A Review of Newer Pathophysiological Insights Into Pediatric Brain Tumors: Revisiting Maintenance and Metronomic Chemotherapy in Resource-Limited Settings



Abdolkarimi B ; Goodarz S ; Seyedi D ; Arbab Solimani S ; Pajouhi A ; Panahi N ; Ashrafi M ; Nourian M
Source: Iranian Journal of Blood and Cancer Published:2026

Abstract

Pediatric brain tumors remain a leading cause of morbidity and mortality worldwide, with management in developing countries particularly constrained by limited healthcare resources. This review highlights emerging concepts in tumor biology, particularly the roles of the tumor microenvironment (TME) and cancer stem cells (CSCs), which are increasingly recognized as critical drivers of tumor progression and therapy resistance. We summarize current evidence linking these biological mechanisms with therapeutic strategies, emphasizing practical and cost-effective approaches such as metronomic chemotherapy, maintenance chemotherapy, and intrathecal therapy delivered into the cerebrospinal fluid (CSF). While molecular targeted therapies and immunotherapies offer promise; their high costs limit accessibility in low-resource settings. Nevertheless, carefully tailored use may provide long-term benefits. By integrating pathophysiological insights with pragmatic treatment strategies, this review provides a biologically grounded and clinically applicable framework for oncologists practicing in low-resource environments. © 2026, Iranian Pediatric Hematology and Oncology Society. All rights reserved.