Adjuvant chemotherapy

Children aged 3 years and younger with pineoblastoma are usually treated initially with chemotherapy in the hope of delaying, if not obviating, the need for radiation therapy.[16] Overall prognosis for this group remains very poor.[17-19] In two sequential, multicenter, prospective clinical trials, all five children younger than 3 years who were treated with chemotherapy died.[20][Level of evidence B4] In children responding to chemotherapy, the timing and amount of radiation therapy required after chemotherapy is unclear. The addition of craniospinal irradiation to chemotherapy-based regimens may successfully treat some children but with anticipated neurodevelopmental decline.[21][Level of evidence B4] Two large pooled analyses both revealed dismal survival for children younger than 3 or 4 years with pineoblastoma.[18,19]