Sequential chemotherapy, high-dose thiotepa, circulating progenitor cell rescue, and radiotherapy for childhood high-grade glioma
| Autor: | Michela Casanova, Graziella Cefalo, Lorenza Gandola, Daniela Polastri, Fernando Ravagnani, Roberto Luksch, Daria Riva, Maura Massimino, Marco Zecca, Carlo L. Solero, Paola Collini, Felice Giangaspero, Franco Locatelli, Andrea Ferrari, Filippo Spreafico, Monica Terenziani, Davide Scaramuzza, Marta Podda, Fabio Bozzi, Franca Fossati-Bellani, Cristina Meazza, Emanuele Pignoli |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Oncology Cancer Research medicine.medical_specialty Vincristine Adolescent medicine.medical_treatment Clinical Investigations Blood Component Transfusion ThioTEPA Internal medicine Glioma Antineoplastic Combined Chemotherapy Protocols medicine Humans Child Antineoplastic Agents Alkylating Etoposide Erythroid Precursor Cells Chemotherapy Brain Neoplasms business.industry Lomustine medicine.disease Combined Modality Therapy Chemotherapy regimen Surgery Treatment Outcome Child Preschool Female Radiotherapy Adjuvant Neurology (clinical) business Thiotepa medicine.drug Anaplastic astrocytoma |
| Zdroj: | Neuro-Oncology. 7:41-48 |
| ISSN: | 1523-5866 1522-8517 |
| Popis: | Childhood malignant gliomas are rare, but their clinical behavior is almost as aggressive as in adults, with resistance to therapy, rapid progression, and not uncommonly, dissemination. Our study protocol incorporated sequential chemotherapy and high-dose thiotepa in the preradiant phase, followed by focal radiotherapy and maintenance with vincristine and lomustine for a total duration of one year. The induction treatment consisted of two courses of cisplatin (30 mg/m2) plus etoposide (150 mg/m2) × 3 days and of vincristine (1.4 mg/m2) plus cyclophosphamide (1.5 g/m2) plus high-dose methotrexate (8 g/m2), followed by high-dose thiotepa (300 mg/m2 × 3 doses), with harvesting of peripheral blood progenitor cells after the first cisplatin/etoposide course. From August 1996 to March 2003, 21 children, 14 females and 7 males, with a median age of 10 years were enrolled, 18 presenting with residual disease after surgery. Histologies were glioblastoma multiforme in 10, anaplastic astrocytoma in nine, and anaplastic oligodendroglioma in two; sites of origin were supratentorial areas in 17, spine in two, and posterior fossa in two. Of the 21 patients, 12 have died (10 after relapse, with a median time to progression for the whole series of 14 months; one with intratumoral bleeding at 40 months after diagnosis; and one affected by Turcot syndrome for duodenal cancer relapse). Four of 12 relapsed children had tumor dissemination. At a median follow-up of 57 months, overall survival and progression-free survival at four years were 43% and 46%, respectively. Sequential and high-dose chemotherapy can be afforded in front-line therapy of childhood malignant glioma without excessive morbidity and rather encouraging results. |
| Databáze: | OpenAIRE |
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