Treatment Option Overview
Many of the improvements in survival in childhood cancer have been made as a
result of clinical trials that have attempted to improve upon the best available,
accepted therapy. Clinical trials in pediatrics are designed to compare new
therapy with therapy that is currently accepted as standard. This comparison
may be done in a randomized study of two treatment arms, or by evaluating a
single new treatment and comparing the results with previously obtained
results using existing standard therapy.
Because of the relative rarity of cancer in children, all patients with brain
tumors should be considered for entry into a clinical trial. To determine and
implement optimum treatment, treatment planning by a multidisciplinary team of
cancer specialists who have experience treating childhood brain tumors is
required. Radiation therapy of pediatric brain tumors is technically very
demanding and should be carried out in centers with experience in that area in
order to ensure optimal results.
Debilitating effects on growth and neurologic development have frequently been
observed following radiation therapy, especially in younger children.[1-3] There are also other less common complications of radiation therapy, including cerebrovascular accidents.[4] For
this reason, the role of chemotherapy in allowing a delay in the administration
of radiation therapy is under study, and preliminary results suggest that
chemotherapy can be used to delay, and sometimes obviate, the need for
radiation therapy in children with benign and malignant lesions.[5] Long-term
management of these patients is complex and requires a multidisciplinary
approach.
The designations in PDQ that treatments are “standard” or “under clinical
evaluation” are not to be used as a basis for reimbursement determinations.
References
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Packer RJ, Sutton LN, Atkins TE, et al.: A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-year results. J Neurosurg 70 (5): 707-13, 1989.
[PUBMED Abstract]
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Johnson DL, McCabe MA, Nicholson HS, et al.: Quality of long-term survival in young children with medulloblastoma. J Neurosurg 80 (6): 1004-10, 1994.
[PUBMED Abstract]
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Packer RJ, Sutton LN, Goldwein JW, et al.: Improved survival with the use of adjuvant chemotherapy in the treatment of medulloblastoma. J Neurosurg 74 (3): 433-40, 1991.
[PUBMED Abstract]
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Bowers DC, Mulne AF, Reisch JS, et al.: Nonperioperative strokes in children with central nervous system tumors. Cancer 94 (4): 1094-101, 2002.
[PUBMED Abstract]
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Duffner PK, Horowitz ME, Krischer JP, et al.: Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. N Engl J Med 328 (24): 1725-31, 1993.
[PUBMED Abstract]
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