Proton-beam radiation therapy and health-related quality of life in children with CNS tumors

摘要

For more than three decades we have been aware that children who are treated for tumors of the CNS with conventional photon-beam radiotherapy, or cranial radiation therapy (CRT), are at high risk of neurocognitive impairment or dysfunction.1'2 To address this concern, several major changes in treatment have occurred. By using what was, at the time, considered to be adjuvant chemotherapy, the Pediat-ric Oncology Group demonstrated that delaying CRT resulted in benefits with respect to the neurocognitive function of young children.3 Reduction in the dose of CRT, particularly for younger children being treated for medulloblastoma, was also associated with better long-term cognitive function.4 During the intervening years, this strategy has resulted in increasing use of chemotherapy regimens and stem-cell transplantation along with reduced doses or elimination of CRT, with improvement in survival as a consequence.