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Radiation

How effective is radiation if the tumor cannot be removed by surgery?
Our neurosurgeon said that he removed the entire tumor. Why would radiation be recommended?
Is proton radiation better than photon radiation?
What happens during radiation?
Is radiation painful?
Will radiation make my child’s hair fall out?

How effective is radiation if the tumor cannot be removed by surgery?
Radiation uses high-energy X-rays directed at the tumor and the area surrounding it. It works by damaging the DNA of cancer cells (but will damage those healthy cells in that area, too). Radiation alone can be effective in curing some cases of cancers, including germinomas (a type of CNS germ cell tumor). It can also be used to destroy the part of the tumor that the neurosurgeon could not remove and prevent recurrences. It can also successfully shrink those tumors that are not resectable.

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Our neurosurgeon said that he removed the entire tumor. Why would radiation be recommended?
Depending on the tumor type and grade, radiation may be recommended even if a gross total resection (GTR), or total removal, has been achieved. That’s because not every possible cancer cell can be identified on an MRI. Treating with radiation or chemotherapy in this situation can improve outcomes for children with some tumor types.

Questions and concerns about the use of radiation therapy for your child can be directed to your child’s radiation oncologist and medical oncologist. If you’re hesitant about radiation for your child, which can be a difficult decision, seek a second opinion.

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Is proton radiation better than photon radiation?
Techniques such as IMRT and 3D-CRT are commonly used at hospitals with renowned brain tumor centers. The goal of both of these types of photon radiation is to deliver high-energy X-rays to the tumor or resected tumor area, and to minimize damage to the surrounding healthy tissues.

Proton beams work a little differently from X-rays, which release energy both before and after they reach their target. They release their energy when they reach their destination, causing little damage to the tissues “behind” the targeted tumor. It is thought that proton radiation might be useful at reducing damage to healthy brain tissues, and this is an active area of brain tumor research. There are only a few proton beam centers in the United States at this time.

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What happens during radiation?
In children, radiation is usually delivered to the tumor from outside of the body (as opposed to brachytherapy, when radioactive material is implanted into or near the tumor). Before treatment, your child will undergo simulation in which the targeted treatment field is defined and the angles for aiming the beams are determined. A mask will be made that will enable your child to stay still during treatments.

Usually the total dose of radiation is divided into daily fractions given over a course of several weeks, with larger amounts directed at the tumor than the surrounding areas. Radiation is typically an outpatient procedure, with each session lasting about 20 minutes. Although it is much quicker than an MRI, very young children may require anesthesia to remain sufficiently still for their treatments.

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Is radiation painful?
Treatment is not painful, but it can cause skin irritation. Nausea and vomiting are uncommon but are more likely in children undergoing spinal radiation. Fatigue and appetite loss may occur but are usually mild. In children undergoing craniospinal radiation (full brain and spine), symptoms can be more severe.

Some children become drowsy a few weeks after radiation is completed. This is called radiation somnolence syndrome and usually resolves after a few weeks.

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Will radiation make my child’s hair fall out?
Your child will only lose hair in the area of the head that has been treated. Children undergoing craniospinal radiation receive treatment to their full brain and spine, so they will lose all of their hair. Hair usually starts to regrow a few weeks after treatment completion, but may be sparse or not grow back at all in some spots.

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