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J Neurooncol. 2005 Sep 10;
Broniscer A, Chintagumpala M, Fouladi M, Krasin MJ, Kocak M, Bowers DC, Iacono LC, Merchant TE, Stewart CF, Houghton PJ, Kun LE, Ledet D, Gajjar A.
Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA, alberto. broniscer@stjude.org.
Chemotherapy is commonly used in the treatment of children with high-grade glioma, although its usefulness is uncertain. We conducted a multi-institutional study to evaluate the efficacy of temozolomide given after radiotherapy in children with newly diagnosed high-grade glioma and unfavorable low-grade glioma (gliomatosis cerebri or bithalamic involvement). Optional window therapy of intravenous irinotecan (10 doses of 20 mg/m(2) per cycle x 2) was given over 6 weeks. The 5-day schedule of temozolomide (200 mg/m(2) per day) started 4 weeks after the completion of radiotherapy and continued for a total of 6 cycles. Thirty-one eligible patients (median age: 12.3 years) participated. Tumors most commonly involved cerebral hemispheres (n=13, 42%) and thalamus (n=14, 45%). Whereas six patients underwent radical resection, the remainder had limited surgery, including biopsy (n=14, 45%). The predominant histologic diagnoses were glioblastoma multiforme (n=15, 48%) and anaplastic astrocytoma (n=10, 32%). Two patients had bithalamic grade II astrocytoma. Twenty-seven patients received radiotherapy (median dose: 59.4 Gy), including craniospinal irradiation in 3 because of leptomeningeal spread. Four patients did not receive radiotherapy in this study because of consent withdrawn (n=2), toxicity during window therapy (n=1), or at the physician's discretion (n=1). Twenty-three patients received 112 cycles of temozolomide therapy. The 2-year progression-free and overall survival estimates were 11+/-5% and 21+/-7%, respectively. Although the heterogeneity of prognostic factors in our patients made assessment of treatment outcome more difficult, the addition of 6 cycles of temozolomide after radiotherapy did not seem to alter the poor outcome of these patients.
PMID: 16200343 [PubMed - as supplied by publisher]