Twenty-four children with progressive chiasmatic/hypothalamic glioma (CHG) have been treated with actinomycin D and vincristine combination chemotherapy without radiotherapy and followed for a median of 4.3 yrs at the Children’s Hospital of Philadelphia, PA. Diagnosis and treatment required a positive CT or MRI, histological confirmation in 15 without optic nerve involvement, and progressive neurological or visual deterioration. Fifteen (62.5%) are free of progression with normal IQ’s, 9 showing tumor regression, and 9 have radio-graphic or clinical progression of the tumor within 2-6 yrs after initiation of therapy. The authors allude to intellectual and endocrinological sequelae of radiotherapy for CHG in young children and conclude that chemotherapy may significantly delay the need for radiotherapy. 
COMMENT. Both radiotherapy and chemotherapy carry the risk of potentially serious adverse effects. Histological confirmation of the tumor type before initiation of therapy may now be possible since thin-needle biopsy with CT guidance is an accepted low risk procedure for neurosurgeons.