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Purpose <p>Gamma Knife radiosurgery (GKRS) is increasingly applied in pediatric neuro-oncology; however, integrated analyses of outcomes and procedural factors remain limited. This study evaluated histology-specific outcomes and technical considerations of GKRS for pediatric brain tumors.</p> Methods <p>This study retrospectively analyzed 139 GKRS procedures performed in 108 pediatric patients (age 3–18&#xa0;years) with brain tumors between 2002 and 2024. The clinical, radiological, dosimetric, and anesthetic data were analyzed. Progression-free survival (PFS) was estimated by Kaplan–Meier analysis and stratified by tumor histology.</p> Results <p>The mean age at GKRS was 12.4&#xa0;years (M: F ratio 1:1.16). The most common histologies were craniopharyngiomas (31 procedures), vestibular schwannomas (20), and pilocytic astrocytomas (16). The mean target coverage was 96.9% and the mean prescription dose was 18&#xa0;Gy. Frameless mask fixation was feasible from age 6 and frame-based fixation from age 12. General anesthesia was required in 25.9%, predominantly in younger or uncooperative patients (8.5 vs 14.0&#xa0;years, p &lt; 0.001). Pediatric-type diffuse high-grade gliomas had the poorest outcomes (PFS 2.6&#xa0;months, 100% mortality). Craniopharyngiomas showed high recurrence (48%) but a long failure interval (35.8&#xa0;months) and low mortality (8%). Benign and low-grade tumors showed durable local control with a 5-year PFS exceeding 70%.</p> Conclusion <p>GKRS provides durable local control in selected benign and low-grade pediatric brain tumors; however, outcomes remain poor in aggressive histologies, with high rates of progression and mortality. These findings highlight the importance of histology-based patient selection and integration of GKRS into multimodal treatment strategies. Age-adapted procedural approaches facilitate safe application in pediatric patients.</p>

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Gamma knife radiosurgery in pediatric neuro-oncology: histology-specific outcomes and age-adapted procedural strategies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月14日

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  • Jong Seok Lee,
  • Jung Il Lee,
  • Hyung Jin Shin,
  • Jung Won Choi

摘要

Purpose

Gamma Knife radiosurgery (GKRS) is increasingly applied in pediatric neuro-oncology; however, integrated analyses of outcomes and procedural factors remain limited. This study evaluated histology-specific outcomes and technical considerations of GKRS for pediatric brain tumors.

Methods

This study retrospectively analyzed 139 GKRS procedures performed in 108 pediatric patients (age 3–18 years) with brain tumors between 2002 and 2024. The clinical, radiological, dosimetric, and anesthetic data were analyzed. Progression-free survival (PFS) was estimated by Kaplan–Meier analysis and stratified by tumor histology.

Results

The mean age at GKRS was 12.4 years (M: F ratio 1:1.16). The most common histologies were craniopharyngiomas (31 procedures), vestibular schwannomas (20), and pilocytic astrocytomas (16). The mean target coverage was 96.9% and the mean prescription dose was 18 Gy. Frameless mask fixation was feasible from age 6 and frame-based fixation from age 12. General anesthesia was required in 25.9%, predominantly in younger or uncooperative patients (8.5 vs 14.0 years, p < 0.001). Pediatric-type diffuse high-grade gliomas had the poorest outcomes (PFS 2.6 months, 100% mortality). Craniopharyngiomas showed high recurrence (48%) but a long failure interval (35.8 months) and low mortality (8%). Benign and low-grade tumors showed durable local control with a 5-year PFS exceeding 70%.

Conclusion

GKRS provides durable local control in selected benign and low-grade pediatric brain tumors; however, outcomes remain poor in aggressive histologies, with high rates of progression and mortality. These findings highlight the importance of histology-based patient selection and integration of GKRS into multimodal treatment strategies. Age-adapted procedural approaches facilitate safe application in pediatric patients.