Adjuvant Therapy for Central Nervous System Tumors Occurring During Infancy

Medical

• Chemotherapy – cytoreduction neoadjuvant therapy and routine adjuvant therapy: Chemotherapy is rarely a primary mode of treatment for CNS tumors in infants, with the exception of neuroblastomas. However, it has a very important role for disease modification either as a neoadjuvant cytoreductive intervention or, more usually, as adjuvant therapy to allow delay of radiation therapy until the infant matures. The role of the oncologist is vital in the multidisciplinary team approach to these patients, as treatment often is highly individualized with alterations in management strategies as the disease evolves.
• Clinical trial: Consideration should be given to inclusion of the infant in a clinical trial if appropriate.

Radiation

• Rarely used: Most centers aim to avoid external radiation therapy to patients younger than 3–5 years. Infants, therefore, are rarely considered for adjuvant radiotherapy. In selected cases, however, if the disease process is refractory to other modes of therapy, it may be that in the interest of patient survival one must consider all modes of treatment.
• Cystic tumors and brachytherapy: Interstitial brachytherapy such as P32 can be considered for the rare cases of giant cystic tumors such as craniopharyngioma. However, these tumors are incredibly rare in infants.

Immunotherapy

Alpha interferon has been cited as useful in the interstitial therapy of cystic craniopharyngioma but not specifically in infants (25). It will not be further discussed in this chapter.