Craniospinal Irradiation using Proton Beam Scanning with Vertebral Body Sparing in Improving Marrow Reserve and Decreasing Growth Decrement in Children with Brain Tumors

Inclusion Criteria

• Age ≥ 3 years and ≤ 18 years at the time of registration
• Histologically proven malignancy necessitating cranio-spinal irradiation; this will include patients with a diagnosis of medulloblastoma, supratentorial primitive neuroectodermal tumor (SPNET), disseminated ependymoma, embryonal tumor with abundant neuropil and true rosettes (ETANTR), atypical teratoid/rhabdoid tumor (ATRT), and disseminated low-grade glioma (LGG) or histologically confirmed germ cell tumor or elevated alpha-fetoprotein (AFP) (serum > 10 IU/L or cerebrospinal fluid [CSF] > than institutional norm) or beta human chorionic gonadotropin (B-HCG) (serum or CSF > than institutional norm) in the setting of radiographic disease consistent with a germ cell tumor necessitating cranio-spinal irradiation
• Scheduled radiation treatment using intensity-modulated pencil beam scanning (PBS) proton therapy
• Life expectancy >= 12 months
• Signed informed consent document and assent when appropriate

Exclusion Criteria

• Any prior therapeutic radiation therapy > 500 centigray (cGy) has been delivered
• Individuals with a history of a different malignancy are ineligible except for the following circumstances: if they have been disease-free for at least 5 years and are deemed by the treating physician to be a low-risk for recurrence of that malignancy; or, have had only cervical cancer in situ, or basal cell or squamous cell carcinoma of the skin
• Any major uncontrolled or poorly controlled intercurrent illness that would limit compliance with study requirements
• Pregnant females are excluded; females of childbearing age/menstruating must confirm that either they are not sexually active or have a negative pregnancy test prior to initiation of radiation therapy
• Patients that receive concurrent chemotherapy with the exception of concurrent vincristine