tumors after risk-adapted craniospinal and conformal primary-site irradiation and high-dose chemotherapy with stem-cell rescue on the SJMB-96 trial. J Clin Oncol 26(7):1112–1118. doi:10.1200/JCO.2008.13.5293

    Article  CAS  PubMed  Google Scholar 

  • Littley MD, Shalet SM, Beardwell CG, Ahmed SR, Applegate G, Sutton ML (1989) Hypopituitarism following external radiotherapy for pituitary tumours in adults. Q J Med 70(262):145–160

    CAS  PubMed  Google Scholar 

  • Livesey EA, Hindmarsh PC, Brook CG, Whitton AC, Bloom HJ, Tobias JS, Godlee JN, Britton J (1990) Endocrine disorders following treatment of childhood brain tumours. Br J Cancer 61(4):622–625

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lustig RH, Post SR, Srivannaboon K, Rose SR, Danish RK, Burghen GA, Xiong X, Wu S, Merchant TE (2003) Risk factors for the development of obesity in children surviving brain tumors. J Clin Endocrinol Metab 88(2):611–616. doi:10.1210/jc.2002-021180

    Article  CAS  PubMed  Google Scholar 

  • Mailhot Vega R, Kim J, Hollander A, Hattangadi-Gluth J, Michalski J, Tarbell NJ, Yock TI, Bussiere M, MacDonald SM (2015) Cost effectiveness of proton versus photon radiation therapy with respect to the risk of growth hormone deficiency in children. Cancer 121(10):1694–1702. doi:10.1002/cncr.29209

    Article  PubMed  Google Scholar 

  • Meacham L (2003) Endocrine late effects of childhood cancer therapy. Curr Probl Pediatr Adolesc Health Care 33(7):217–242

    Article  PubMed  Google Scholar 

  • Meacham LR, Sklar CA, Li S, Liu Q, Gimpel N, Yasui Y, Whitton JA, Stovall M, Robison LL, Oeffinger KC (2009) Diabetes mellitus in long-term survivors of childhood cancer. Increased risk associated with radiation therapy: a report for the childhood cancer survivor study. Arch Intern Med 169(15):1381–1388. doi:10.1001/archinternmed.2009.209

    Article  PubMed  PubMed Central  Google Scholar 

  • Merchant TE, Rose SR, Bosley C, Wu S, Xiong X, Lustig RH (2011) Growth hormone secretion after conformal radiation therapy in pediatric patients with localized brain tumors. J Clin Oncol 29(36):4776–4780. doi:10.1200/JCO.2011.37.9453

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Miyoshi Y, Ohta H, Hashii Y, Tokimasa S, Namba N, Mushiake S, Hara J, Ozono K (2008) Endocrinological analysis of 122 Japanese childhood cancer survivors in a single hospital. Endocr J 55(6):1055–1063

    Article  PubMed  Google Scholar 

  • Mulder RL, Kremer LC, van Santen HM, Ket JL, van Trotsenburg AS, Koning CC, Schouten-van Meeteren AY, Caron HN, Neggers SJ, van Dalen EC (2009) Prevalence and risk factors of radiation-induced growth hormone deficiency in childhood cancer survivors: a systematic review. Cancer Treat Rev 35(7):616–632. doi:10.1016/j.ctrv.2009.06.004

    Article  CAS  PubMed  Google Scholar 

  • Muller J (2002) Disturbance of pubertal development after cancer treatment. Best Pract Res Clin Endocrinol Metab 16(1):91–103

    Article  PubMed  Google Scholar 

  • Ning MS, Perkins SM, Dewees T, Shinohara ET (2015) Evidence of high mortality in long term survivors of childhood medulloblastoma. J Neuro-Oncol 122(2):321–327. doi:10.1007/s11060-014-1712-y

    Article  CAS  Google Scholar 

  • Oberfield SE, Soranno D, Nirenberg A, Heller G, Allen JC, David R, Levine LS, Sklar CA (1996) Age at onset of puberty following high-dose central nervous system radiation therapy. Arch Pediatr Adolesc Med 150(6):589–592

