AN INTENSIVE MULTIAGENT CHEMOTHERAPY REGIMEN FOR BRAIN-TUMORS OCCURRING IN VERY YOUNG-CHILDREN

Standard treatment for the majority of malignant brain tumours consist s of surgery and radiotherapy. This treatment has late morbidity which is accentuated in the very young child. As part of a strategy to impr ove quality of Life and overall survival of young children with brain tumours, members of the United Kingdom Children's Cancer Study Group ( UKCCSG) have piloted an intensive chemotherapy regimen which aims to a void or delay radiotherapy following surgery. Twenty eight children wi th a variety of malignant brain tumours have received the regimen, whi ch contains carboplatin, vincristine, cyclophosphamide, methotrexate, and cisplatin. The treatment is toxic, resulting in one death from inf ection. The bulk of the toxicity was associated with the administratio n of carboplatin. All but three children eventually required adjuvant radiotherapy and this was given between 1.5 and 27 months from diagnos is (median delay to radiotherapy, 12 months). Using this treatment reg imen, overall survival at four years is 35% (confidence intervals 10% to 60%). While there is no evidence from this study that radiotherapy can be abandoned in the management of malignant brain tumours, its int roduction may be delayed using suitable chemotherapy, thus allowing ti me for further CNS development. This treatment strategy has been taken forward as an international clinical trial run through the Internatio nal Society for Paediatric Oncology, but using a smaller dose of carbo platin to reduce toxicity.