Medical therapy and outcome

Research output: Contribution to journalArticle

Abstract

The gold standard in the treatment of brain tumors of any age is radiotherapy. Both pediatric neurooncologists and radiotherapists are well aware of the price their patients have to pay, especially children and adolescents. Chemotherapy has been adopted in the multimodality treatment of childhood brain tumors with two aims: improving results and lowering total doses or reducing radiotherapy fields. In some instances such as germ cell tumors or low-grade gliomas, this has allowed to maintain exceptionally good results while dramatically reducing radiotherapy fields (from whole CNS to the ventricular system in the case of germinomas) or completely omitting radiotherapy (in the majority of low-grade gliomas). In infants, where late effects on the psychological and neurological development are unbearable, intensive chemotherapy schedules have allowed to postpone and, in some cases completely abandon, radiotherapy. In medulloblastoma patients we are always pursuing the goal of reducing total radiotherapy doses while adding featured chemotherapy schedules with various modality and at different stages of the prescribed therapeutical plan. Unfortunately, for some histotypes and sites of tumor (i.e., malignant gliomas and brainstem tumors) a satisfactory therapeutical strategy has not been developed yet. While there is a multitude of papers about the toxic effects of radiotherapy in the treatment of childhood brain tumors, chemotherapy-induced neurotoxic effects are still a matter of doubt. A lot of concern about methotrexate effects has almost led to completely abandon its administration intrathecally, while also intravenously there is evidence of its toxic synergism with CSI irradiation. New data will be collected from the observation of patients treated with chemotherapy and from the evaluation of the outcome in those children who did not receive radiotherapy but on whom we will see the effects of tumor, surgery and maybe chemotherapy in future.

Original languageEnglish
Pages (from-to)33-43
Number of pages11
JournalSAGGI - Child Development and Disabilities
Volume30
Issue number2
Publication statusPublished - 2004

Keywords

  • Adjuvant therapy for brain tumors
  • Chemotherapy toxicity
  • Childhood brain tumors

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Rehabilitation
  • Neuropsychology and Physiological Psychology

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