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Abstract
Central nervous system (CNS) tumors are the second most common pediatric malignancies after acute leukemias and are the most common pediatric solid tumors. Although cure rates have improved with numerous technical advances in multimodal therapy, the prognosis remains poor for some high-risk histological type and for patients with residual, recurrent or disseminated disease. Radiotherapy (RT) remains an integral part of treatment for childhood brain tumors; however, the profound and irreversible sequelae of brain irradiation in the younger children are now well documented. In an effort to decrease irradiation toxicity while improving survival and quality of life in these patients, high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HD-CT&autoHSCT) has been incorporated in both up-front as well as recurrent therapies. In up-front treatment, it is used in patients under the age of 3 years to delay RT or not to use RT at all. It can be used tandem non-myeloablatively in patients older than 3 years of age, after dose-intensive chemotherapy, both to shorten the neutropenic period and to give more intense chemotherapy in a shorter time when compared to conventional chemotherapy treatment approaches. AutoHSCT may also be considered after a myeloablative conditioning regimen for relapsed embryonal brain tumors, as either once or tandem, in cases with good response to salvage therapy as consolidation. In this talk, the role of autoHSCT in childhood brain tumors will be discussed by giving the results from international studies.
Published Version
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