Section 2 Clinical Challenges

study of autophagy inhibition using hydroxychloroquine in patients with metastatic pancreatic adenocarcinoma. The Oncologist. 2014;**19**:637-638

*Current Cancer Treatment*

mRNA and miRNA genes reveals that CK2 and MEK inhibitors may synergize to induce apoptosis KRAS-active NSCLC. Cancer Informatics. 2019;**18**:

[71] Kawada K, Toda K, Sakai Y. Targeting metabolic reprogramming in KRAS-driven cancers. International Journal of Clinical Oncology. 2017;**22**:

[72] Anderson GR, Winter PS, Lin KH, et al. A landscape of therapeutic cooperativity in KRAS mutant cancers reveals principles for controlling tumor evolution. Cell Reports. 2017;**20**:

1176935119843507

651-659

999-1015

[64] Catenacci DV, Junttila MR,

inhibitor, in patients with metastatic pancreatic cancer.

4284-4292

Karrison T, et al. Randomized phase Ib/ II study of gemcitabine plus placebo or vismodegib, a hedgehog pathway

Journal of Clinical Oncology. 2015;**33**:

[65] Chung V, McDonough S, Philip PA, et al. Effect of selumetinib and MK-2206

vs oxaliplatin and fluorouracil in patients with metastatic pancreatic cancer after prior therapy: SWOG S1115 study randomized clinical trial. JAMA

[66] Faivre S, Niccoli P, Castellano D,

randomized study. Annals of Oncology.

[67] Ko AH, Murphy PB, Peyton JD, et al. A randomized, double-blinded, phase II trial of gemcitabine and nabpaclitaxel plus apatorsen or placebo in patients with metastatic pancreatic cancer: The RAINIER trial. The Oncologist. 2017;**22**:1427-e1129

[68] Laquente B, Lopez-Martin J, Richards D, et al. A phase II study to evaluate LY2603618 in combination with gemcitabine in pancreatic cancer patients. BMC Cancer. 2017;**17**:137

[69] Van Cutsem E, Hidalgo M, Canon JL, et al. Phase I/II trial of pimasertib plus gemcitabine in patients with metastatic pancreatic cancer. International Journal of Cancer. 2018;

[70] Gober MK, Flight RM, Lambert J, et al. Deregulation of a network of

**143**:2053-2064

**144**

Oncology. 2017;**3**:516-522

et al. Sunitinib in pancreatic neuroendocrine tumors: Updated progression-free survival and final overall survival from a phase III

2017;**28**:339-343

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**Chapter 6**

**Abstract**

tumours.

**1. Overview**

in location [1].

**2. Incidence**

Malignancies

*Neha Sharma and Deepti Sharma*

**Keywords:** CNS, pediatric, adjuvant, radiation therapy

An Overview of Pediatric CNS

Central nervous system tumours are the most common solid tumours and second most common malignancy in pediatric age group. They are the leading cause of cancer related morbidity and mortality. It accounts for 3.5% of all deaths in the 1–14 years age group. Childhood central nervous system (CNS) tumors differ significantly from adult brain tumors in reference to their sites of origin, clinical presentation, tendency to disseminate early, histological features and their biological behaviour. Supratentorial tumors are more common in infants and children up to 3 years of age and again after age 10, whereas between ages 4 and 10 infratentorial tumors are more common. The initial workup of patients with brain tumors must include a complete history, physical examination, imaging and biopsy confirmation of primary. The management of pediatric brain tumours is important due to their high incidence, challenging aspects of surgery and high mortality. Many CNS malignancies, which were once universally fatal are now curable with multimodality approaches that integrate surgery, chemotherapy and radiotherapy. In this chapter, we will discuss these issues in detail and summarize the ongoing efforts to reduce the morbidity and mortality in pediatric CNS

Tumors of the central nervous system are the most common solid tumors in the pediatric age group and the second most common childhood malignancy. They are the leading cause of morbidity and mortality associated with cancer. Although it affects all ages, the incidence peaks among children between the ages of 3 and 7. In adults and older children, most tumours are supratentorial in location while in young children they are more commonly infratentorial

The incidence of childhood CNS tumor varies from 1.12 to 5.14 cases per 100,000 individuals [2]. Based upon data from the Central Brain Tumor Registry of the United States (CBTRUS), the estimated incidence of primary non-malignant and malignant CNS tumors for children and adolescents up to 19 years of age was 7.18 cases per 100,000 person-year in 2016 [3]. More than 100 different
