Is there a role for myeloablative chemotherapy with autologous hematopoietic cell rescue in the management of childhood high-grade astrocytomas?

High-grade or malignant glioma represent 10% of pediatric brain tumors and are, taken as a whole, the second more frequent malignant histotype after medulloblastoma. Apart from a complete excision followed by full dose local radiotherapy, chemotherapy seems to give some beneficial to final outcome. Different trials have explored the role of high-dose chemotherapy that theoretically could give an advantage to these patients by overcoming blood-brain barrier, tumor cell chemo-resistance and inducing a wider number of responses. It is, however, still doubtful if better responses translate into improved outcome and which patients can have a true beneficial from this treatment strategy.