Research

Head Start Research The series of treatment studies, known worldwide as the “Head Start” studies, were first developed in 1990 by Dr. Jonathan Finlay. These studies  focus on improving the cure rate and quality of survival for the youngest children (less than 10 years of age) newly diagnosed with all types of malignant brain tumors. There have been three separate Head Start research studies:
  • “Head Start I” – conducted between 1991 and 1997
  • “Head Start II” – conducted between 1997 and 2003
  • “Head Start III” – opened in the early part of 2003 (current and ongoing)

Collaboration

The Head Start studies have benefited from the participation of leading childrens’ brain tumor centers throughout the world, including many centers throughout the United States and Canada, as well as centers in Argentina, Australia and New Zealand. Currently, centers in Brazil are planning to join the “Head Start III” protocols, as well as other leading USA centers including Memorial Sloan-Kettering Cancer Center in New York.

Treatment Strategy

The treatment strategy involves intensive drug treatments (chemotherapy) over a six-month period following diagnosis:
  • Surgical resection of the tumor is encouraged when this is possible, without producing unacceptable side-effects to the children.
  • Drug treatment starts with four or five courses, about three to four weeks apart, of intensive but conventional chemotherapy, using well-established drugs in the treatment of childhood brain tumors.
  • At the end of these five months of treatments, provided the tumor has been successfully reduced to a minimal degree, the children then receive a single course of extremely high dose, marrow destructive chemotherapy (the equivalent of receiving one year of drug treatment in six days)  followed by “rescue” with infusion of the child’s own (previously ‘harvested’) blood stem cells.
  • Provided there is no evidence of disease (on MRI scans and on a spinal tap examination of the cerebrospinal fluid) then NO RADIATION TREATMENT IS GIVEN TO THE CHILDREN FOLLOWING THE CHEMOTHERAPY, FOR CHILDREN LESS THAN SIX YEARS OF AGE, AND REDUCED AMOUNTS OF IRRADIATION ARE GIVEN TO CHILDREN WHO ARE EITHER OVER SIX YEARS OF AGE,  OR WHO HAVE EVIDENCE OF RESIDUAL TUMOR.

Challenge

A major challenge is to determine that the avoidance of radiation therapy to the brain will result not only in improved survival for these young children, but also an improved quality of life, with acceptable performance in the school and family environment.  Therefore, formal evaluations of children, with neuropsychological testing every few years, as well as parent questionnaires, are crucial components of these studies.  Results so far have indicated that the survival rates for young children with medulloblastoma, other primitive neuro-ectrodermal tumors of the brain (PNETs) and ependymoma are at least as good as the best results published from other studies.

Additional Information

For further information, please contact either of the individuals listed below:
Program Director Jonathan Finlay, MB, ChB

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