Boron Neutron Capture Therapy for Children with Malignant Brain Tumors
Conventional radiation therapy for small children with malignant brain tumors might elongate the lifetime, but causes severe chronic neurocognitive effects and functional deficits. Boron neutron capture therapy (BNCT) can selectively destroy tumor cells w
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Yoshinobu Nakagawa and Teruyoshi Kageji
Contents 29.1
Introduction.................................................................................................................. 505
29.2
Treatment with a Thermal Neutron Beam ................................................................ 506
29.3
Illustrative Cases and Results ..................................................................................... 508 29.3.1 Case 1: A 14-Month-Old Female with Astrocytoma (Grade 3) in the Cerebellum ............................................................................................. 508 29.3.2 Case 2: A 1-Year-Old Female with Anaplastic Ependymoma......................... 510
29.4
Clinical Outcome ......................................................................................................... 510
References ................................................................................................................................ 511
29.1
Introduction
The ideal treatment for children with a malignant brain tumor should be a treatment that causes as little damage as possible to the developing central nervous system. However, children surviving treatment often have problems associated with tumor invasion of the brain parenchyma, increased intracranial pressure, injury from surgical resection, neurotoxicity induced by chemotherapy, and late effects of radiation therapy. Radiation therapy especially improves clinical outcomes, but also increases the risk of a poor quality of life with chronic neurocognitive effects and functional deficits. The late effects of radiotherapy have been followed and characterized by CT or MRI Y. Nakagawa (*) Department of Neurosurgery, Kagawa National Children’s Hospital, Kagawa 765-8501, Japan e-mail: [email protected] T. Kageji Department of Neurosurgery, School of Medicine, The University of Tokushima, Kuramoto-cho 3-18-15, Tokushima 770-8503, Japan e-mail: [email protected] W.A.G. Sauerwein et al. (eds.), Neutron Capture Therapy, DOI 10.1007/978-3-642-31334-9_29, © Springer-Verlag Berlin Heidelberg 2012
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Fig. 29.1 A 2-year-old girl with a brain tumor in the basal ganglia underwent conventional radiotherapy (54 Gy). Follow-up CT demonstrated marked calcification in the parenchyma 6 years (left) and 10 years (right) after conventional radiotherapy. The patient has marked mental retardation
(Fig. 29.1). However, technical advances in radiotherapy now offer hope for lowering the frequency of neurocognitive sequelae and thus allowing more attention to be focused on the late effects of cancer treatment. Boron neutron capture therapy (BNCT) is a promising modality for the selective irradiation of tumor tissue. The thermal neutron is captured by the 10B-nucleus, which disintegrates into two heavy particles, alpha particles (4He) and recoiling lithium-7 (7Li). These densely ionizing particles have high biological effectiveness and a short path length that is almost equal to the size of tumor cell
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