MANAGEMENT OF BRAIN-TUMORS IN PEDIATRIC-P ATIENTS YOUNGER THAN 3 YEARS - ROLE OF CHEMOTHERAPY

Nearly 20% of pediatric brain tumors, irrespective of histologic type, occur before three years of age. Outcomes in terms of survival and qu ality of life are usually poor after conventional treatment similar to that used in older children, i.e., combining surgery (if possible) wi th adjunctive radiation therapy. This may be ascribable to the large s ize and frequent dissemination of brain tumors in younger patients and , above all, to the common practice of reducing radiation doses by 10% to 20% to avoid adverse effects on the developing brain. Despite this precaution, the potential delayed effects of brain irradiation are of great concern in this population, since they include pituitary dysfun ction and cognitive impairment responsible for poor academic achieveme nt. Several studies have been conducted to determine whether postopera tive chemotherapy allows to postpone or avoid radiotherapy. In 1985, t he Pediatric Oncology group undertook a study aimed at postponing irra diation therapy until after the age of three years. In 1990, the Frenc h Society for Pediatric Oncology developed a long-term chemotherapy pr otocol intended to be used instead of radiation therapy, with a salvag e strategy for patients with recurrences. These studies have led to in disputable advances in the management of these patients. The indicatio ns of chemotherapy have recently been extended to severe forms of unop erable, low-grade glioma.