Therapeutic Considerations on Malignant Brain Tumors in very Young Children

Abstract

Until recently the management of infants with malignant brain tumors was surgery followed by radiation. Usually the radiation dosage was reduced by 10–20% because of fears of damaging the developing nervous system. The overall survival of these very young children is significantly worse than children in older age groups. Furthermore, the late effects of radiation such as mental retardation, endocrinopathies, shortening of the spinal column, are of special concern in this population. Although these effects have been reported throughout childhood, they appear to be particularly severe in the very young. Since standard treatment has been associated with poor outcome, there have been several studies which have addressed the possibility of delaying (or omitting) radiotherapy in this population. Preliminary studies have enrolled small numbers of patients, but the first results were encouraging with MOPP regimen or combination of drugs including cis-platinum. In North America, the Pediatric Oncology Group has initiated the “Baby POG“ protocol in which post-operative chemotherapy is given in an attempt to delay radiation for 12 months in children 2–3 years of age and for 24 months in children less than 2 years of age at diagnosis. More than 200 infants have been included in this study but results are not yet available.