{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T21:40:04Z","timestamp":1788471604134,"version":"build-2803163510"},"reference-count":57,"publisher":"Bioscientifica","issue":"9","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["ec.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,8,11]]},"abstract":"<jats:p>Multimodality cancer therapy has led to remarkable improvements in survival of childhood and young adult cancer, with survival rates exceeding 85%. Such remission rates come with their own adverse sequelea or \u2018late effects\u2019. Although the cause of these late effects is multi-factorial, radiation-related adverse effects are one of the most prevalent. Hypopituitarism is a recognised complication of irradiation of brain tumours distant to the hypothalamo-pituitary (HP) axis when the axis is included within the exposed field. Much of the data concerning the development of hypopituitarism, however, relate to early forms of photon-based radiotherapy. In this narrative review, we discuss advances in individual radiotherapy techniques currently used in treating brain tumours and their theoretical benefits based primarily on dosimetric studies. Increasingly precise radiation techniques, including advances in the delivery of photons (i.e. intensity-modulated radiotherapy) and proton beam therapy, are now available options. The premise behind these newer techniques is to reduce the dose and volume of normal tissue irradiated whilst maintaining an effective radiation dose to target tissue. When treating brain tumours distant to the HP axis the expectation, based upon dosimetric studies, is that newer forms of radiotherapy will less frequently involve the HP axis in the exposed field, and where incorporated within the field it will be exposed to a lower radiotherapy dosage. Intuitively the dosimetric studies should translate into significant reductions in the prevalence of HP dysfunction. These data are promising; however, to date there are minimal robust clinical data to determine if the theoretical benefits of these newer techniques on HP dysfunction is to be realised.<\/jats:p>","DOI":"10.1530\/ec-22-0490","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T16:31:47Z","timestamp":1689352307000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":10,"title":["The impact of radiotherapy on the hypothalamo-pituitary axis: old vs new radiotherapy techniques"],"prefix":"10.1530","volume":"12","author":[{"given":"David S","family":"McLaren","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospital NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aarani","family":"Devi","sequence":"additional","affiliation":[{"name":"Clinical Oncology, Leeds Cancer Centre, Leeds Teaching Hospital NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Kyriakakis","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospital NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Kwok-Williams","sequence":"additional","affiliation":[{"name":"Clinical Oncology, Leeds Cancer Centre, Leeds Teaching Hospital NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6730-6109","authenticated-orcid":true,"given":"Robert D","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Leeds Centre for Diabetes & Endocrinology, Leeds Teaching Hospital NHS Trust, Leeds, UK"},{"name":"Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Children, teenagers and young adults. UK cancer statistics report 2021","year":"2021","unstructured":"Public Health England. Children, teenagers and young adults. UK cancer statistics report 2021. London, UK: National Cancer Registration and Analysis Service for England, 2021. (available at: http:\/\/www.ncin.org.uk\/cancer_type_and_topic_specific_work\/cancer_type_specific_work\/cancer_in_children_teenagers_and_young_adults\/)"},{"key":"bib2","series-title":"Journal of Cancer Policy","first-page":"17","article-title":"The SIOPE strategic plan: a European cancer plan for children and adolescents","volume":"8","author":"Vassal","year":"2016","unstructured":"Vassal GSchrappe MPritchard-Jones KArnold FBasset