Radiation therapy is the standard and most effective treatment for diffuse intrinsic pontine glioma (DIPG), a type of pediatric brain tumor, though it is not a cure.
Radiation therapy uses high-energy rays or particles to destroy childhood brain tumor cells,but it can cause side effects, especially cognitive issues, and may damage a child’s developing brain. To minimize harm, especially in children under 3, doctors often try alternative treatments like chemotherapy first, or use specialized techniques like proton therapy which minimizes damage to healthy tissue. Doctors carefully plan treatment based on the child’s age and tumor to limit long-term effects, which can include learning, physical, and developmental problems.
How radiation therapy works:
– Radiation uses high-energy rays or particles to destroy cancer cells.
– It can be given from outside the body (external beam radiation).
– Some tumors require radiation to the entire brain and spinal cord, while others are treated with more focused beams.
– Sometimes, chemotherapy is used to make radiation more effective, a combination known as chemoradiation.
Potential risks and side effects
– Developmental impact:
Because a child’s brain is still developing, radiation can interfere with normal growth and development, leading to potential long-term effects on thinking, memory, and physical abilities.
Cognitive effects:
Side effects can include impacts on memory, attention, processing speed, and executive function.
Other side effects:
Other side effects can be temporary, such as fatigue, hair loss, nausea, headaches, and skin problems.
Long-term risks:
Some studies show increased risk of cerebrovascular disease (CVD) in long-term survivors.
Managing risks and treatment planning
Proton therapy:
This specialized form of radiation therapy delivers a more precise dose to the tumor, which can significantly reduce exposure to surrounding healthy brain tissue and lower the risk of side effects.
Alternative treatments:
For very young children, doctors may postpone radiation and use chemotherapy instead until they are old enough to reduce the risk of damaging their developing brain.
Personalized plans:
Treatment plans are carefully tailored to each child, considering their age, the type of tumor, and its location.
(Talk with your child’s doctor for the best plan of action)
What to expect during AND after treatment.
During treatment:
It is common for a child to feel tired, especially after chemotherapy or radiation.
After treatment:
Monitor your child’s energy levels and encourage gentle participation in regular activities if they feel up to it.
At-home care:
Keep a record of your child’s condition, including body temperature, energy levels, and sleeping patterns, and share this with the healthcare team.
Nutrition:
A registered dietitian can help ensure your child gets enough nutrients, as treatment can affect appetite.
Vaccinations:
Check with the healthcare team before giving your child any vaccinations, as cancer treatment can affect the immune system.
Radiation therapy is the standard and most effective treatment for diffuse intrinsic pontine glioma (DIPG), a type of pediatric brain tumor, though it is not a cure. Radiation therapy is an effective palliative treatment that improves symptoms in about 80% of children with DIPGs.
As radiation patients must lie still and alone on a table, some children are too young or too ill to tolerate the radiation treatments while awake. In these cases, the planning session and treatments can be performed under general anesthesia. A commonly used anesthetic agent in radiation therapy is propofol. Propofol is an intravenous anesthetic that allows for rapid induction and recovery, and—most importantly—does not require intubation (insertion of a tube) for protection of the airway. Even with daily use, the risks of complications with propofol are very low. Typically, the child is brought into the room awake, with the parents, and the anesthesia is initiated. After induction of anesthesia, the parents leave the room and the radiation therapy procedures are performed.
It uses high-energy beams to kill cancer cells or slow their growth, which can temporarily improve symptoms and extend survival by several months, but the tumor will eventually progress. Radiation for DIPG is external-beam radiation therapy, delivered typically over several weeks in daily sessions.
Proton radiation therapy (PRT)
is a form of radiation therapy that has very limited availability. PRT uses protons to deliver therapeutic radiation. Protons differ significantly from the photons used in conventional radiation therapy because they have no mass or charge, compared to protons, which have mass and are positively charged. The mass and charge of protons results in a phenomenon called the Bragg Peak, which results in no energy deposited after a certain depth in tissue depending on the energy of the proton (higher energies go deeper). This technique allows protons to potentially deliver less radiation therapy to normal tissues, with fewer late effects of therapy. Numerous theoretical modeling studies have shown benefit to using proton radiation. For children with DIPGs, the potential benefit of protons is unfortunately minimal. The difference in normal tissue radiated between PRT and current photon radiation therapy techniques is small, and late effects in these children is not yet a significant concern due to the extremely low survival rate in this population
FLASH Radiation:
FLASH radiotherapy is an experimental approach to cancer treatment that delivers radiation therapy at ultra-high dose rates, typically in fractions of a second, compared to the conventional radiotherapy, which delivers radiation at much lower dose rates over several minutes. While FLASH radiation therapy is still in its early stages of research and development, it holds several potential benefits over conventional radiation therapy.