    Article  CAS  PubMed  Google Scholar 

  • Ogilvy-Stuart AL, Clayton PE, Shalet SM (1994) Cranial irradiation and early puberty. J Clin Endocrinol Metab 78(6):1282–1286. doi:10.1210/jcem.78.6.8200926

    CAS  PubMed  Google Scholar 

  • Palmert MR, Dunkel L (2012) Clinical practice. delayed puberty. N Engl J Med 366(5):443–453. doi:10.1056/NEJMcp1109290

    Article  CAS  PubMed  Google Scholar 

  • Patterson BC, Truxillo L, Wasilewski-Masker K, Mertens AC, Meacham LR (2009) Adrenal function testing in pediatric cancer survivors. Pediatr Blood Cancer 53(7):1302–1307. doi:10.1002/pbc.22208

    Article  PubMed  Google Scholar 

  • Patterson BC, Chen Y, Sklar CA, Neglia J, Yasui Y, Mertens A, Armstrong GT, Meadows A, Stovall M, Robison LL, Meacham LR (2014) Growth hormone exposure as a risk factor for the development of subsequent neoplasms of the central nervous system: a report from the childhood cancer survivor study. J Clin Endocrinol Metab 99(6):2030–2037. doi:10.1210/jc.2013-4159

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Quigley C, Cowell C, Jimenez M, Burger H, Kirk J, Bergin M, Stevens M, Simpson J, Silink M (1989) Normal or early development of puberty despite gonadal damage in children treated for acute lymphoblastic leukemia. N Engl J Med 321(3):143–151

    Article  CAS  PubMed  Google Scholar 

  • Raman S, Grimberg A, Waguespack SG, Miller BS, Sklar CA, Meacham LR, Patterson BC (2015) Risk of neoplasia in pediatric patients receiving growth hormone therapy—a report from the Pediatric Endocrine Society Drug and Therapeutics Committee. J Clin Endocrinol Metab 100(6):2192–2203. doi:10.1210/jc.2015-1002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rose SR, Lustig RH, Pitukcheewanont P, Broome DC, Burghen GA, Li H, Hudson MM, Kun LE, Heideman RL (1999) Diagnosis of hidden central hypothyroidism in survivors of childhood cancer. J Clin Endocrinol Metab 84(12):4472–4479. doi:10.1210/jcem.84.12.6097

    CAS  PubMed  Google Scholar 

  • Rose SR, Danish RK, Kearney NS, Schreiber RE, Lustig RH, Burghen GA, Hudson MM (2005) ACTH deficiency in childhood cancer survivors. Pediatr Blood Cancer 45(6):808–813. doi:10.1002/pbc.20327

    Article  PubMed  Google Scholar 

  • Russell DL, Keil MF, Bonat SH, Uwaifo GI, Nicholson JC, McDuffie JR, Hill SC, Yanovski JA (2001) The relation between skeletal maturation and adiposity in African American and Caucasian children. J Pediatr 139(6):844–848. doi:10.1067/mpd.2001.119446

    Article  CAS  PubMed  Google Scholar 

  • Rutter MM, Rose SR (2007) Long-term endocrine sequelae of childhood cancer. Curr Opin Pediatr 19(4):480–487. doi:10.1097/MOP.0b013e3282058b56

    Article  PubMed  Google Scholar 

  • Schmiegelow M, Lassen S, Poulsen HS, Feldt-Rasmussen U, Schmiegelow K, Hertz H, Muller J (2000a) Cranial radiotherapy of childhood brain tumours: growth hormone deficiency and its relation to the biological effective dose of irradiation in a large population based study. Clin Endocrinol 53(2):191–197

    Article  CAS  Google Scholar 

  • Schmiegelow M, Lassen S, Poulsen HS, Feldt-Rasmussen U, Schmiegelow K, Hertz H, Muller J (2000b) Growth hormone response to a growth hormone-releasing hormone stimulation test in a population-based study following cranial irradiation of childhood brain tumors. Hormone Res 54(2):53–59. doi:53232

