The role of chemotherapy in the treatment of pediatric brain tumors

The past 20 to 30 years have seen significant developments in the diagnosis and treatment of pediatric brain tumors, the most common solid organ tumor in children. Advances have been made in imaging methodologies, such as magnetic resonance imaging, surgical approaches to treatment, classification of brain tumors according to pathological and molecular features, and overall understanding of pertinent prognostic factors. Translation of our knowledge into appropriate therapy for each type of brain tumor has resulted in an overall improved survival. However, subtypes of brain tumor that have actually shown enhanced survival are few, and the overall prognosis for children with brain tumors remains poor compared to that of patients treated for other pediatric malignancies. Recent clinical trials aim to minimize treatment-related toxicity for brain tumors with superior survival, while attempting to improve the cure rate for those tumors with continued poor prognosis through intensified treatment, introduction of novel chemotherapeutic drugs, or targeted treatment based on identified molecular markers. This review outlines the overall role of chemotherapy in the treatment of childhood brain tumors, with an emphasis on recently identified molecular markers and current trends in treatment.