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For 303 children newly diagnosed with cancer, we investigated the prevalence of parental smoking and examined patients’ respiratory or pulmonary symptoms according to household smoking status. Results indicated that approximately 45 percent of patients came from households with at least one current parent smoker and 20 percent of current non-smoking parents reported past tobacco use. There was a trend for more patients from smoking households to experience respiratory problems than patients from non-smoking households ( p = .068). In conclusion, many patients are at risk for parental smoke exposure and associated health problems if they are continually exposed during therapy. Clinician-delivered interventions to reduce environmental smoke exposure are clearly warranted.

Preirradiation chemotherapy is a potentially important component of combined treatment for brain tumors; however, concerns over its side effects and antitumor activity have impeded its evaluation in clinical trials. To determine the feasibility of administering such therapy to children, we assessed the responses of 38 brain tumor patients (median age, 2 years) to 12 weeks of combination chemotherapy given after surgical resection but before irradiation. Transient myelosuppression was noted in all patients, but was not associated with infections or complications of surgical wounds. The ability of the patients to perform activities of daily life, as rated with the Karnofsky performance scale, was either improved (n = 14) or unchanged (n = 18) at the end of the evaluation period. In the remainder of the group, functional deterioration was clearly related to causes other than drug treatment. Prior chemotherapy did not compromise the delivery of radiation except for a brief interruption of spinal irradiation in 3 patients. Objective responses to chemotherapy, defined as a >50% decrease in tumor masses, occurred in 16 of the 31 patients who had subtotal resections; only 6 patients in the entire group showed disease progression during the 12 weeks of drug administration. We conclude that chemotherapy of the type used in this study is well tolerated and produces beneficial effects in children with brain tumors.