Postoperative Chemotherapy in Children Less Than 4 Years of Age with Malignant Brain Tumors
| Autor: | I. Toogood, Heather M. Johnston, Elizabeth Gray, Keith Waters, Les White, Scott Macfarlane, Liane Lockwood, Stewart J. Kellie |
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| Rok vydání: | 1998 |
| Předmět: |
Ependymoma
medicine.medical_specialty Vincristine medicine.medical_treatment Population Gastroenterology chemistry.chemical_compound Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Neuroectodermal Tumors Primitive education Cyclophosphamide Etoposide Postoperative Care Medulloblastoma Chemotherapy education.field_of_study Brain Neoplasms business.industry Infant Hematology medicine.disease Combined Modality Therapy Carboplatin Surgery Regimen Oncology chemistry Child Preschool Pediatrics Perinatology and Child Health business medicine.drug |
| Zdroj: | Journal of Pediatric Hematology/Oncology. 20:125-130 |
| ISSN: | 1077-4114 |
| DOI: | 10.1097/00043426-199803000-00007 |
| Popis: | PURPOSE Postoperative chemotherapy with indefinite postponement of radiation therapy in children < 4 years old with brain tumors was investigated in a multi-institutional study. PATIENTS AND METHODS From 1991 to 1995, 42 patients aged 3 to 47 months (median 20) with brain tumors were enrolled in a 2-phase chemotherapy protocol: 16 patients had medulloblastoma (MB); 8 had supratentorial primitive neuroectodermal tumor (PNET); 14 had ependymoma; and 4 had other tumors. The initial phase was comprised of 4 courses of the 3-drug regimen: vincristine (VCR), etoposide (VP-16), and intensive cyclophosphamide (CPA) in a previously reported schedule (VETOPEC). The continuation phase was comprised of 2-drug courses: A, CPA + VCR; B, cisplatin + VP-16; and C, carboplatin + VP-16, for a total duration of 64 weeks. RESULTS Response to VETOPEC was evaluable in 28 patients with postresection residual (25) and/or metastatic (1 M2, 6 M3) tumor. There were 9 complete responses (CR) and 9 partial responses (PR) with a combined CR + PR of 64% (95% confidence interval [CI] 44 to 81). In 12 evaluable patients with MB, CR + PR was 82% (48 to 98); in 6 patients with PNET, 50% (12 to 88); and, in 8 patients with ependymoma, 86% (42 to 99). Of 40 patients eligible for further analysis, 6 remain progression-free at a median of 30 months, 14 are alive at a median of 38 months, 29 have progressed at a median of 7 months (range, 2 to 37 months), and 26 have died. The progression-free and overall survival rates at 36 months are estimated to be 11% (95% CI 1 to 22) and 34% (18 to 50), respectively. CONCLUSIONS The initial response to the VETOPEC regimen is encouraging and warrants study of further dose escalation. Survival remains poor with current strategies in this high-risk population. |
| Databáze: | OpenAIRE |
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