    Article  CAS  PubMed  Google Scholar 

  • Schriock EA, Lustig RH, Rosenthal SM, Kaplan SL, Grumbach MM (1984) Effect of growth hormone (GH)-releasing hormone (GRH) on plasma GH in relation to magnitude and duration of GH deficiency in 26 children and adults with isolated GH deficiency or multiple pituitary hormone deficiencies: evidence for hypothalamic GRH deficiency. J Clin Endocrinol Metab 58(6):1043–1049. doi:10.1210/jcem-58-6-1043

    Article  CAS  PubMed  Google Scholar 

  • Shalet SM, Gibson B, Swindell R, Pearson D (1987) Effect of spinal irradiation on growth. Arch Dis Child 62(5):461–464

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sigurdson AJ, Ronckers CM, Mertens AC, Stovall M, Smith SA, Liu Y, Berkow RL, Hammond S, Neglia JP, Meadows AT, Sklar CA, Robison LL, Inskip PD (2005) Primary thyroid cancer after a first tumour in childhood (the Childhood Cancer Survivor Study): a nested case-control study. Lancet 365(9476):2014–2023. doi:10.1016/S0140-6736(05)66695-0

    Article  PubMed  Google Scholar 

  • Sklar CA, Constine LS (1995) Chronic neuroendocrinological sequelae of radiation therapy. Int J Radiat Oncol Biol Phys 31(5):1113–1121. doi:10.1016/0360-3016(94)00427-M

    Article  CAS  PubMed  Google Scholar 

  • Stanley T (2012) Diagnosis of growth hormone deficiency in childhood. Curr Opin Endocrinol Diabetes Obes 19(1):47–52. doi:10.1097/MED.0b013e32834ec952

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stephen MD, Zage PE, Waguespack SG (2011) Gonadotropin-dependent precocious puberty: neoplastic causes and endocrine considerations. Int J Pediatr Endocrinol 2011:184502. doi:10.1155/2011/184502

    Article  PubMed  PubMed Central  Google Scholar 

  • Tonorezos ES, Hudson MM, Edgar AB, Kremer LC, Sklar CA, Wallace WH, Oeffinger KC (2015) Screening and management of adverse endocrine outcomes in adult survivors of childhood and adolescent cancer. Lancet Diabetes Endocrinol 3(7):545–555. doi:10.1016/S2213-8587(15)00038-8

    Article  PubMed  PubMed Central  Google Scholar 

  • Toogood AA (2004) Endocrine consequences of brain irradiation. Growth Horm IGF Res 14(Suppl A):S118–S124. doi:10.1016/j.ghir.2004.03.038

    Article  CAS  PubMed  Google Scholar 

  • Weinzimer SA, Homan SA, Ferry RJ, Moshang T (1999) Serum IGF-I and IGFBP-3 concentrations do not accurately predict growth hormone deficiency in children with brain tumours. Clin Endocrinol 51(3):339–345

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrine Neoplasia and Hormonal Disorders, The Children’s Cancer Hospital, The University of Texas MD Anderson Cancer Center, PO Box 301402, Unit 1461, Houston, TX, 77230, USA

    Steven G. Waguespack M.D.

  2. Division of Endocrinology, Department of Pediatric Medicine and the Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place MS737, Memphis, TN, 38105, USA

    Wassim Chemaitilly M.D.

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  1. Steven G. Waguespack M.D.
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Correspondence to Steven G. Waguespack M.D. .

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Editors and Affiliations

  1. Dept. of Radiation Oncology, Mayo Clinic Dept. of Radiation Oncology, Rochester, Minnesota, USA

    Anita Mahajan

  2. MD Anderson Cancer Center, Houston, Texas, USA

    Arnold Paulino

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Waguespack, S.G., Chemaitilly, W. (2018). Endocrine Sequelae of Central Nervous System Irradiation. In: Mahajan, A., Paulino, A. (eds) Radiation Oncology for Pediatric CNS Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-55430-3_31

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