Radiotherapy followed by high dose busulfan and thiotepa: a prospective assessment of high dose chemotherapy in children with diffuse pontine gliomas.
BACKGROUND
The role of high dose chemotherapy (HDC) in patients with pediatric brain tumors currently is ill-defined. The purpose of this pilot study was to assess the feasibility and the benefit of HDC after radiotherapy in a group of children with newly diagnosed diffuse pontine gliomas.


METHODS
Patients eligible for study were ages 3-18 years with diffuse intrinsic tumors arising in the pons, who were not treated previously with radiotherapy or chemotherapy. Histologic confirmation was not mandatory, provided clinical findings and magnetic resonance imaging were typical. Patients were given focal radiotherapy followed 2-3 months later by HDC. Busulfan (150 mg/m(2) on Days 8, 7, 6, and 5) and thiotepa (300 mg/m(2) on Days 4, 3, and 2) were administered prior to autologous bone marrow transplantation. Survival was the endpoint, and the statistical procedure was based on sequential subgroup analysis.


RESULTS
Thirty-six patients were entered on to the study, 12 of whom underwent stereotactic biopsy or open surgery at the time of diagnosis. One patient eventually was excluded due to inappropriate eligibility criteria. All 35 eligible patients received irradiation. Early progression (9 patients) and parental refusal (2 patients) precluded the use of HDC in 11 patients. Three patients died of HDC-related complications. All 21 patients who survived HDC eventually died of disease progression. The median survival time was 10 months for the study group. The median survival time in the subgroup of patients who received HDC was 10 months (range, 3-26 months). Statistical analysis did not suggest any evidence of survival benefit.


CONCLUSIONS
For patients with diffuse pontine gliomas, survival using this aggressive treatment modality does not appear to be any better than that reported for conventional radiotherapy.
Bouffet
E
E
Service d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France.
Raquin
M
M
Doz
F
F
Gentet
J C
JC
Rodary
C
C
Demeocq
F
F
Chastagner
P
P
Lutz
P
P
Hartmann
O
O
Kalifa
C
C
D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D016026:Bone Marrow Transplantation; D020295:Brain Stem Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*; D002066:Busulfan / Q000008:administration & dosage* / Q000009:adverse effects; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D005910:Glioma / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D013238:Stereotaxic Techniques; D015996:Survival Rate; D013852:Thiotepa / Q000008:administration & dosage* / Q000009:adverse effects; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D013852:Thiotepa; D002066:Busulfan