title: Preradiation chemotherapy in primary high-risk brainstem tumors: phase II study CCG-9941 of the Children's Cancer Group.
abstract: OBJECTIVE
  This Children's Cancer Group group-wide phase II trial evaluated the efficacy and toxicity of two chemotherapy arms administered before hyperfractionated external-beam radiotherapy (HFEBRT).
  
  
  METHODS
  Thirty-two patients with newly diagnosed brainstem gliomas were randomly assigned to regimen A and 31 to regimen B. Regimen A comprised three courses of carboplatin, etoposide, and vincristine; regimen B comprised cisplatin, etoposide, cyclophosphamide, and vincristine. Both arms included granulocyte colony-stimulating factor. Patients were evaluated by magnetic resonance imaging after induction chemotherapy and HFEBRT at a dose of 72 Gy.
  
  
  RESULTS
  Ten percent +/- 5% of regimen A patients objectively responded to chemotherapy. For combined induction and radiotherapy, 27% +/- 9% of patients improved. The neuroradiographic response rate for regimen B was 19% +/- 8% for chemotherapy and 23% +/- 9% after HFEBRT. Response rates were not statistically significant between regimens after induction or chemotherapy/HFEBRT. Event-free survival was 17% +/- 5% (estimate +/- SE) at 1 year and 6% +/- 3% at 2 years. Survival was significantly longer among patients who responded to chemotherapy (P <.05). Among patients who received regimen A induction, grades 3 and 4 leukopenia were observed in 50% to 65%, with one toxicity-related death. For regimen B, severe leukopenia occurred in 86% to 100%, with febrile neutropenia in 48% to 60% per course.
  
  
  CONCLUSIONS
  Neither chemotherapy regimen meaningfully improved response rate, event-free survival, or overall survival relative to previous series of patients with brainstem gliomas who received radiotherapy with or without chemotherapy.
authors.affiliation: Vanderbilt Cancer Center, Nashville, TN, USA. mark.jennings@mcmail.vanderbilt.edu
authors.forename: Mark T
authors.initials: MT
authors.lastname: Jennings
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.forename: James M
authors.initials: JM
authors.lastname: Boyett
authors.forename: L Gilbert
authors.initials: LG
authors.lastname: Vezina
authors.forename: Emi
authors.initials: E
authors.lastname: Holmes
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Berger
authors.forename: Carol S
authors.initials: CS
authors.lastname: Bruggers
authors.forename: Janet M
authors.initials: JM
authors.lastname: Bruner
authors.forename: Ka-Wah
authors.initials: KW
authors.lastname: Chan
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Dusenbery
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Ettinger
authors.forename: Charles R
authors.initials: CR
authors.lastname: Fitz
authors.forename: Deborah
authors.initials: D
authors.lastname: Lafond
authors.forename: David E
authors.initials: DE
authors.lastname: Mandelbaum
authors.forename: Vicky
authors.initials: V
authors.lastname: Massey
authors.forename: Warren
authors.initials: W
authors.lastname: McGuire
authors.forename: Lee
authors.initials: L
authors.lastname: McNeely
authors.forename: Thomas
authors.initials: T
authors.lastname: Moulton
authors.forename: Ian F
authors.initials: IF
authors.lastname: Pollack
authors.forename: Violet
authors.initials: V
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D020295:Brain Stem Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin; D002945:Cisplatin