title: Treatment of pediatric low-grade gliomas with a nitrosourea-based multiagent chemotherapy regimen.
abstract: 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.
authors.affiliation: Department of Neurological Surgery, School of Medicine, University of California, San Francisco, USA.
authors.forename: M D
authors.initials: MD
authors.lastname: Prados
authors.forename: M S
authors.initials: MS
authors.lastname: Edwards
authors.forename: J
authors.initials: J
authors.lastname: Rabbitt
authors.forename: K
authors.initials: K
authors.lastname: Lamborn
authors.forename: R L
authors.initials: RL
authors.lastname: Davis
authors.forename: V A
authors.initials: VA
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007223:Infant; D008130:Lomustine / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008936:Mitolactol / Q000008:administration & dosage / Q000009:adverse effects; D011344:Procarbazine / Q000008:administration & dosage / Q000009:adverse effects; D013866:Thioguanine / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D011344:Procarbazine; D014750:Vincristine; D008130:Lomustine; D013866:Thioguanine; D008936:Mitolactol