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This chapter covers the approach taken by the M. D. Anderson Cancer Center Division of Pediatrics in the diagnosis, treatment, and supportive care of children with central nervous system (CNS) tumors. The unique aspects of state-of-the-art radiotherapy and neurosurgery techniques available to children are discussed as well as our comprehensive supportive-care program. The specialized care of children with neurofibromatosis and CNS tumors are described. Chemotherapy programs and clinical trials for children with CNS tumors are discussed in Chapter 4, “Brain Tumors: Chemotherapy and Investigational Therapy.”

Pediatric cancer is one of the most difficult challenges a family may face. The experience will have a lasting effect on the patient and all family members. There will be some personal and shared triumphs, but there will likely be some stressful situations and encounters that could impede the child’s natural developmental course and affect family dynamics. The behavioral medicine program in the Child and Adolescent Center at M. D. Anderson Cancer Center is a multidisciplinary service designed to address the many psychological, emotional, and psychosocial issues related to the experience of childhood cancer.

Cancer in children is a very different reality now from what it was only a few decades ago. Instead of cancer being an invariably fatal disease, it is now a disease in which biological cure is the norm. The long-term survival rate varies among cancers, but the overall cure rate approximates 60%. One in 600 children between birth and 15 years of age acquires some form of neoplastic disease (Young and Miller, 1975). Therefore, in approximately 10 years, one in 1000 individuals reaching the age of 20 will be a survivor of childhood cancer and its therapy (Meadows, Krejmas, and Belasco, 1980). We must, therefore, be concerned not only with effective therapy but also with the effects of our therapy. There is a significant medical cost of cure and that cost should be taken into consideration in designing new therapies. However, there is also a documentable psychological cost of cure (Zwartes, 1980).