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s of the Ninth Scientific Meeting 230 the absorptive surfaces remains intact, and (3) because the blood does not coagulate in the organism, no blood clotting factors are mobilized, the danger of DIC is diminished. The functional results in a series of patients are fairly good. 30 Prognosis of Benign Cerebellar Astrocytoma in Children J. Szénάsy, F. Slowik National Institute of Neurosurgery, Budapest, Hungary A total of 137 operated benign astrocytoma cases are analyzed in this retrospective long-term follow-up study. All patients were under the age of 14 at admission and all surgical interventions were undertaken in our institute between 1954 and 1975. Follow-up was terminated in 1980. Histological findings were reassured and classified with special respect to the tumor invasive nature and malignity. Localization, extension of the tumor and possible leptomeningeal infiltration were also considered. Clinical information of prognostic value can be extracted from the correlative analysis of morphological findings and the outcome as measured on the frequency rate of recurrences and the survival time. 31 Long-Term Prognosis of Medulloblastoma D. Norris, D.A. Bruce, L. Schut Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pa., USA Between 1969 and 1979, 22 patients with medulloblastoma were treated by the same surgical group and radiation therapy group. The patients were divided into two groups because of the clinical availability, in December of 1974, of the computerized tomography scanner and the operating microscope used in the initial surgical procedure. There were 11 patients in each group. Relapse-free survival in the group treated between 1969 and 1974 (group I) was 38% at 4 years. The survival in the 11 patients treated between 1974 and 1979 (group 2) was 84% at 4 years. This improvement is statistically significant (p 0.001). All patients received the same dose of radiation. Efforts to minimize tumor burden at diagnosis by total surgical resection did not increase postoperative morbidity or mortality. These results will be discussed along with the relative impact of the CT scan, total resection at surgery, and increased focus for radiation therapy on the improved outcome. Results using adjunctive chemotherapy will be discussed. 32 Intracranial Ependymomas in Children: A Review of 39 Cases A. Pierre-Kahn, J.F. Hirsch, F.-X. Roux, D. Renier Service de Neurochirurgie, Hôpital des Enfants Malades, Paris, France In intracranial ependymomas, should the whole axis be irradiated, as is presently performed in medulloblastomas? To answer this question, a series of children less than 15 years old was reviewed. There were 11 supratentorial and 28 infratentorial ependymomas, treated by surgery and radiotherapy, from 1969 to 1979. In these cases, radiotherapy was delivered exclusively to the cerebral hemispheres in supratentorial ependymomas, to the Abstracts of the Ninth Scientific Meeting 231 whole brain in infratentorial ependymomas, and to only the posterior fossa when the tumor was infratentorial in children less than 2 years old. In this series a complementary prophylactic spinal radiotherapy was completed only in 1 patient. The overall postoperative mortality for this series was 15.3%; in supratentorial ependymomas 9%, in infratentorial ependymomas 18%. Suvival rates at 3 and 5 years were 45 and 36 %, respectively. The principal prognostic factors were: (a) histological grading: two thirds of the survivors had been operated for a benign ependymoma while 9 out of the local recurrences or metastases were found in the group with malignant ependymomas; (b) tumoral site: supratentorial ependymomas did not show any metastasis in the posterior fossa or spinal axis, whereas secondary spinal lesions occurred in 18% (4 cases: 3 malignant, 1 benign) of the infratentorial ependymomas. Remarkably in these 4 cases, it was impossible to demonstrate, clinically and by scan, any recurrence in the posterior fossa at the time of metastasis. This study and a review of the literature strongly suggest that, in malignant ependymomas, radiotherapy should be delivered to the whole craniospinal axis. In benign supratentorial ependymomas, radiotherapy could be limited to the tumoral site and the cerebral hemispheres. In benign infratentorial ependymomas, the posterior fossa and the spinal axis should be irradiated. 33 ICNG Trial on Malignant Brain Tumors in Children: Current Survey S. Pezzotta, G. Butti, R. Knerich, P. Paoletti Neurosurgical Clinic, University of Pavia, Pavia, Italy During the past decade approximately 35 and 25% of the children with medulloblas-toma who underwent major surgery and CNS irradiation have had 5and 10-year survival rates, respectively. The effectiveness of adjuvant chemotherapy in medulloblastoma and malignant ependymoma in childhood is unclear. The Italian Child’s Neurooncology Group (ICNG), a multicenter study group founded in 1979, designed a prospective, controlled and randomized trial to compare the efficacy of CCNU, VCR and PCZ combined versus CCNU and VCR in medulloblastoma and malignant ependymoma in children after surgery and radiotherapy (RT). This protocol was started in January 1980 and is still open to randomization. All patients undergo surgery and RT (3,500^1,000 rad to the craniospinal axis and 5,500 rad to the posterior fossa). Chemotherapy for the control group consists of CCNU, (120 mg/m2 p.o. on day 1) and vincristine D ow nl oa de d by : 54 .7 0. 40 .1 1 11 /1 /2 01 7 6: 26 :0 7 P M (VCR; 1.0 mg/m2 i.v. weekly during RT; 1.5 mg/m2 i.v. on day 1, 8 and 15 in subsequent courses). The patients in the second group are given the same treatment as above plus procarbazine (PCZ; 100 mg/m2 p.o. from the 8th to 21st day of every subsequent chemotherapy course). The course of chemotherapy is repeated every 8 weeks. The drug dose is reduced if toxicity develops. The response to treatment is evaluated using neurological examinations, Karnofsky ratings and CT scans. To date 20 patients, ranging from 18 months to 15 years of age, have entered the study. Each group of this protocol has 10 patients. CT findings, response rates and survival will be presented. 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