The results of a multiinstitional phase I/phase II trial, using 100 cGy of radiation therapy twice daily to a total dose of 7,200 cGy in 31 children with high risk brainstem gliomas are reported from the Neuro-Oncology Program, The Children’s Hospital of Philadelphia; the University of Pennsylvania, Philadelphia; New York University Medical Center; University of Minnesota; Children’s Memorial Hospital, Chicago; and the Robert Wood Johnson Medical School, New Brunswick, NJ. Of the 35 patients evaluated, 24 (69%) had developed progressive disease and 11 (31%) remained in remission at the completion of the three year study period. Survival rate at 20 months was 32%. Patients relapsed at a median of eight months after diagnosis. Those in remission had been followed for a median of 18 months. No patient died as a result of treatment. Glucocorticoid therapy was tapered and discontinued during or soon after completion of treatment. In comparison to control patients and those treated in a previous trial using smaller doses of hyperfractionated radiotherapy, there was a statistically significant improvement in progression-free survival rate. Further studies seemed warranted. 
COMMENT. Brainstem gliomas account for approximately 10% of all childhood central nervous system tumors and are the most resistant to therapy. High risk patients with tumors involving the brain stem diffusely rarely survive after conventional doses of radiotherapy. Hyperfractionated radiation therapy offers greater potential benefit.