3D conformal radiation therapy (3DCRT) and intensity-modulated radiation therapy (IMRT) are both commonly utilized for pediatric brain tumors. 3DCRT has been available for a longer period. There is protracted follow-up on patients treated with 3DCRT. IMRT is a newer technology that developed in parallel with advances in other radiation delivery such as image guidance. Similar tumor coverage can be either 3DCRT or IMRT. They differ in the ability to achieve conformity around irregularly volumes. IMRT can achieve highly conformal plans although intense modulation can impact dose homogeneity. VMAT is a form of IMRT rotational. The addition of static or rotational beams can expose nontarget tissue to lose dose radiation. The balance of tumor coverage and dose homogeneity against the impact of collateral radiation to nontarget tissues impacting neurocognitive functioning for cranial radiation or anticipated renal and cardiopulmonary function in craniospinal radiation is the main factor in deciding what the optimal photon radiation treatment is for pediatric CNS tumors.
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