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Current Treatment Approaches for Infants with Malignant Central Nervous System Tumors

Alberta Children's Hospital and Departments of Oncology and Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada

Key Words. Infants • Brain tumors • Chemotherapy • Radiation therapy

Correspondence: Correspondence: Lucie Lafay-Cousin, M.D., M.Sc., Alberta Children's Hospital, Pediatric Oncology, 2888 Shaganappi Trail NW, Calgary, Alberta, T3B 6A8, Canada. Telephone: 403-955-7203; Fax: 403-955-2645; e-mail: lucie.lafay-cousin{at}albertahealthservice.ca or luciecou{at}hotmail.com

Received August 27, 2008; accepted for publication February 16, 2009.

Disclosures: Lucie Lafay-Cousin: None; Douglas Strother: None. Section editors <disclosures to come>. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

The management of brain tumors in very young children remains a challenge for neuro-oncologists in large part because of the greater vulnerability of the developing brain to treatment-related toxicity. Nearly three decades of infant brain tumor clinical trials have led to significant progress in the delineation of prognostic factors and improvements in outcome. Innovative strategies that employ high-dose chemotherapy, intrathecal chemotherapy, modified focal irradiation, or combinations of these have been used to delay or avoid the use of conventional craniospinal irradiation in order to minimize the risk for deleterious neurocognitive impairment in survivors. However, it is difficult to evaluate the impact of such approaches on intellectual and functional outcome, and results to date are limited. This review covers the most recent therapeutic advances for the most common histological subtypes of malignant infant brain tumors: medulloblastoma, supratentorial primitive neuroectodermal tumor, ependymoma, atypical teratoid rhabdoid tumor, choroid plexus carcinoma, and high-grade glioma. Survival and neurocognitive outcome are emphasized.