Progress and challenges in childhood brain tumors.

Although many challenges lie ahead, there has been definite progress made in the management of childhood brain tumors. Some of these advances have increased progression-free and overall survival. Other advances, while not improving survival, have resulted in a better quality of life for long-term survivors. Probably the best example of progress is manifest in the outcome of children with medulloblastoma. Seventy percent, and in some subsets as high as 80% of children with this disease can be expected to be cured, compared to approximately 50% three decades ago. This improvement in disease control has been associated with a reduction in the dose of radiotherapy for many patients and possibly an improved quality of survival. For other tumor types, especially brain stem gliomas, there has been little progress made. A primary challenge in the years ahead will be how to integrate biologic discoveries into the care of children for brain tumors, with the hope that molecular biologically based therapy will be more effective and improve the quality of life for survivors.