The overall survival for children with malignant brain tumours has not greatly improved in recent years, so that apparently innovative treatments may seem attractive, especially in cases with a poor prognosis. Problems associated with treating such children include balancing the need to provide optimum treatment for individual patients with the need to properly evaluate advances in treatment in clinical trials and determining who should be responsible for decisions about funding such treatments. Treatment abroad is rarely justified when judged on the basis of whether the treatment is available in Britain (or European Community) and whether there is accepted evidence for its clinical benefit. However, referral to specialist paediatric centres is essential. The range of daily experience in such centres allows an educated choice between established and new treatments. Close collaboration between these centres is essential for clinical trials.

Most progress in the treatment of childhood cancer has been due to incremental improvement in survival resulting from carefully planned clinical trials.1 2 Although the aim of this approach is ultimately to improve overall survival for all children with a specific diagnosis, individual families need to seek the best possible outcome for their own child. Moreover, while clinical trials are evaluating newer, and hopefully better, forms of therapy, the emergency of apparently innovative treatments may pose an attractive alternative to some families, particularly those of children with a disease with a poor prognosis. This area has recently attracted media interest, specifically in relation to the treatment of children with brain tumours, with the possibility that treatment offering better prospects for cure may be available outside the United Kingdom.

Three main tensions underlie this debate. Firstly, how do …