The Role of Chemotherapy in Pediatric Gliomas

Pediatric gliomas are a heterogeneous group of brain tumors that include low-grade and high-grade malignancies. Historically, treatment for these tumors has been a combination of surgery and radiation therapy. In certain situations, addition of chemotherapy to treatment regimens has proven beneficial in the treatment of pediatric gliomas. The role of chemotherapy in pediatric gliomas is now expanding. Two main reasons exist for the addition of chemotherapy to treatment plans for children with these neoplasms. First, the historically grave prognosis with high-grade gliomas and diffuse intrinsic pontine gliomas has prompted the addition of chemotherapy agents to standard radiation and surgery in an attempt to improve survival. Second, the adverse effects of radiation on children are well established. Chemotherapy, however, has proven to be less toxic in these patients. This chapter addresses the uses of chemotherapy in the treatment of pediatric gliomas, including low-grade gliomas, optic pathway/hypothalamic gliomas, high-grade gliomas, and diffuse intrinsic pontine gliomas.