[en] Objectives: To review the clinical characteristics of childhood brain tumors, including neurologic signs, neuroimaging and neuropathology. To critically assess indications for therapy relevant to presenting characteristics, age, and disease status. To discuss current management strategies including neurosurgery, radiation therapy, and chemotherapy. To analyze current clinical trials and future directions of clinical research. Brain tumors account for 20% of neoplastic diseases in children. The most common tumors include astrocytoma and malignant gliomas, medulloblastoma and supratentorial PNET's, ependymoma, craniopharyngioma, and intracranial germ cell tumors. The clinical characteristics and disease extent largely determine the relative merits of available 'standard' and investigational therapeutic approaches. Treatment outcome, including disease control and functional integrity, is dependent upon tumor type and site, age at presentation, and disease extent. An understanding of the clinical, neuroimaging, and histologic characteristics as they relate to decisions regarding therapy is critical to the radiation oncologist. Appropriate radiation therapy is central to curative therapy for a majority of pediatric brain tumor presentations. Technical advances in neurosurgery provide greater safety for 'gross total resection' in a majority of hemispheric astrocytomas and medulloblastomas. The relative roles of radiation therapy and chemotherapy for centrally located astrocytomas (e.g., diencephalic, optic pathway) need to be analyzed in the context of initial and overall disease control, neurotoxicities, and potential modifications in the risk:benefit ratio apparent in the introduction of 3-dimensional radiation techniques. Modifications in radiation delivery are important components of current investigations in medulloblastoma; the rationale for contemporary cooperative group trials will be presented as well as the background data re surgical, radiotherapeutic, and chemotherapeutic components of therapy. The outcome of supratentorial malignant gliomas and diffusely infiltrating pontine gliomas remains poor; data from recent studies will be presented to highlight current therapy and investigational approaches. The impact of tumor extent and resectability in ependymoma and craniopharyngioma will be reviewed to emphasize current practice, clinical investigations, and debate regarding the indications for radiation therapy and introduction of 3-D techniques. The rationale for recommended radiation volume(s) for intracranial germinomas will be reviewed, as well as recent data addressing combined chemoradiation for CNS germ cell tumors. Recognizing the unique risk:benefit ratio in treating infants and young children with malignant brain tumors, the indications for radiation therapy, timing, and potential modifications of therapy will be highlighted