Radiotherapy still represents with surgery the cornerstone in the management of pediatric
brain tumors. Techniques of irradiation have benefited greatly from modern imaging, CT scan and MRI for
tumor-volume delineation, as well as megavoltage equipment, mainly
linear accelerators delivering both high-energy X-Rays and electrons, widely used in cranial-spinal irradiations. Furthermore, new modalities of doses and volumes have been tested in various
tumors (
medulloblastomas,
germ cell tumors...), in studies frequently combining
chemotherapy with conventional
therapies. Nevertheless, local control remains a major concern in
tumors such as brain stem and high grade supratentorial
gliomas. Concerning iatrogenic neurological sequelae, particularly harmful in children, limited data suggest an improvement in recent years. This improvement is partly due to the reduced prophylactic doses for the treatment of
medulloblastomas, but further long-term observations are necessary. For these reasons, multiple technical innovations have been investigated. Some of them concern irradiation selectivity: stereotactic pencil beams, interstitial
brachytherapy, heavy charged particles, 3-dimensional treatment planning. Others aim to increase the irradiation "efficacy": multifractionation, high LET particles,
radiation-sensitizers.