POSTOPERATIVE CHEMOTHERAPY WITHOUT RADIATION IN YOUNG-CHILDREN WITH MALIGNANT NON-ASTROCYTIC BRAIN-TUMORS - A REPORT FROM THE RALIA-AND-NEW-ZEALAND-CHILDHOOD-CANCER-STUDY-GROUP (ANZCCSG)

Young children with malignant brain tumours have particularly poor sur vival and manifest severe sequelae of radiation therapy. A multi-insti tutional pilot study of post-operative primary chemotherapy for childr en under 3 years with primitive neuroectodermal tumours (PNET) or epen dymoma was initiated in 1987. The chemotherapy protocol comprised carb oplatin, vincristine and the ''eight drugs in 1 day'' regimen. Radiati on was recommended only if tumour progression or recurrence was docume nted. A total of 14 patients between 5 and 36 months of age were enrol led. Seven had supratentorial tumours (PNET, pinealoblastoma, intracra nial retinoblastoma) with multiple predictors of adverse outcome. Four of these responded to initial chemotherapy but subsequently progresse d and all had died by 16 months from diagnosis. The seven patients wit h infratentorial tumours (three medulloblastomas, four ependymomas) ha d more favourable predictors of outcome: no meningeal dissemination an d gross macroscopic resection in six of the seven cases. One patient p rogressed rapidly and died within 5 months. The other six are alive at 37-57 months from diagnosis. Four are in continuous complete remissio n at 57, 51, 41 and 37 months, respectively from the time of their tum our resection. One is described as having stable disease with a persis tent radiographic lesion at 41 months from diagnosis. One has relapsed on two occasions and is the only surviving patient to have been irrad iated. Intelligence scores for the six long-term survivors have thus f or remained within the normal range. It is suggested that some infants with standard-risk ependymoma and, possibly, medulloblastoma may be c ured without radiation therapy.