Radiotherapy of brain tumours in paediatric oncology

Brain tumours account for 25% of all childhood neoplasms and are the most frequent solid tumour in children and treated according to multidisciplinary treatment concepts with surgery and depending on tumour type also chemotherapy and radiotherapy. Developing brain tissue in younger children is more sensitive to high energy x-rays and long-term side effects are more pronounced; therefore, radiotherapy has to be planned and applied very carefully to reduce the risk of long term side effects such as neurocognitive-, endocrine-, and neurological deficits. 3-D planning with individually adopted beams guarantees an individual configuration of dose plans, intensity modulated radiotherapy (IMRT) allows dose painting with higher doses to the more active parts of the tumour diagnosed on proton emission tomography (PET-CT; PET-MRI). The development of modern techniques and energies is evolving at a steady pace. Proton therapy carries a lower risk of radiation-induced morbidity and in the nearer future an increasing number of children will benefit from proton beam irradiation.