The expanding role of chemotherapy for pediatric supratentorial malignant gliomas.

Supratentorial malignant gliomas are among the most difficult tumors to treat in children. With a combination of surgery and irradiation, the median survival for children with malignant gliomas is only 9 months. Even among survivors, irradiation causes long-lasting neurological impairment, especially in young children. These disappointing results have stimulated interest in adjuvant chemotherapy as a more effective treatment for pediatric gliomas. In 1976, the first pediatric randomized trial of adjuvant chemotherapy incorporated CCNU, vincristine and prednisone. The addition of these agents to standard irradiation and surgery enhanced the 5-year survival rate from 18% to 43%. Other trials with multiple drug regimens, now considered to be suboptimal in dosing, have not further enhanced disease-free survival. Current trials of high-dose chemotherapy combined with autologous bone marrow rescue for children with recurrent malignant gliomas have produced some durable survivors, but long-term benefits for children with newly diagnosed malignant gliomas are yet to be realized.