Evidence Based Management For

In children, tumours of the central nervous system comprise 20% of all tumours and are second most common after leukaemia. Unlike adults, almost half of all the paediatric brain tumours are in the Infratentorial region as shown in table 1. In the infratentorial region, the common tumours are medulloblastoma, low grade cerebellar astrocytoma, brain stem glioma and ependymoma. In the supratentorial region, most of the paediatric tumours are in the supra or parasellar region (craniopharyngioma, optico-chiasmal or hypothalamic gliomas); hemispheric gliomas / PNETs or pineal region tumours. Fortunately, with the exception of brain stem gliomas, high grade hemispheric gliomas and some undifferentiated malignant tumours, most paediatric brain tumours have a 50-90% chance of long term cure with appropriate management. The treatment in itself could however result in moderate to severe neuro cognitive, psychological and endocrine dysfunction. The radiation dose, volume of brain irradiated and the age at which radiotherapy is given all correlate with the incidence and severity of post radiation sequelae (Jannoun, IJROBP, 1990). The aim of treatment for childhood brain tumours is therefore not only to achieve long-term cures but also focus on treatment strategies with minimal treatment related toxicity. The goal is also to integrate available scientific evidence in routine practice respecting local issues in terms of patient population, logistics, financial support and continued monitoring during and after treatment.