Advances have recently been made in the use of chemotherapy for pediatric brain tumors. Chemotherapy increases disease-free survival in high-risk primitive neuroectodermal tumor/medulloblastoma patients and enables the reduction of radiation therapy in standard-risk patients. Radiation can be significantly delayed and neurotoxicity ameliorated in many infants using chemotherapy. Chemotherapy can cause reduction in size of low-grade glioma, optic glioma, and oligodendroglioma. High-grade glioma and ependymoma are relatively chemoresistant. Physicians caring for children with brain tumors are encouraged to participate in controlled studies, so that objective information can be gathered and the role of chemotherapy in these tumors can be better defined.