S1023
Clinical – Paediatric tumours
ESTRO 2026
dose parameters, refine patient selection criteria, optimize fractionation schedules, and evaluate long- term efficacy, safety, neurocognitive outcomes, and quality-of-life measures. References: 1. Asklid A, et al. Reirradiation in Paediatric Tumours of the Central Nervous System: Outcome and Side Effects After Implementing National Guidelines. Clin Oncol (R Coll Radiol). 2025 Jan;37:103667. doi: 10.1016/j.clon.2024.103667. Epub 2024 Oct 28. PMID: 39571206.2. Shariff N, et al. Re-irradiation for children with diffuse intrinsic pontine glioma and diffuse midline glioma. Radiother Oncol. 2025 Jun;207:110865. doi: 10.1016/j.radonc.2025.110865. Epub 2025 Mar 24. PMID: 40139463.3. Lu VM, et al. Reirradiation for diffuse intrinsic pontine glioma: a systematic review and meta-analysis. Childs Nerv Syst. 2019 May;35(5):739-746. doi: 10.1007/s00381-019-04118-y. Epub 2019 Mar 16. PMID: 30879125. Keywords: Paediatric; Reirradiation; Cumulative dose. Survival outcomes of low-risk WNT-pathway medulloblastoma treated with de-escalated radiotherapy followed by adjuvant systemic chemotherapy Tejpal Gupta 1 , Simran Gulati 1 , Archya Dasgupta 1 , Abhishek Chatterjee 1 , Savita Goswami 2 , Jayita Deodhar 2 , Sridhar Epari 3 , Arpita Sahu 4 , Aliasgar Moiyadi 5 , Maya Prasad 6 , Girish Chinnaswamy 6 1 Radiation Oncology, Tata Memorial Centre, Mumbai, India. 2 Psycho-Oncology, Tata Memorial Centre, Mumbai, India. 3 Pathology, Tata Memorial Centre, Mumbai, India. 4 Radio-diagnosis, Tata Memorial Centre, Mumbai, India. 5 Neurosurgery, Tata Memorial Centre, Mumbai, India. 6 Pediatric Oncology, Tata Memorial Centre, Mumbai, India Purpose/Objective: Wingless (WNT) pathway medulloblastoma in children is associated with excellent survival with maximal safe resection followed by standard-of-care post-operative radio-chemotherapy. However, such contemporary multi-modality therapy is associated with substantial long-term treatment-related toxicities. De-escalation strategies are being tested in WNT-subgroup medulloblastoma to improve functional outcomes by reducing long-term sequelae without compromising survival. We have previously reported suboptimal survival in low-risk WNT-pathway medulloblastoma treated with focal radiotherapy alone plus systemic chemotherapy with omission of upfront CSI. This is our single-institution successor study testing the safety and efficacy of low dose craniospinal irradiation (CSI) plus focal tumor-bed boost in this favorable Proffered Paper 4510
Conclusion: Re-irradiation using modern conformal techniques is a feasible and safe therapeutic approach for recurrent pediatric brain tumors when appropriate cumulative dose management is implemented. This strategy maintains organ-at-risk tolerances within acceptable limits and is associated with minimal acute toxicity. Re- irradiation represents a potential treatment option for carefully selected cases of recurrent/progressive disease. Further prospective studies with larger patient populations are needed to establish optimal
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