Chemo instead of radiotherapy cuts long-term side effects for children with brain tumours

Using chemotherapy to delay or avoid radiotherapy in children under three with a type of brain tumour called ependymoma reduces the risk of potentially damaging long term side effects, reveal trial results published online in the Lancet Oncology.

Researchers from the Children's Cancer and Leukaemia Group (CCLG), funded by Cancer Research UK and Samantha Dickson Brain Tumour Trust, undertook a ten-year trial involving 89 children from the UK, Scandinavia and The Netherlands with newly diagnosed ependymomas, and monitored their progress for up to 12 years.

All of the children on the trial underwent surgery to try and remove their tumours followed by an intensive course of chemotherapy to kill off any remaining cancer cells.

Radiation treatment was reserved only for those children whose disease had spread or progressed. Of these patients, the chemotherapy treatment managed to delay their need for radiotherapy by more than one and a half years, so that the average age of children when they were given radiotherapy was 3.6 years, when their brains were more developed. This was opposed to the children being given radiotherapy as a first-line treatment as soon as they were diagnosed, often at a much younger age.

Around 350 children under the age of 15 are diagnosed with brain cancer each year in the UK. Around a tenth of these cases are ependymomas – equating to around 35 cases each year – half of which occur in children under the age of four. The researchers hope these results will benefit infants with other types of brain cancers.

Overall, 42 per cent of the patients did not receive any radiation treatment for their cancer and almost two-thirds of the children – 64 per cent – were still alive five years after diagnosis. The three-year survival rate for children on the trial is equal to the best published radiotherapy results and the five-year survival rate is better than previous trials that have used radiotherapy as a matter of course.

Study author Professor Richard Grundy from the Children's Brain Tumour Research Centre at the Queen's Medical Centre, University of Nottingham said: "It's clear from this study that a significant proportion of children can be spared, or have delayed, the effects of radiotherapy by using chemotherapy.

"We know radiotherapy can be harmful to the developing brain, so avoiding it or using it at an older age if needed will hopefully reduce any learning difficulties these children may develop as a result of this treatment without compromising their chance of a cure."

The purpose of this trial was to see if doctors could spare children radiotherapy by using chemotherapy instead. The majority of long term survivors who are treated with radiotherapy for ependymomas experience reduced IQ and short term memory loss.

Kate Law, director of clinical trials at Cancer Research UK, said: "This study provides exciting results for young children with ependymomas. This improvement in quality of life could be significant and we hope children diagnosed with this and other types of brain cancer in the future will benefit from these findings.

"As more children survive cancer, we welcome any research that adds to our understanding of how to reduce the long-term side effects of treatment."

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