CHEMOTHERAPY AS PROPHYLAXIS AND TREATMENT OF MENINGOSIS IN CHILDREN LESS-THAN 3 YEARS OF AGE WITH MEDULLOBLASTOMA

The outcome of children less than 3 years of age with medulloblastoma has been poor in comparison to older children. The cure rates were bel ow 30%, and the quality of life for cured children was frequently redu ced by a complex syndrome of long-term sequelae including intellectual retardation and growth hormone deficiency. Due to the deleterious sid e-effects of radiotherapy in very young children chemotherapy has play ed an important role in this group of patients. Firstly, chemotherapy should improve their survival rate. Secondly, it should allow dose sed uction of craniospinal irradiation and a smaller involved field. With the goal of improving quality of life radiotherapy should be delayed o r even replaced by postoperative chemotherapy. The EFS of low-risk pat ients steadily improved and is now as high as at least 50%. Since most patients of this group do not need radiation, treatment-related long- term sequelae are minimal. High-risk patients, by contrast, with metas tatic disease or measurable postoperative tumor still have a very disa ppointing progression-free survival in a range below 30% at 3 to 3 yea rs in all large studies. Therefore prevention and effective therapy of meningosis, as well as a good response to induction chemotherapy, are essential for the outcome. Strategies to increase the efficacy of con ventional treatment modalities in high-risk patients are under investi gation. Recently, interesting results have been published on high-dose chemotherapy followed by autologous stem cell rescue and intraventric ular administration of the alkylating agent mafosfamide.