The following information is based on a selection of some topics that were covered. Epidemiology of Pediatric Brain Tumors was the opening topic. Dr. Archie Bleyer provided numerous informational facts. Brain tumors may be as common as leukemia when you include all brain tumors. For Y2K 1 in every 3-4 cancer deaths in children are due to CNS tumors. Children numbering 20,000-25,000 die annually from brain tumors. Less progress is made with brain tumors than any other type of cancer. In conclusion, the central nervous system provides the greatest challenge in pediatric oncology and despite the tremendous advancements of the past decade, more advancements need to be made. The cooperative groups, such as the Children’s Oncology Group and the Pediatric Brain Tumor Consortium, continue to work together to find a cure for central nervous system tumors.

Dr. Robert Zimmerman from Children’s Hospital of Philadelphia presented Advances of Pediatric Neuro Imaging. He explained the significance in the measurement of choline ratios in tumors stating that the more malignant tumors have increased choline levels. Improving cure rates, reducing radiation or eliminating when possible, modifications of delivery and techniques are key goals for improvements in radiation oncology. The Director of Radiation Oncology from St. Jude’s Hospital, Dr. Larry Kun presented the topic Fractionation and Conformal Techniques in Radiation Oncology. In diagnostics and planning 3 dimensional imaging provides gross tumor volume, target volume and physical volume, all of which factor into the treatment planning. 3D coplanar planning is where dose homogeneity within the target at defined dose level can minimize dose to treatment area. Intensity Modulated Radiation Therapy (IMRT) is similar to 3D conformal and use of IMRT is dependent on tumor size. Dr. Nancy Tarbel radiation oncologist, Massachusetts General Hospital, provided updates about Focused Radiation. Details were given regarding stereotactic radiotherapy and surgery.

Dr. L. Liau reviewed current information regarding Tumor Vaccines, current studies and strategies. Radiolabeled antibodies have proven to be better when injected in surgically created cavities than in solid tumors. Anti-idiotype antibodies are made to minimize the tumor antigens. Dr. F. McCormick covered Gene Therapy Strategies. He explained how gene therapy is engineered to replicate selectively. Dr. Lucy Rorke neuropathologist, Children’s of Philadelphia, provided information on Tumor Classification and poorly differentiated ependymal tumors. Dr. Roger Packer of Children’s National Medical Center’s Update on U.S. Cooperative Group Trials was very informative. His talk focused on medulloblastoma and Dr. Packer coordinated a discussion on new therapeutic approaches for medulloblastoma.

The topic Infant Tumors included speakers Dr. Gilbert Vezina, Imaging Advances; Dr. Jacqueline Biegel, Biology Update; and Dr. R. Geyer, Clinical Trials. Infant brain tumors have a disproportionate malignant history behavior and poor prognosis. Hydrocephalus is often a factor for the infant and patients with widespread disease. Radiologist, Dr. Gilbert Vezina explained that atypical teratoid/Rhabdoid tumors mimic PNET tumors pathologically and radiographically. These tumors show intense contrast enhancement and are more resistant to therapy than PNET. Medulloblastomas are more hemispheric and disseminate. Generally, 5-10% do not enhance on imaging.

Neurosurgeon, Dr. Jeffrey Wisoff, NY University Hospital, discussed surgical strategies: Extent of Resection and Outcome in Low Grade Gliomas and was followed by Dr. Joan Ater, oncologist, covered Chemotherapy Trials in Low-Grades. Dr. Ater suggested that conservative surgery with chemotherapy would provide a better quality for these patients and that delaying radiation would be wise. Dr. Judiah Folkman was present to give a special lecture about Antiangiogensis. In the first evening there were focused breakout sessions. Dr. Packer led the session discussing the long term effects of treatments and spoke on the results of the Childhood Cancer Survey Study. Dr. Phil Cogen, for the Children’s National Medical Institute, led the biology breakout session and discussed his work on medulloblastoma. Dr. Tobey MacDonald participated in the New-Agents breakout session. The Germ Cell breakout session was coordinated by Drs. Jeffrey C. Allen and Jonathan Finley.

The symposium concluded with Updates and Advances. Speakers included Drs. C. Kalifa, Henry Friedman, and Jonathan Finlay. Dr. Finlay, oncologist, Memorial Sloan Kettering, presented information about recurrent, resistant disease. He reviewed treatments using myoblative chemotherapy with Autologous Stem Cell Rescue (ASCR). He indicated that patients who have benefitted from this combination include recurrent medulloblastoma/PNET, malignant glioma, and central nervous system germ cell tumors. He focused on toxicity of chemotherapy with ASCR and mentioned the patients at risk being, patients with bulky residual tumor, prior spinal irradiation, patients with sub-optimal stem cell yield, those who have had prior high-dose cranial radiation and neurotoxicity. Many advances have been made, techniques improved and new chemotherapeutic agents, alkylating agents, radiation and surgical techniques are always under investigation for improvements to provide a better quality of life and cures for patients. Clearly, this frontier has further investigations ahead.

This conference was very beneficial and provided CBTF representative, Jeanne Young, the opportunity to remain current about the latest treatments and investigations for pediatric brain tumors. Several other brain tumor organization members were present and this also afforded us the opportunity to network with each other and the medical community.