LBiondi ABode GEggert AHjorth LKameric L, The SIOPE strategic plan: a European cancer plan for children and adolescents. Journal of Cancer Policy2016817\u201332. (https:\/\/doi.org\/10.1016\/j.jcpo.2016.03.007)"},{"key":"bib3","series-title":"New England Journal of Medicine","first-page":"1572","article-title":"Chronic health conditions in adult survivors of childhood cancer","volume":"355","author":"Oeffinger","year":"2006","unstructured":"Oeffinger KCMertens ACSklar CAKawashima THudson MMMeadows ATFriedman DLMarina NHobbie WKadan-Lottick NS, Chronic health conditions in adult survivors of childhood cancer. New England Journal of Medicine20063551572\u20131582. (https:\/\/doi.org\/10.1056\/NEJMsa060185)"},{"key":"bib4","series-title":"Journal of the National Cancer Institute","first-page":"1368","article-title":"Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study","volume":"100","author":"Mertens","year":"2008","unstructured":"Mertens ACLiu QNeglia JPWasilewski KLeisenring WArmstrong GTRobison LL & Yasui Y. Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. Journal of the National Cancer Institute20081001368\u20131379. (https:\/\/doi.org\/10.1093\/jnci\/djn310)"},{"key":"bib5","series-title":"Journal of the National Cancer Institute","first-page":"946","article-title":"Long-term outcomes among adult survivors of childhood central nervous system malignancies in the Childhood Cancer Survivor Study","volume":"101","author":"Armstrong","year":"2009","unstructured":"Armstrong GTLiu QYasui YHuang SNess KKLeisenring WHudson MMDonaldson SSKing AAStovall M, Long-term outcomes among adult survivors of childhood central nervous system malignancies in the Childhood Cancer Survivor Study. Journal of the National Cancer Institute2009101946\u2013958. (https:\/\/doi.org\/10.1093\/jnci\/djp148)"},{"key":"bib6","series-title":"Cancer","first-page":"663","article-title":"Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: childhood Cancer Survivor Study","volume":"97","author":"Gurney","year":"2003","unstructured":"Gurney JGKadan-Lottick NSPacker RJNeglia JPSklar CAPunyko JAStovall MYasui YNicholson HSWolden S, Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors: childhood Cancer Survivor Study. Cancer200397663\u2013673. (https:\/\/doi.org\/10.1002\/cncr.11095)"},{"key":"bib7","series-title":"Journal of Clinical Oncology","first-page":"5277","article-title":"Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study","volume":"24","author":"Bowers","year":"2006","unstructured":"Bowers DCLiu YLeisenring WMcNeil EStovall MGurney JGRobison LLPacker RJ & Oeffinger KC. Late-occurring stroke among long-term survivors of childhood leukemia and brain tumors: a report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology2006245277\u20135282. (https:\/\/doi.org\/10.1200\/JCO.2006.07.2884)"},{"key":"bib8","series-title":"BMJ","first-page":"271","article-title":"Developing strategies for long term follow up of survivors of childhood cancer","volume":"323","author":"Wallace","year":"2001","unstructured":"Wallace WHBlacklay AEiser CDavies HHawkins MLevitt GAJenney ME & Late Effects Committee of the United Kingdom Children's Cancer Study Group (UKCCSG). Developing strategies for long term follow up of survivors of childhood cancer. BMJ2001323271\u2013274. (https:\/\/doi.org\/10.1136\/bmj.323.7307.271)"},{"key":"bib9","series-title":"Journal of Clinical Endocrinology and Metabolism","article-title":"Is chemotherapy implicated in the development of hypopituitarism in childhood cancer survivors?","volume":"105","author":"Seejore","year":"2020","unstructured":"Seejore KKyriakakis N & Murray RD. Is chemotherapy implicated in the development of hypopituitarism in childhood cancer survivors?Journal of Clinical Endocrinology and Metabolism2020105. (https:\/\/doi.org\/10.1210\/clinem\/dgz132)"},{"key":"bib10","series-title":"Clinical Endocrinology","first-page":"191","article-title":"Cranial radiotherapy of childhood brain tumours: growth hormone deficiency and its relation to the biological effective dose of irradiation in a large population