Pushing the Boundaries: Re-Irradiation for Pediatric Brain Tumors

Over the last 10 years, new studies have emerged demonstrating efficacy and safety of re-irradiation for children with recurrent brain tumors. However, there remains a knowledge gap in the oncology community, with many physicians remaining hesitant to apply re-irradiation due to concerns regarding safety, toxicity, and cumulative dose limits. In this activity, we present an overview of re-irradiation for the most common pediatric brain tumors: ependymoma, medulloblastoma and brainstem glioma (diffuse intrinsic pontine glioma). Speakers discuss treatment indications, other therapies (surgery), clinical data demonstrating efficacy of re-irradiation, dose selection, latent time (from 1st to 2nd RT), contouring guidelines (GTV/CTV/PTV margins), treatment delivery techniques (proton vs. photon), plan evaluation, and methods to minimize potential toxicity. The session is moderated by Dr. Derek Tsang and includes three speaker presentations. A question-and-answer period follows for all speakers. 

Topic:

  1. Re-Irradiation for Pediatric Brain Tumors (Ependymoma)
    Thomas E. Merchant, DO, PhD
  2. Re-Irradiation for Relapsed Medulloblastoma
    Sarah A. Milgrom, MD
  3. Re-Irradiation for Brainstem Glioma
    Natalie Logie, MD
  4. Q and A
    Full Panel

This activity is available from July 9, 2024, through 11:59 p.m. Eastern time on July 8, 2026. 

This activity was originally recorded at the 2023 ASTRO Annual Meeting.

Target Audience

The activity is designed to meet the interests of medical oncologists, radiation oncologists, surgeons, physicists, diagnostic radiologists, dosimetrists, residents and pediatric oncologists.   

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Identify indications for re-irradiation for children with ependymoma, medulloblastoma and brainstem glioma.
  • Discuss methods to safely apply re-irradiation, including need for prior surgery, latent time from first treatment, dose prescription, contouring margins, choice of treatment modality (proton vs. photon), and plan evaluation.   
  • Safely implement re-irradiation as an effective treatment option in their radiation oncology practice for children with recurrent brain tumors.  
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Certificate of Attendance
    This activity was designated for 1.00 AMA PRA Category 1 Credit™.
Course opens: 
07/09/2024
Course expires: 
07/08/2026
Cost:
$0.00
Rating: 
0
  • Derek S.C. Tsang, MD, MSc, FRCPC, is employed by Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network. 
  • Thomas E. Merchant, DO, PhD, is employed by St. Jude Children's Research Hospital. Dr. Merchant serves as Chair of the Radiation Oncology Department at St. Jude. 
  • Sarah A. Milgrom, MD, is employed by the University of Colorado School of Medicine. Dr. Milgrom is Vice Chair of the Appropriate Use Criteria Lymphoma Committee of the American Radium Society. Dr. Milgrom serves as a consultant (non-compensated) for Bristol Myers Squibb.   
  • Natalie Logie, MD, is employed by Alberta Health Services, University of Calgary. 

The person(s) above served as the developer(s) of this activity. Additionally, the Education Committee had control over the content of this activity. All relevant relationships have been mitigated.

Disclosure link: 
Committee Disclosures

The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council of Continuing Medical Education to provide continuing education to physicians.

ASTRO is awarded Deemed Status by the American Board of Radiology to provide SA-CME as part of Part II Maintenance of Certification. 

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  • 1.00 Certificate of Attendance
    This activity was designated for 1.00 AMA PRA Category 1 Credit™.

Price

Cost:
$0.00
Please login or register to take this course.

Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.

Nonmember: $149
Member: $99
Member-in-training: $49
Student/Grad Student/PGY: $49
Postdoctoral Fellow: $49
 

Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the course by the end of the qualification date. The qualification date for each course is listed in the course catalog on the ASTRO website under availability.

Participants using ASTRO's online courses to satisfy the requirement of a Maintenance of Certification (MOC) program should verify the number, type and availability dates of any course before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased courses that do not align with their MOC requirement.

The course and its materials will only be available on the ASTRO website until July 8, 2026, regardless of purchase date. At the expiration of the qualification, participants will no longer have access to the course or its materials. ASTRO reserves the right to remove a course before the end of its qualification period.

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