STATE-OF-THE-ART TREATMENT OF TUMORS OF THE NERVOUS SYSTEM IN CHILDHOOD

Objectives: To review the current state of management of childhood brain tumors, with emphasis on chemotherapeutic approaches and neurobiologic insights.

Methods and Results: The management of childhood brain tumors has evolved over the past decade. Chemotherapy has now become an integral component of the management of tumors. Five-year survival of children with such tumors, after treatment with surgery and radiotherapy, was approximately 50% and now, with the addition of chemotherapy, is nearly 90% in children >3 years of age, with nondisseminated lesions. Improvements have also been seen, with the addition of chemotherapy, for those patients with higher stage lesions. Chemotherapy has been most successful when used during and after radiotherapy, and high-dose chemotherapy supported by peripheral stem cell rescue is increasingly employed. The utilization of higher dose chemotherapy and intrathecal chemotherapy are being actively investigated. Neurobiologic investigations have identified critical pathways involved in tumor growth and dissemination. Studies are presently underway utilizing biologic agents that disrupt cellular signaling and hold great promise for the more effective and safer treatment of these primitive tumors. Similar investigations are underway for benign and malignant pediatric glial tumors. How to best utilize these drugs and combine them with more conventional chemotherapies and radiation is being explored. Advances in radiotherapy have also enhanced the ability to treat childhood brain tumors; with techniques such as conformal radiotherapy, focused irradiation therapy, and proton beam therapy.

Conclusion: The management of childhood brain tumors continues to evolve and is increasingly biologically based. This has already resulted in improved survival for subsets of children with brain tumors, allowing them to be treated more effectively and at the same time more safely.

Keywords: Childhood brain tumors; chemotherapy; biologic-based therapy; radiotherapy