based study","volume":"53","author":"Schmiegelow","year":"2000","unstructured":"Schmiegelow MLassen SPoulsen HSFeldt-Rasmussen USchmiegelow KHertz H & Muller J. Cranial radiotherapy of childhood brain tumours: growth hormone deficiency and its relation to the biological effective dose of irradiation in a large population based study. Clinical Endocrinology200053191\u2013197. (https:\/\/doi.org\/10.1046\/j.1365-2265.2000.01079.x)"},{"key":"bib11","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"3888","article-title":"Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline","volume":"101","author":"Fleseriu","year":"2016","unstructured":"Fleseriu MHashim IAKaravitaki NMelmed SMurad MHSalvatori R & Samuels MH. Hormonal replacement in hypopituitarism in adults: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism20161013888\u20133921. (https:\/\/doi.org\/10.1210\/jc.2016-2118)"},{"key":"bib12","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"6101","article-title":"Hypothalamic-pituitary disorders in childhood cancer survivors: prevalence, risk factors and long-term health outcomes","volume":"104","author":"van Lersel","year":"2019","unstructured":"van Lersel LLi ZSrivastava DKBrinkman TMBjornard KLWilson CLGreen DMMerchant TEPui CHHowell RM, Hypothalamic-pituitary disorders in childhood cancer survivors: prevalence, risk factors and long-term health outcomes. Journal of Clinical Endocrinology and Metabolism20191046101\u20136115. (https:\/\/doi.org\/10.1210\/jc.2019-00834)"},{"key":"bib13","series-title":"Clinical Endocrinology","first-page":"372","article-title":"Pituitary dysfunction following cranial radiotherapy for adult-onset nonpituitary brain tumours","volume":"84","author":"Kyriakakis","year":"2016","unstructured":"Kyriakakis NLynch JOrme SMGerrard GHatfield PLoughrey CShort SC & Murray RD. Pituitary dysfunction following cranial radiotherapy for adult-onset nonpituitary brain tumours. Clinical Endocrinology201684372\u2013379. (https:\/\/doi.org\/10.1111\/cen.12969)"},{"key":"bib14","series-title":"New England Journal of Medicine","first-page":"87","article-title":"Hypothalamic-pituitary dysfunction after radiation for brain tumors","volume":"328","author":"Constine","year":"1993","unstructured":"Constine LSWoolf PDCann DMick GMcCormick KRaubertas RF & Rubin P. Hypothalamic-pituitary dysfunction after radiation for brain tumors. New England Journal of Medicine199332887\u201394. (https:\/\/doi.org\/10.1056\/NEJM199301143280203)"},{"key":"bib15","series-title":"Clinical Endocrinology","first-page":"131","article-title":"Hypothalamic-pituitary axis irradiation dose thresholds for the development of hypopituitarism in adult-onset gliomas","volume":"91","author":"Kyriakakis","year":"2019","unstructured":"Kyriakakis NLynch JOrme SMGerrard GHatfield PShort SCLoughrey C & Murray RD. Hypothalamic-pituitary axis irradiation dose thresholds for the development of hypopituitarism in adult-onset gliomas. Clinical Endocrinology201991131\u2013140. (https:\/\/doi.org\/10.1111\/cen.13971)"},{"key":"bib16","series-title":"Endocrine Reviews","first-page":"794","article-title":"Hypothalamic-pituitary and other endocrine surveillance among childhood cancer survivors","volume":"43","author":"van Lersel","year":"2022","unstructured":"van Lersel LMulder RLDenzer CCohen LESpoudeas HAMeacham LRSugden ESchouten-van Meeteren AYNHoving EWPacker RJ, Hypothalamic-pituitary and other endocrine surveillance among childhood cancer survivors. Endocrine Reviews202243794\u2013823. (https:\/\/doi.org\/10.1210\/endrev\/bnab040)"},{"key":"bib17","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"5183","article-title":"Endocrine and metabolic disorders in survivors of childhood cancers and health-related quality of life and physical activity","volume":"104","author":"Pradhan","year":"2019","unstructured":"Pradhan KRChen YMoustoufi-Moab SKrull KOeffinger KCSklar CArmstrong GTNess KKRobison LYasui Y, Endocrine and metabolic disorders in survivors of childhood cancers and health-related quality of life and physical activity. Journal of Clinical Endocrinology and Metabolism20191045183\u20135194. (https:\/\/doi.org\/10.1210\/jc.2019-00627)"},{"key":"bib18","series-title":"Journal of Clinical Oncology","first-page":"2356","article-title":"Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort","volume":"27","author":"Meadows","year":"2009","unstructured":"Meadows ATFriedman DLNeglia JPMertens ACDonaldson SSStovall MHammond SYasui Y & Inskip PD. Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort. Journal of Clinical Oncology2009272356\u20132362. (https:\/\/doi.org\/10.1200\/JCO.2008.21.1920)"},{"key":"bib19","series-title":"International Journal of Hematology","first-page":"95","article-title":"Late effects and quality of life of childhood cancer survivors: Part 2. Impact of radiotherapy","volume":"92","author":"Ishida","year":"2010","unstructured":"Ishida YSakamoto NKamibeppu KKakee NIwai TOzono SMaeda NOkamura JAsami KInada H, Late effects and quality of life of childhood cancer survivors: Part 2. Impact of radiotherapy. International Journal of Hematology20109295\u2013104. (https:\/\/doi.org\/10.1007\/s12185-010-0611-z)"},{"key":"bib20","series-title":"Bulletin du Cancer","first-page":"571","article-title":"New radiation techniques in paediatric cancers","volume":"98","author":"Claude","year":"2011","unstructured":"Claude LTodisco LLeseur JLaprie AAlapetite C & Bernier V. New radiation techniques in paediatric cancers. Bulletin du Cancer201198571\u2013580. (https:\/\/doi.org\/10.1684\/bdc.2011.1350)"},{"key":"bib21","series-title":"Archives of Neurology","first-page":"642","article-title":"Harvey Cushing and medulloblastoma","volume":"59","author":"Kunschner","year":"2002","unstructured":"Kunschner LJ. Harvey Cushing and medulloblastoma. Archives of Neurology200259642\u2013645. (https:\/\/doi.org\/10.1001\/archneur.59.4.642)"},{"key":"bib22","series-title":"Lancet. Oncology","first-page":"e91","article-title":"Prevention of radiotherapy-induced neurocognitive dysfunction in survivors of paediatric brain tumours: the potential role of modern imaging and radiotherapy techniques","volume":"18","author":"Ajithkumar","year":"2017","unstructured":"Ajithkumar TPrice SHoran GBurke A & Jefferies S. Prevention of radiotherapy-induced neurocognitive dysfunction in survivors of paediatric brain tumours: the potential role of modern imaging and radiotherapy techniques. Lancet. Oncology201718e91\u2013e100. (https:\/\/doi.org\/10.1016\/S1470-2045(1730030-X)"},{"key":"bib23","series-title":"International Journal of Radiation Oncology, Biology, Physics","first-page":"e151","article-title":"Historical trends in the use of radiation therapy for pediatric cancers: 1973\u20132008","volume":"85","author":"Jairam","year":"2013","unstructured":"Jairam VRoberts KB & Yu JB. Historical trends in the use of radiation therapy for pediatric cancers: 1973\u20132008. International Journal of Radiation Oncology, Biology, Physics201385e151\u2013e155. (https:\/\/doi.org\/10.1016\/j.ijrobp.2012.10.007)"},{"key":"bib24","series-title":"Cancer Imaging","first-page":"68","article-title":"Intensity-modulated radiotherapy--what is it?","volume":"4","author":"Taylor","year":"2004","unstructured":"Taylor A & Powell ME. Intensity-modulated radiotherapy--what is it?Cancer Imaging2004468\u201373. (https:\/\/doi.org\/10.1102\/1470-7330.2004.0003)"},{"key":"bib25","series-title":"Nature Reviews. Cancer","first-page":"737","article-title":"Radiation oncology: a century of achievements","volume":"4","author":"Bernier","year":"2004","unstructured":"Bernier JHall EJ & Giaccia A. Radiation oncology: a century of achievements. Nature Reviews. Cancer20044737\u2013747. (https:\/\/doi.org\/10.1038\/nrc1451)"},{"key":"bib26","series-title":"International Journal of Radiation Oncology, Biology, Physics","first-page":"1598","article-title":"Treatment planning and delivery of external beam radiotherapy for pediatric sarcoma: the St. Jude Children's Research Hospital experience","volume":"70","author":"Hua","year":"2008","unstructured":"Hua CGray JMMerchant TEKun LE & Krasin MJ. Treatment planning and delivery