THE EXPANDING ROLE OF CHEMOTHERAPY FOR PEDIATRIC SUPRATENTORIAL MALIGNANT GLIOMAS

Supratentorial malignant gliomas are among the most difficult tumors t o treat in children. With a combination of surgery and irradiation, th e median survival for children with malignant gliomas is only 9 months . Even among survivors, irradiation causes long-lasting neurological i mpairment, especially in young children. These disappointing results h ave stimulated interest in adjuvant chemotherapy as a more effective t reatment for pediatric gliomas. In 1976, the first pediatric randomize d trial of adjuvant chemotherapy incorporated CCNU, vincristine and pr ednisone. The addition of these agents to standard irradiation and sur gery enhanced the 5-year survival rate from 18% to 43%. Other trials w ith multiple drug regimens, now considered to be suboptimal in dosing, have not further enhanced disease-free survival. Current trials of hi gh-dose chemotherapy combined with autologous bone marrow rescue for c hildren with recurrent malignant gliomas have produced some durable su rvivors, but long-term benefits for children with newly diagnosed mali gnant gliomas are yet to be realized.