Reporter Volume 25, No.9 October 28, 1993

By LOIS BAKER
News Bureau Staff
A multi-center study headed by a UB pediatric neurologist has shown
that very young children with brain tumors can be treated successfully
with chemotherapy immediately after surgery, postponing, and in some
cases eliminating, the need for radiation treatments that are
devastating to the developing brain.  
	The study was the lead article in a recent issue of The New
England Journal of Medicine.
	"To understand the importance of these results," said Patricia
K. Duffner, UB professor of neurology and pediatrics, "you need to
consider the situation when we began the study in 1986.  At that time,
children less than one year old with brain tumors were let die. The
only treatment available was radiation, and the survival rate was
terrible. Children who did survive were so profoundly retarded, so
damaged, their survival brought no quality of life.
	"Chemotherapy had never been used as the primary
post-operative treatment for brain tumors,"  said Duffner. "We showed
that for most tumor groups, chemotherapy is as effective, if not more
effective, than radiation as an early treatment in very young
children, and we anticipate it will be a lot less damaging to the
brain."  
	The study was conducted by the Pediatric Oncology Group, which
includes institutions in both the United States and Europe.  In
addition to UB and Children's Hospital of Buffalo, where Duffner is
associate director of childhood neurology, the major investigators
came from Roswell Park Cancer Institute in Buffalo; the National
Cancer Institute; the University of Florida in Gainesville; Duke
Medical Center in Durham, N.C.;  St. Jude's Children's Research
Hospital in Memphis, Tenn.; Children's Mercy Hospital in Kansas City,
Mo.; the University of California Medical Center in San Diego, and
Montreal General Hospital. 
	The study as conducted between August 1986 and April 1990 and
involved 198 children under the age of 3 with malignant brain tumors.
	Following complete or partial surgical removal of their
tumors, 132 children who were less than 24 months of age when
diagnosed received multi-agent chemotherapy for two years.
Sixty-six children between the ages of 24 and 36 months when diagnosed
received the chemotherapy regimen for one year. Treatment ceased
earlier if the disease progressed.  Following completion of
chemotherapy, all children received radiation treatments. 
	The results showed that chemotherapy produced complete or
greater than 50 percent reduction in the tumor size in 39 percent of
the children. Cancer had not progressed in 41 percent of the older
group after one year of chemotherapy, and in 39 percent of those under
24 months after two years of chemotherapy.  
	Certain tumors responded better than others, the study showed.
Embryonal tumors did not respond well, while 61 percent of infants and
very small children with ependymoma tumors -- those affecting the
lining of the ventricles of the brain and the central spinal cord
canal--were still alive after three years. 
	Results showed children who had no tumors following
chemotherapy survived nearly as long as children whose tumors were
removed completely through surgery. 
	Researchers found no deterioration of brain function as a
result of the chemotherapy.
	"This study has demonstrated that chemotherapy is effective
against malignant brain tumors in infancy," Duffner said. 
	"Further studies hold out hope that more intensive
chemotherapy may achieve even better results, allowing us to delay or
eliminate radiation in a large proportion of infants and very young
children."