of external beam radiotherapy for pediatric sarcoma: the St. Jude Children's Research Hospital experience. International Journal of Radiation Oncology, Biology, Physics2008701598\u20131606. (https:\/\/doi.org\/10.1016\/j.ijrobp.2007.12.013)"},{"key":"bib27","series-title":"British Journal of Radiology","first-page":"967","article-title":"Volumetric modulated arc therapy: a review of current literature and clinical use in practice","volume":"84","author":"Teoh","year":"2011","unstructured":"Teoh MClark CHWood KWhitaker S & Nisbet A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. British Journal of Radiology201184967\u2013996. (https:\/\/doi.org\/10.1259\/bjr\/22373346)"},{"key":"bib28","series-title":"International Journal of Radiation Oncology, Biology, Physics","first-page":"17","article-title":"Intensity modulated radiation therapy and second cancer risk in adults","volume":"100","author":"Filippi","year":"2018","unstructured":"Filippi ARVanoni VMeduri BCozzi LScorsetti MRicardi U & Lohr F. Intensity modulated radiation therapy and second cancer risk in adults. International Journal of Radiation Oncology, Biology, Physics201810017\u201320. (https:\/\/doi.org\/10.1016\/j.ijrobp.2017.09.039)"},{"key":"bib29","series-title":"Radiology","first-page":"487","article-title":"Radiological use of fast protons","volume":"47","author":"Wilson","year":"1946","unstructured":"Wilson RR. Radiological use of fast protons. Radiology194647487\u2013491. (https:\/\/doi.org\/10.1148\/47.5.487)"},{"key":"bib30","series-title":"Cancer Research","first-page":"121","article-title":"Pituitary irradiation with high-energy proton beams: a preliminary report","volume":"18","author":"Lawrence","year":"1958","unstructured":"Lawrence JHTobias CABorn JLMcCombs RKRoberts JEAnger HOLow-Beer BV & Huggins CB. Pituitary irradiation with high-energy proton beams: a preliminary report. Cancer Research195818121\u2013134."},{"key":"bib31","series-title":"International Journal of Radiation Oncology, Biology, Physics","first-page":"1219","article-title":"Conformal proton radiation therapy of the posterior fossa: a study comparing protons with three-dimensional planned photons in limiting dose to auditory structures","volume":"48","author":"Lin","year":"2000","unstructured":"Lin RHug EBSchaefer RAMiller DWSlater JM & Slater JD. Conformal proton radiation therapy of the posterior fossa: a study comparing protons with three-dimensional planned photons in limiting dose to auditory structures. International Journal of Radiation Oncology, Biology, Physics2000481219\u20131226. (https:\/\/doi.org\/10.1016\/s0360-3016(0000741-0)"},{"key":"bib32","series-title":"Radiation Oncology","first-page":"58","article-title":"Low early ototoxicity rates for pediatric medulloblastoma patients treated with proton radiotherapy","volume":"6","author":"Moeller","year":"2011","unstructured":"Moeller BJChintagumpala MPhilip JJGrosshans DRMcAleer MFWoo SYGidley PWVats TS & Mahajan A. Low early ototoxicity rates for pediatric medulloblastoma patients treated with proton radiotherapy. Radiation Oncology2011658. (https:\/\/doi.org\/10.1186\/1748-717X-6-58)"},{"key":"bib33","series-title":"British Journal of Radiology","first-page":"20190601","article-title":"Paediatric proton therapy","volume":"93","author":"Thomas","year":"2020","unstructured":"Thomas H & Timmermann B. Paediatric proton therapy. British Journal of Radiology20209320190601. (https:\/\/doi.org\/10.1259\/bjr.20190601)"},{"key":"bib34","series-title":"Radiotherapy and Oncology","first-page":"267","article-title":"Selection of patients for radiotherapy with protons aiming at reduction of side effects: the model-based approach","volume":"107","author":"Langendijk","year":"2013","unstructured":"Langendijk JALambin PDe Ruysscher DWidder JBos M & Verheij M. Selection of patients for radiotherapy with protons aiming at reduction of side effects: the model-based approach. Radiotherapy and Oncology2013107267\u2013273. (https:\/\/doi.org\/10.1016\/j.radonc.2013.05.007)"},{"key":"bib35","series-title":"Clinical Commissioning Policy: