title: Outcome and long-term side effects after synchronous radiochemotherapy for childhood brain stem gliomas.
abstract: Between 1993 and 1999, 11 children with histologically confirmed diffuse and exophytic brain stem glioma (BSG) were treated with intensive induction chemotherapy and simultaneous external beam irradiation. Chemotherapy was performed according to the German/Austrian Pediatric Brain Tumor Study HIT '91 and included two cycles of ifosfamide (days 1-3), etoposide (days 4-6), methotrexate (days 15 and 22), cisplatin (days 29-31) and cytarabine (days 29-31), separated by a 3-week interval. Maintenance chemotherapy with carmustine, carboplatin and vincristine (8 cycles over a 1-year period) was given in those patients who responded clinically or radiographically to induction chemotherapy. Six of 11 patients showed an objective reduction in tumor size on magnetic resonance imaging and 4 of 11 are alive in good general condition >22, >22, >90 and >92 months, respectively, after diagnosis without radiographic evidence of tumor progression (1 complete remission, 2 partial remissions, 1 stable disease), but suffer from moderate to severe long-term side effects. Three patients died due to disease progression after having achieved a partial remission which lasted 5, 6 and 18 months, respectively, whereas only short-term stabilization was observed in 4 patients who died within 1 year after diagnosis. Acute hematologic toxicity was severe but manageable. This intensive combined modality treatment was toxic but yielded objective responses in more than 50% and long-term survivors in one third of childhood BSG patients.
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Benesch
authors.forename: H
authors.initials: H
authors.lastname: Lackner
authors.forename: A
authors.initials: A
authors.lastname: Moser
authors.forename: R
authors.initials: R
authors.lastname: Kerbl
authors.forename: W
authors.initials: W
authors.lastname: Schwinger
authors.forename: R
authors.initials: R
authors.lastname: Oberbauer
authors.forename: H G
authors.initials: HG
authors.lastname: Eder
authors.forename: R
authors.initials: R
authors.lastname: Mayer
authors.forename: K
authors.initials: K
authors.lastname: Wiegele
authors.forename: C
authors.initials: C
authors.lastname: Urban
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects*; D020295:Brain Stem Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011832:Radiation Injuries / Q000209:etiology* / Q000401:mortality; D015996:Survival Rate