Pediatric neuro-oncology: controversies in current therapy

Current Phase III clinical trials for the treatment of malignant central nervous system (CNS) tumors of childhood are reviewed. Combination neurosurgical, radiation treatment and chemotherapy have improved both the quality and duration of life for the affected children. Controversy exists regarding the appropriate adjunctive chemotherapy for newly diagnosed CNS neoplasms but this is being prospectively studied in controlled trials. Major dilemmas persist regarding the management of low-grade gliomas and recurrent CNS neoplasms. Preliminary data on possibly favourable protocols are cited. Future directions for clinical and basic laboratory investigation are also briefly reviewed.