Proton Beam Therapy for Children, Teenagers and Young Adults in the Treatment of Malignant and Non-malignant Tumours","year":"2020","unstructured":"NHS England. Clinical Commissioning Policy: Proton Beam Therapy for Children, Teenagers and Young Adults in the Treatment of Malignant and Non-malignant Tumours. Leeds, UK: NHS England2020. (available at: https:\/\/www.england.nhs.uk\/publication\/proton-beam-therapy-for-children-teenagers-and-young-adults-in-the-treatment-of-malignant-and-non-malignant-tumours\/)"},{"key":"bib36","series-title":"Radiotherapy and Oncology","first-page":"89","article-title":"Quality of life outcomes in proton and photon treated pediatric brain tumor survivors","volume":"113","author":"Yock","year":"2014","unstructured":"Yock TIBhat SSzymonifka JYeap BYDelahaye JDonaldson SSMacDonald SMPulsifer MBHill KSDeLaney TF, Quality of life outcomes in proton and photon treated pediatric brain tumor survivors. Radiotherapy and Oncology201411389\u201394. (https:\/\/doi.org\/10.1016\/j.radonc.2014.08.017)"},{"key":"bib37","series-title":"Radiotherapy and Oncology","first-page":"128","article-title":"Ototoxicity and cochlear sparing in children with medulloblastoma: proton vs. photon radiotherapy","volume":"128","author":"Paulino","year":"2018","unstructured":"Paulino ACMahajan AYe RGrosshans DRFatih Okcu MSu JMcAleer MFMcGovern SMangona VA & Chintagumpala M. Ototoxicity and cochlear sparing in children with medulloblastoma: proton vs. photon radiotherapy. Radiotherapy and Oncology2018128128\u2013132. (https:\/\/doi.org\/10.1016\/j.radonc.2018.01.002)"},{"key":"bib38","series-title":"International Journal of Radiation Oncology, Biology, Physics","first-page":"133","article-title":"Clinical outcomes among children with standard-risk medulloblastoma treated with proton and photon radiation therapy: a comparison of disease control and overall survival","volume":"94","author":"Eaton","year":"2016","unstructured":"Eaton BREsiashvili NKim SWeyman EAThornton LTMazewski CMacDonald TEbb DMacDonald SMTarbell NJ, Clinical outcomes among children with standard-risk medulloblastoma treated with proton and photon radiation therapy: a comparison of disease control and overall survival. International Journal of Radiation Oncology, Biology, Physics201694133\u2013138. (https:\/\/doi.org\/10.1016\/j.ijrobp.2015.09.014)"},{"key":"bib39","series-title":"Lancet. Oncology","first-page":"287","article-title":"Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: a phase 2 single-arm study","volume":"17","author":"Yock","year":"2016","unstructured":"Yock TIYeap BYEbb DHWeyman EEaton BRSherry NAJones RMMacDonald SMPulsifer MBLavally B, Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: a phase 2 single-arm study. Lancet. Oncology201617287\u2013298. (https:\/\/doi.org\/10.1016\/S1470-2045(1500167-9)"},{"key":"bib40","series-title":"Cancer","first-page":"2570","article-title":"Progression-free survival of children with localized ependymoma treated with intensity-modulated radiation therapy or proton-beam radiation therapy","volume":"123","author":"Sato","year":"2017","unstructured":"Sato MGunther JRMahajan AJo EPaulino ACAdesina AMJones JYKetonen LMSu JMOkcu MF, Progression-free survival of children with localized ependymoma treated with intensity-modulated radiation therapy or proton-beam radiation therapy. Cancer20171232570\u20132578. (https:\/\/doi.org\/10.1002\/cncr.30623)"},{"key":"bib41","series-title":"Frontiers in Oncology","first-page":"440","article-title":"Proton vs. photon radiation therapy for Primary gliomas: an Analysis of the National Cancer Data Base","volume":"8","author":"Jhaveri","year":"2018","unstructured":"Jhaveri JCheng ETian SBuchwald ZChowdhary MLiu YGillespie TWOlson JJDiaz AZVoloschin A, Proton vs. photon radiation therapy for Primary gliomas: an Analysis of the National Cancer Data Base. Frontiers in Oncology20188440. (https:\/\/doi.org\/10.3389\/fonc.2018.00440)"},{"key":"bib42","series-title":"Cancer","first-page":"1712","article-title":"Proton therapy for low-grade gliomas: results from a prospective