Radiation therapy to the brain and spinal cord in children is a complex and delicate procedure, and it requires careful consideration due to the potential risks and benefits involved. Here are some facts about brain and spinal cord radiation in children:
- Brain and spinal cord radiation may be used in children with certain types of brain tumours, central nervous system (CNS) tumours, or leukemia involving the central nervous system. It is typically used as a part of multimodal treatment, along with surgery and/or chemotherapy.
- Brain and spinal cord radiation in children is usually delivered using external beam radiation therapy (EBRT). EBRT involves directing high-energy X-rays or other types of radiation beams precisely to the tumour or affected area.
- Young children undergoing radiation therapy often require anesthesia or sedation to ensure they remain still during treatment. This is essential to target the radiation accurately and minimize damage to healthy tissues.
- Before radiation begins, a team of experts, including radiation oncologists and medical physicists, carefully plan the treatment. Advanced imaging techniques, such as MRI, CT scans, or PET scans, help create a detailed map of the tumour and surrounding structures to guide radiation delivery.
- Focal radiation therapy and whole brain radiation therapy are two distinct approaches used in the treatment of children with brain tumours.
- Focal radiation targets a specific area of the brain where the tumour is located, sparing surrounding healthy tissue from radiation exposure. This targeted approach helps reduce potential long-term side effects on cognitive and developmental functions in paediatric patients.
- Techniques like intensity-modulated radiation therapy (IMRT) and proton therapy are types of focal radiation are used to minimize radiation exposure to healthy tissues surrounding the tumour. These methods help reduce the risk of long-term complications.
- On the other hand, whole brain radiation therapy involves irradiating the entire brain, which is sometimes necessary if the tumour is widespread or multiple tumours are present. However, whole brain radiation carries a higher risk of neurocognitive deficits and other neurological side effects, making it a less preferred option in children when focal radiation is a viable alternative.
- Radiation to the brain and spinal cord can cause short-term and long-term side effects.
- Short-term effects may include fatigue, hair loss, skin irritation, and changes in appetite.
- Although radiation can cure some children, it has lifelong consequences, including cognitive impairments, growth delays, and hormonal imbalances. Even with focal or restricted radiation, children may develop other cancers in the future. If the whole brain is radiated at a young age, the intellectual development of the child is significantly compromised. Many children who survive after radiation treatment never complete formal schooling and do not have enough skills to live independent adult lives. The economic and emotional burden of raising a survivor is also enormous. Although radiation is particularly harmful to the young child’s brain, it has been shown that a brain radiated at any age will be less effective.
- In some cases, craniospinal irradiation (CSI) may be necessary, where radiation is delivered to both the brain and the entire length of the spinal cord. This is often performed in certain types of brain tumours and metastatic diseases to the CNS.
- Children who receive brain and spinal cord radiation require regular follow-up visits with their medical team to monitor their growth, development, and potential late effects of radiation.
Our research team at SickKids Hospital in Toronto is learning that for young children with certain types of embryonal brain cancers including ATRT and ETMR, radiation can be omitted safely in up to 40% of patients without comprising cure.
Imagine if researchers can find a way to make that apply to even more patients, and then imagine being able to extrapolate that knowledge to spare radiation in older children and adults!
Learn more about the SickKids Toronto Radiation Sparing Protocol