New Hope Against Brain Tumors

Three studies in today's New England Journal of Medicine report progress in treating brain tumors. In a study from Germany, researchers report success in treating medulloblastoma, the most common childhood brain tumor, while sparing youngsters from therapies that can harm their intellectual development. Children with this type of tumor often are treated with surgery, chemotherapy and radiation to the head and spine, that saves the lives of many older children, but radiation to the brain can lead to severe learning problems if given to younger children.

In the new study of 43 patients, which is described in the journal as the largest of its kind in children under 3, two-thirds of those whose cancer had not spread were able to avoid radiation. Overall, about two thirds of children survived at least five years; researchers say the usual survival rate is 25 per cent to 45 per cent. Children who skipped radiation scored higher on IQ tests than children in an earlier trial who had radiation treatment. The treatments were not benign, however. Children who were treated with surgery and chemo still scored worse than healthy children of the same age.

In a study of adults with a type of brain tumor called glioblastomas, researchers found that patients who combined radiation with a chemo drug called temozolomide, or Temodar, lived longer than patients who didn't receive the drug. More than 26 per cent of patients who received the combination lived at least two years, compared with 10 per cent of patients treated with radiation alone, according to the study. It was led by researchers from the European Organisation for Research and Treatment of Cancer and the National Cancer Institute of Canada. In an editorial, Lisa DeAngelis of Memorial Sloan-Kettering Cancer Center notes that this is the first time chemotherapy has been proven to extend survival for brain cancer in the most rigorous type of scientific study.

Doctors today have no way to tell which patients will benefit from the drug and which won't respond at all, she writes. But a third article in the issue might offer a clue: Patients who don't respond to temozolomide, which kills tumor cells by damaging their DNA, have an active form of a gene that allows cancer cells to repair themselves. In people with inactive forms of the gene, tumor cells can't recover and they die. If doctors could use the gene as a marker, they could give chemo to those who may benefit from it, but spare others, says Monika Hegi, an author of the study from University Hospital in Lausanne, Switzerland.

In her editorial, DeAngelis notes that testing for this gene is tricky and doesn't always provide clear results. The test also is unavailable in most hospitals. For now, she advises, doctors should give temozolomide to all patients with this tumor because it helps some and causes few dangerous problems.

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