en Pediatric Hematology & Oncology Pediatric Hematology & Oncology مقاله مروری Review Article <div style="text-align: justify;"><span style="line-height:2;"><span style="font-family:Times New Roman;"><span style="font-size:14px;">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.</span></span></span></div> Pediatric brain tumors, Developing countries, Tumor microenvironment, Metronomic chemotherapy, Intrathecal chemotherapy, Maintenance chemotherapy, Resource-limited settings 113 123 http://ijbc.ir/browse.php?a_code=A-10-2395-1&slc_lang=en&sid=1 Babak Abdolkarimi b.abdolkarimi@yahoo.com 100319475328460013164 100319475328460013164 Yes Department of pediatrics, Tehran University of Medical Science, Tehran, Iran. Sina Goodarzi 100319475328460013165 100319475328460013165 No Lorestan University of Medical Sciences, Khorramabad, Iran. Dina Seyedi 100319475328460013166 100319475328460013166 No School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Sahar Arbab Solimani 100319475328460013167 100319475328460013167 No Mahak Hematology Oncology Research Center (Mahak-HORC), Mahak Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ali Pajouhi Pajuhia@yahoo.com 100319475328460013168 100319475328460013168 No Student Research Committee, Faculty of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran. Niki Panahi 100319475328460013169 100319475328460013169 No Health Services Management Department, Science and Research Branch, Islamic Azad University, Tehran, Iran. Morteza Ashrafi 100319475328460013170 100319475328460013170 No Mahak Hematology Oncology Research Center (Mahak-HORC), Mahak Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mahyar Nourian 100319475328460013171 100319475328460013171 No Mahak Hematology Oncology Research Center (Mahak-HORC), Mahak Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.