[Systemic chemotherapy with conventional doses for brain tumors in children: phase II trials]

The analysis of Phase II trials with regard to brain tumors in children, aiming to test the activity of 1 drug or a combination of drugs is not easy, due to the following reasons: poor selection of patients (clinical and pathological heterogeneity), not always rational choice of the drugs and mostly, variability of the criteria and the methods used to assess the tumor response. When using a single drug, the current most efficient agents seem to be: cisplatinum, carboplatin, cyclophosphamide and etoposide, while nitroso-ureas have not been strictly studied. When using polychemotherapy, the best results have been obtained with the "8 drugs in 1 d" regimen. The most chemo-sensitive tumors are: medulloblastomas, primitive neurectodermal tumors, pinealoblastomas; high grade ependymomas and astrocytomas have been studied less in children than in adults. Present and future strict organisation of Phase II trials in brain tumors is compulsory in order to select the active agents, and to establish the best modalities of administration. The need to assess chemotherapy not only in refractory or relapsing patients, but also at diagnosis in high-risk patients is emphasized (after incomplete surgery and before radiotherapy).