Chemotherapy for Tumors in the Nervous System of Children Homepage

Author

Juliette Hukin, M.D.

Section Editors

Kristian Aquilina, M.D.

Editor in Chief

Rick Abbott, M.D.

Introduction

The cure rate for children with brain tumors has improved dramatically in the last 30 years. Chemotherapy has played an increasing role in the management of brain tumors, particularly in the last 20 years. Its role is mostly as an adjunct after resection with radiation or as alternative to radiation. In certain circumstances chemotherapy is used without resection, thus avoiding the morbidity of surgery with tumors in critical cerebral locations. It is hoped that advances in molecular biology will help direct additional therapeutic approaches for those tumors that are resistant to current therapeutic approaches.

Key Points

• Decreased radiation dosage: Intensive chemotherapy allows avoidance of radiation in young children with certain malignant brain tumors.
• Improved outcome for medulloblastoma: Chemotherapy has increased cure rates and allowed decreases in radiation dose in children with medulloblastoma, thus reducing long-term morbidity.
• Improved management of benign CNS tumors: Chemotherapy can be used to manage benign brain tumors to reverse neurological dysfunction and alter biological behavior, although it is rarely curative as a single therapy. It is an important consideration in the treatment of tumors arising from midline structures that are impossible to cure with resection.
• Improved management of germ cell tumors: Chemotherapy has improved cure rates in children with malignant germ cell tumors and allowed decreases in radiation exposure in children with germinomas.