trial","volume":"121","author":"Shih","year":"2015","unstructured":"Shih HASherman JCNachtigall LBColvin MKFullerton BCDaartz JWinrich BKBatchelor TTThornton LTMancuso SM, Proton therapy for low-grade gliomas: results from a prospective trial. Cancer20151211712\u20131719. (https:\/\/doi.org\/10.1002\/cncr.29237)"},{"key":"bib43","series-title":"Pediatric Blood and Cancer","first-page":"1431","article-title":"Acute toxicity of proton beam radiation for pediatric central nervous system malignancies","volume":"60","author":"Suneja","year":"2013","unstructured":"Suneja GPoorvu PDHill-Kayser C & Lustig RA. Acute toxicity of proton beam radiation for pediatric central nervous system malignancies. Pediatric Blood and Cancer2013601431\u20131436. (https:\/\/doi.org\/10.1002\/pbc.24554)"},{"key":"bib44","series-title":"International Journal of Radiation Oncology, Biology, Physics","first-page":"149","article-title":"Outcomes following proton therapy for pediatric low-grade glioma","volume":"104","author":"Indelicato","year":"2019","unstructured":"Indelicato DJRotondo RLUezono HSandler ESAldana PRRanalli NJBeier ADMorris CG & Bradley JA. Outcomes following proton therapy for pediatric low-grade glioma. International Journal of Radiation Oncology, Biology, Physics2019104149\u2013156. (https:\/\/doi.org\/10.1016\/j.ijrobp.2019.01.078)"},{"key":"bib45","series-title":"Acta Oncologica","first-page":"1298","article-title":"Incidence and dosimetric parameters of pediatric brainstem toxicity following proton therapy","volume":"53","author":"Indelicato","year":"2014","unstructured":"Indelicato DJFlampouri SRotondo RLBradley JAMorris CGAldana PRSandler E & Mendenhall NP. Incidence and dosimetric parameters of pediatric brainstem toxicity following proton therapy. Acta Oncologica2014531298\u20131304. (https:\/\/doi.org\/10.3109\/0284186X.2014.957414)"},{"key":"bib46","series-title":"International Journal of Radiation Oncology, Biology, Physics","first-page":"929","article-title":"Radiosurgery in the management of pediatric brain tumors","volume":"50","author":"Hodgson","year":"2001","unstructured":"Hodgson DCGoumnerova LCLoeffler JSDutton SBlack PMAlexander E3rdXu RKooy HSilver B & Tarbell NJ. Radiosurgery in the management of pediatric brain tumors. International Journal of Radiation Oncology, Biology, Physics200150929\u2013935. (https:\/\/doi.org\/10.1016\/s0360-3016(0101518-8)"},{"key":"bib47","series-title":"Stereora","year":"2019","unstructured":"NHS England Radiotherapy Clinical Reference Group. Stereoradiosurgery and Steroeotactic Radiotherapy (Intracranial) (All Ages). London, UK: NHS England, 2019. (available at: https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2019\/04\/SRS-SRT-Intracranial.pdf)"},{"key":"bib48","series-title":"Bioengineering (Basel)","article-title":"Radiotherapy advances in pediatric neuro-oncology","volume":"5","author":"Ludmir","year":"2018","unstructured":"Ludmir EBGrosshans DR & Woodhouse KD. Radiotherapy advances in pediatric neuro-oncology. Bioengineering (Basel)20185. (https:\/\/doi.org\/10.3390\/bioengineering5040097)"},{"key":"bib49","series-title":"Radiotherapy and Oncology","first-page":"269","article-title":"Efficacy and feasibility of stereotactic radiosurgery in the primary management of unfavorable pediatric ependymoma","volume":"43","author":"Aggarwal","year":"1997","unstructured":"Aggarwal RYeung DKumar PMuhlbauer M & Kun LE. Efficacy and feasibility of stereotactic radiosurgery in the primary management of unfavorable pediatric ependymoma. Radiotherapy and Oncology199743269\u2013273. (https:\/\/doi.org\/10.1016\/s0167-8140(9701926-9)"},{"key":"bib50","series-title":"Clinical Endocrinology","first-page":"663","article-title":"Endocrine sequelae beyond 10 years in survivors of medulloblastoma","volume":"83","author":"Uday","year":"2015","unstructured":"Uday SMurray RDPicton SChumas PRaju MChandwani M & Alvi S. Endocrine sequelae beyond 10 years in survivors of medulloblastoma. Clinical Endocrinology201583663\u2013670. (https:\/\/doi.org\/10.1111\/cen.12815)"},{"key":"bib51","series-title":"Neuro-Oncology","first-page":"881","article-title":"Endocrine