The longterm outcome of 198 infants with malignant brain tumors treated postoperatively with prolonged chemotherapy (vincristine, cyclophosphamide, cisplatinum, and etoposide) is evaluated by a Pediatric Oncology Study Group. Four of 132 children, 7 to 23 months at diagnosis, and 1 of 66 who were diagnosed between 24 and 36 months developed second malignancies. The primary tumors were choroid plexus carcinomas (2), ependymoma (1), ganglioglioma (1), and medulloblastoma (1). Secondary neoplasms were myelodysplastic syndrome (2), acute myelogenous leukemia (1), sarcoma (1), and meningioma (1). The risk of developing a second malignancy 8 years after diagnosis was 11% in the total group; in children younger than 24 months at diagnosis the risk was 19%, and in children diagnosed at 24 to 36 months it was 5%. The high rate of secondary malignancies, especially leukemia, in infantile brain tumor patients may be attributed to the oncogenic potential of prolonged alkylating chemotherapy and etoposide, with or without irradiation. 
COMMENT. The authors conclude that the longterm chemotherapy regimen for infantile brain tumors may delay and decrease the risk of irradiation-induced neurotoxicity at the expense of increasing the risk of secondary malignancies.
In an editorial, “Rethinking brain tumors in babies and more,“ Fisher PG of Stanford University comments that these discouraging results of prolonged chemotherapy should stimulate research in the clinical biology of brain tumors and prompt a more selective approach to aggressive oncology.