OBJECTIVES:

• Determine whether high-dose tamoxifen with radiotherapy increases the median survival and overall survival of children with newly diagnosed brain stem gliomas.
• Determine the time to neurologic or radiographic progression in patients treated with this regimen.
• Determine the acute and chronic toxicity of high-dose tamoxifen in these patients.

OUTLINE: This is a multicenter study.

Patients undergo radiotherapy once daily 5 days a week for 6 weeks. Within 2 weeks after the initiation of radiotherapy, patients receive oral high-dose tamoxifen once daily. Tamoxifen continues in the absence of disease progression or unacceptable toxicity.

PROJECTED ACCRUAL: Approximately 60 patients will be accrued for this study within 4 years.

DISEASE CHARACTERISTICS:

• Newly diagnosed tumor of the brain stem (diffuse intrinsic lesion centered on the pons)

  • Radiological and clinical diagnostic criteria allowed (biopsy not required)

  • The following astrocytic tumors are allowed if histologically confirmed:

    • Diffuse astrocytoma (all subtypes)
    • Anaplastic astrocytoma
    • Glioblastoma
    • Pilocytic astrocytoma (grade I)
• Less than 6 months since diagnosis

• At least 1 of the following signs of brain stem tumor:

  • Cranial nerve deficit
  • Long tract signs
  • Ataxia
• No focal lesions of the brain stem (either clearly marginated or cystic), cervicomedullary tumors, tumors predominately exophytic, or pontine tumors diagnosed as pilocytic on biopsy

PATIENT CHARACTERISTICS:

Age:

• Under 20

Performance status:

• Not specified

Life expectancy:

• Not specified

Hematopoietic:

• Not specified

Hepatic:

• Not specified

Renal:

• Not specified

Other:

• Not pregnant or nursing
• No frequent vomiting or other medical condition that would preclude oral medication intake

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Not specified

Chemotherapy:

• No prior chemotherapy for brain stem glioma

Endocrine therapy:

• Concurrent steroids allowed

Radiotherapy:

• No prior radiotherapy for brain stem glioma

Surgery:

• Not specified

Other:

• Concurrent anticonvulsants allowed