Treatment of pediatric low-grade gliomas with a nitrosourea-based multiagent chemotherapy regimen

• Published in: Journal of neuro-oncology 1997-05, Vol.32 (3), p.235-241
• Main Authors: PRADOS, M. D, EDWARDS, M. S. B, RABBITT, J, LAMBORN, K, DAVIS, R. L, LEVIN, V. A
• Format: Article
• Language: English
• Subjects: Adolescent; Antineoplastic agents; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Astrocytoma; Biological and medical sciences; Brain cancer; Brain Neoplasms - drug therapy; Brain Neoplasms - mortality; Chemotherapy; Child; Child, Preschool; Children; Disease Progression; Female; Glioma; Glioma - drug therapy; Glioma - mortality; Humans; Infant; Lomustine - administration & dosage; Lomustine - adverse effects; Male; Medical sciences; Mitolactol - administration & dosage; Mitolactol - adverse effects; Neutropenia; Oligodendroglioma; Patients; Pharmacology. Drug treatments; Procarbazine; Procarbazine - administration & dosage; Procarbazine - adverse effects; Thioguanine; Thioguanine - administration & dosage; Thioguanine - adverse effects; Thrombocytopenia; Toxicity; Treatment Outcome; Vincristine; Vincristine - administration & dosage; Vincristine - adverse effects
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1023/A:1005736104205

Between March 9, 1984 and January 29, 1992, 42 children with newly diagnosed symptomatic or previously diagnosed progressive low-grade gliomas received outpatient chemotherapy as their primary treatment. This study was a single arm, phase II trial designed to estimate the time to tumor progression and toxicity of this regimen. Procarbazine, 6-thioguanine, and dibromodulcitol were given before lomustine (CCNU) and vincristine was given 1 and 3 weeks after CCNU. Patients were treated for six treatment cycles or until the tumor progressed, whichever came first. Twenty-three patients had juvenile pilocytic astrocytomas, 11 had astrocytomas, one had oligodendroglioma, one had ganglioglioma, and six had radiographically diagnosed low-grade gliomas. The mean age of the patients was 5 years (median, 3 years). The median time to treatment failure was 132 weeks (95% confidence interval: 106, 186 weeks). Only eight patients have died the estimated 5-year survival rate is 78% (95% confidence interval, 60% 87%). There were two episodes of grade 4 neutropenia, and three episodes of grade 4 thrombocytopenia. This regimen was safe, able to be delivered in the outpatient setting, and produced prolonged periods of disease stabilization in children with low-grade gliomas.