Pediatric Cranial Stereotactic Radiosurgery: Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines

Erin S Murphy; Arjun Sahgal; Jean Regis; Marc Levivier; Laura Fariselli; Alessandra Gorgulho; Lijun Ma; Bruce Pollock; Shoji Yomo; Jason Sheehan; Ian Paddick; John H Suh; Anshul Saxena; Md Ashfaq Ahmed; Rupesh Kotecha

doi:10.1093/neuonc/noae204

Pediatric Cranial Stereotactic Radiosurgery: Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines

Neuro Oncol. 2024 Oct 11:noae204. doi: 10.1093/neuonc/noae204. Online ahead of print.

Authors

Erin S Murphy¹, Arjun Sahgal², Jean Regis³, Marc Levivier⁴, Laura Fariselli⁵, Alessandra Gorgulho^{6

7}, Lijun Ma⁸, Bruce Pollock⁹, Shoji Yomo¹⁰, Jason Sheehan¹¹, Ian Paddick¹², John H Suh¹, Anshul Saxena¹³, Md Ashfaq Ahmed¹³, Rupesh Kotecha¹⁴

Affiliations

¹ Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio, USA.
² Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto, Canada.
³ Department of Functional Neurosurgery, La Timone Hospital, Aix-Marseille University, Marseille, France.
⁴ Neurosurgery Service and Gamma Knife Center, Center Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
⁵ Department of Neurosurgery, Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta Milano, Milan, Italy.
⁶ Department of Neurosurgery, State University of São Paulo, NeuroSapiens Group, São Paulo, Brazil.
⁷ D'Or Institute for Research and Education, São Paulo, Brazil.
⁸ Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA.
⁹ Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
¹⁰ Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, Matsumoto, Japan.
¹¹ Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
¹² Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom.
¹³ Center for Advanced Analytics, Baptist Health South Florida, Miami, FL, USA.
¹⁴ Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.

PMID: 39390948
DOI: 10.1093/neuonc/noae204

Abstract

Background: There are limited data on the use of stereotactic radiosurgery (SRS) for pediatric patients. The aim of this systematic review was to summarize indications and outcomes specific to pediatric cranial SRS to inform consensus guidelines on behalf of the International Stereotactic Radiosurgery Society (ISRS).

Methods: A systematic review, using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), analyzed English-language articles on SRS, published between 1989 and 2021, that included outcomes for at least 5 pediatric patients. MEDLINE database terms included tumor types and locations, and radiosurgical and age-specific terms. We excluded nonclinical reports, expert opinions, commentaries, and review articles. Meta-regressions for associations with local control were performed for medulloblastoma, craniopharyngioma, ependymoma, glioma, and arteriovenous malformation (AVM).

Results: Of the 113 articles identified for review, 68 met the inclusion criteria. These articles described approximately 400 pediatric patients with benign and malignant brain tumors and 5119 with AVMs who underwent cranial SRS. The rates of local control for benign tumors, malignant tumors, and AVMs were 89% (95% CI, 82%-95%), 71% (95% CI, 59%-82%), and 65% (95% CI, 60%-69%), respectively. No significant associations were identified for local control with patient-, tumor-, or treatment-related variables.

Conclusions: This review is the first to summarize outcomes specific to SRS for pediatric brain tumors and AVMs. Although data reporting is limited for pediatric patients, SRS appears to provide acceptable rates of local control. We present ISRS consensus guidelines to inform the judicious use of cranial SRS for pediatric patients.

Keywords: arteriovenous malformations; brain neoplasms; pediatric; stereotactic radiosurgery.

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