title: Preirradiation ifosfamide, carboplatin and etoposide (ICE) for the treatment of high-grade astrocytomas in children.
abstract: BACKGROUND
  Astrocytomas are the most common form of primary intracranial tumor; however, survival of patients with high-grade tumors has not changed much compared with that reported in the early 1970s. OBJECTIVE. Our objective was to assess the efficacy, security, and survival rate of postoperative chemotherapy with ifosfamide, carboplatin, and etoposide (ICE) in pediatric patients with anaplastic astrocytomas (AA) and glioblastoma multiforme (GM).
  
  
  METHODS
  In a phase II study, we evaluated 25 children with AA or GM. The proposed treatment was four courses of chemotherapy with ICE followed by hyperfractionated radiotherapy, and then four more courses of ICE. Patients were evaluated using MRI after surgery, after the second course of chemotherapy, and again after the last. Toxicity was determined before each course.
  
  
  RESULTS
  The overall and disease-free survival at 60 months was 67% and 56% respectively. For supratentorial localization it was 92% at 60 months and 20% at 18 months for brain stem tumors. Fourteen patients had a complete response and 9 died as a result of tumor progression.
  
  
  CONCLUSIONS
  Postoperative chemotherapy with ICE reduces the tumor size and increases the survival rate of pediatric patients with malignant astrocytomas with minimal toxicity.
authors: Oncology Department, Pediatrics Hospital, Centro Médico Nacional Siglo XXI, IMSS Av. Cuauhtémoc 330, Col. Doctores, CP 06720, Mexico City, México. elopezaguilar@hotmail.com
authors: Enrique
authors: E
authors: López-Aguilar
authors: Ana Carolina
authors: AC
authors: Sepúlveda-Vildósola
authors: Hugo
authors: H
authors: Rivera-Márquez
authors: Fernando
authors: F
authors: Cerecedo-Díaz
authors: Martha
authors: M
authors: Valdés-Sánchez
authors: Sandra
authors: S
authors: Delgado-Huerta
authors: Volkmar
authors: V
authors: Wanzke-del Angel
authors: Guillermo
authors: G
authors: Ramón-García
authors: Héctor
authors: H
authors: Rodríguez-Jiménez
authors: Isidro
authors: I
authors: Hernández-Contreras
authors: Enrique
authors: E
authors: Santacruz-Castillo
authors: Hugo A
authors: HA
authors: Romo-Rubio
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001254:Astrocytoma / Q000628:therapy*; D016190:Carboplatin / Q000008:administration & dosage; D016543:Central Nervous System Neoplasms / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D011446:Prospective Studies; D011878:Radiotherapy / Q000379:methods; D015996:Survival Rate
chemical_list: D005047:Etoposide; D016190:Carboplatin; D007069:Ifosfamide