Radiotherapy for pediatric brain tumors: when and how.

Radiotherapy plays a central role in the treatment of pediatric brain tumors. Historically, surgical resection alone was the mainstay of treatment for pediatric CNS malignancies. During the past 75 years, radiotherapy has been incorporated into the upfront treatment of many pediatric brain tumors either as adjuvant therapy for resected tumors, definitive treatment for unresectable malignancies or as prophylactic therapy for occult microscopic disease. Many CNS malignancies, which were once universally fatal are now curable with multimodality approaches that integrate surgery, chemotherapy and radiotherapy. Unfortunately, the long-term CNS side effects of radiotherapy remain a major obstacle for survivors of childhood tumors. In this article we will discuss these issues in detail and summarize the ongoing efforts to reduce the risks of these toxicities.