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Introduction <p>Immunotherapy is a rapidly evolving field in pediatric neuro-oncology, using diverse strategies to enhance or initiate an antitumor immune response. Its use has expanded from hematologic malignancies to solid central nervous system (CNS) tumors, creating new diagnostic challenges in neuroimaging, particularly in children.</p> Purpose <p>The aim of this review is to summarize current immunotherapeutic strategies for pediatric solid CNS tumors and to discuss their characteristic imaging findings and response patterns, with emphasis on pitfalls in differentiating true progression from treatment‑related inflammatory changes.</p> Results <p>Across different immunotherapeutic approaches, a major challenge is distinguishing tumor progression from pseudoprogression, immune‑related flare phenomena, and neurotoxicity. Multiparametric imaging combining advanced MRI techniques and metabolic imaging may improve diagnostic specificity; however, validation in children is limited, and existing response frameworks such as iRANO and RAPNO do not specifically address immunotherapy‑related imaging patterns in the pediatric population.</p> Conclusion <p>Immunotherapy is reshaping the management of pediatric solid CNS tumors, but imaging‑based response assessment remains difficult. There is a pressing need for pediatric‑focused response criteria and standardized imaging strategies that incorporate the unique features of immunotherapy‑related changes in the developing brain.</p>

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Imaging assessment of immunotherapy in pediatric brain tumors

  • 期刊论文

  • 发表日期：

    2026年3月4日

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  • Carlos Robles,
  • Anirban Das,
  • Vivek Pai,
  • Suzanne Laughlin,
  • Birgit Ertl-Wagner

摘要

Introduction

Immunotherapy is a rapidly evolving field in pediatric neuro-oncology, using diverse strategies to enhance or initiate an antitumor immune response. Its use has expanded from hematologic malignancies to solid central nervous system (CNS) tumors, creating new diagnostic challenges in neuroimaging, particularly in children.

Purpose

The aim of this review is to summarize current immunotherapeutic strategies for pediatric solid CNS tumors and to discuss their characteristic imaging findings and response patterns, with emphasis on pitfalls in differentiating true progression from treatment‑related inflammatory changes.

Results

Across different immunotherapeutic approaches, a major challenge is distinguishing tumor progression from pseudoprogression, immune‑related flare phenomena, and neurotoxicity. Multiparametric imaging combining advanced MRI techniques and metabolic imaging may improve diagnostic specificity; however, validation in children is limited, and existing response frameworks such as iRANO and RAPNO do not specifically address immunotherapy‑related imaging patterns in the pediatric population.

Conclusion

Immunotherapy is reshaping the management of pediatric solid CNS tumors, but imaging‑based response assessment remains difficult. There is a pressing need for pediatric‑focused response criteria and standardized imaging strategies that incorporate the unique features of immunotherapy‑related changes in the developing brain.