outcomes with proton and photon radiotherapy for standard risk medulloblastoma","volume":"18","author":"Eaton","year":"2016","unstructured":"Eaton BREsiashvili NKim SPatterson BWeyman EAThornton LTMazewski CMacDonald TJEbb DMacDonald SM, Endocrine outcomes with proton and photon radiotherapy for standard risk medulloblastoma. Neuro-Oncology201618881\u2013887. (https:\/\/doi.org\/10.1093\/neuonc\/nov302)"},{"key":"bib52","series-title":"Journal of Neuro-Oncology","first-page":"93","article-title":"Comparison of hypothyroidism, growth hormone deficiency, and adrenal insufficiency following proton and photon radiotherapy in children with medulloblastoma","volume":"155","author":"Aldrich","year":"2021","unstructured":"Aldrich KDHorne VEBielamowicz KSonabend RYScheurer MEPaulino ACMahajan AChintagumpala MOkcu MF & Brown AL. Comparison of hypothyroidism, growth hormone deficiency, and adrenal insufficiency following proton and photon radiotherapy in children with medulloblastoma. Journal of Neuro-Oncology202115593\u2013100. (https:\/\/doi.org\/10.1007\/s11060-021-03847-y)"},{"key":"bib53","series-title":"Pediatric Hematology and Oncology","first-page":"257","article-title":"Hypothyroidism after craniospinal irradiation with proton or photon therapy in patients with medulloblastoma","volume":"35","author":"Bielamowicz","year":"2018","unstructured":"Bielamowicz KOkcu MFSonabend RPaulino ACHilsenbeck SGDreyer ZSuzawa HBryant RAdesina ADauser R, Hypothyroidism after craniospinal irradiation with proton or photon therapy in patients with medulloblastoma. Pediatric Hematology and Oncology201835257\u2013267. (https:\/\/doi.org\/10.1080\/08880018.2018.1471111)"},{"key":"bib54","series-title":"Acta Oncologica","first-page":"1031","article-title":"A review of dosimetric and toxicity modeling of proton versus photon craniospinal irradiation for pediatrics medulloblastoma","volume":"56","author":"Ho","year":"2017","unstructured":"Ho ESQBarrett SA & Mullaney LM. A review of dosimetric and toxicity modeling of proton versus photon craniospinal irradiation for pediatrics medulloblastoma. Acta Oncologica2017561031\u20131042. (https:\/\/doi.org\/10.1080\/0284186X.2017.1324207)"},{"key":"bib55","series-title":"Neuro-Oncology","first-page":"1552","article-title":"Proton radiotherapy for pediatric central nervous system ependymoma: clinical outcomes for 70 patients","volume":"15","author":"Macdonald","year":"2013","unstructured":"Macdonald SMSethi RLavally BYeap BYMarcus KJCaruso PPulsifer MHuang MEbb DTarbell NJ, Proton radiotherapy for pediatric central nervous system ependymoma: clinical outcomes for 70 patients. Neuro-Oncology2013151552\u20131559. (https:\/\/doi.org\/10.1093\/neuonc\/not121)"},{"key":"bib56","series-title":"JAMA Oncology","first-page":"1368","article-title":"Efficacy of stereotactic conformal radiotherapy vs conventional radiotherapy on benign and low-grade brain tumors: a randomized clinical trial","volume":"3","author":"Jalali","year":"2017","unstructured":"Jalali RGupta TGoda JSGoswami SShah NDutta DKrishna UDeodhar JMenon PKannan S, Efficacy of stereotactic conformal radiotherapy vs conventional radiotherapy on benign and low-grade brain tumors: a randomized clinical trial. JAMA Oncology201731368\u20131376. (https:\/\/doi.org\/10.1001\/jamaoncol.2017.0997)"},{"key":"bib57","series-title":"Acta Oncologica","first-page":"415","article-title":"Visual outcome, endocrine function and tumor control after fractionated stereotactic radiation therapy of craniopharyngiomas in adults: findings in a prospective cohort","volume":"56","author":"Astradsson","year":"2017","unstructured":"Astradsson AMunck Af Rosensch\u00f6ld PFeldt-Rasmussen UPoulsgaard LWiencke AKOhlhues LEngelholm SABroholm HHansen M\u00f8ller EKlose M, Visual outcome, endocrine function and tumor control after fractionated stereotactic radiation therapy of craniopharyngiomas in adults: findings in a prospective cohort. Acta Oncologica201756415\u2013421. 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