title: Sequential chemotherapy, high-dose thiotepa, circulating progenitor cell rescue, and radiotherapy for childhood high-grade glioma.
abstract: Childhood malignant gliomas are rare, but their clinical behavior is almost as aggressive as in adults, with resistance to therapy, rapid progression, and not uncommonly, dissemination. Our study protocol incorporated sequential chemotherapy and high-dose thiotepa in the preradiant phase, followed by focal radiotherapy and maintenance with vincristine and lomustine for a total duration of one year. The induction treatment consisted of two courses of cisplatin (30 mg/m2) plus etoposide (150 mg/m2) x 3 days and of vincristine (1.4 mg/m2) plus cyclophosphamide (1.5 g/m2) plus high-dose methotrexate (8 g/m2), followed by high-dose thiotepa (300 mg/m2 x 3 doses), with harvesting of peripheral blood progenitor cells after the first cisplatin/etoposide course. From August 1996 to March 2003, 21 children, 14 females and 7 males, with a median age of 10 years were enrolled, 18 presenting with residual disease after surgery. Histologies were glioblastoma multiforme in 10, anaplastic astrocytoma in nine, and anaplastic oligodendroglioma in two; sites of origin were supratentorial areas in 17, spine in two, and posterior fossa in two. Of the 21 patients, 12 have died (10 after relapse, with a median time to progression for the whole series of 14 months; one with intratumoral bleeding at 40 months after diagnosis; and one affected by Turcot syndrome for duodenal cancer relapse). Four of 12 relapsed children had tumor dissemination. At a median follow-up of 57 months, overall survival and progression-free survival at four years were 43% and 46%, respectively. Sequential and high-dose chemotherapy can be afforded in front-line therapy of childhood malignant glioma without excessive morbidity and rather encouraging results.
authors.affiliation: Pediatric Oncology Unit, Istituto Nazionale Tumori, Milan, Italy. maura.massimino@istitutotumori.mi.it
authors.forename: Maura
authors.initials: M
authors.lastname: Massimino
authors.forename: Lorenza
authors.initials: L
authors.lastname: Gandola
authors.forename: Roberto
authors.initials: R
authors.lastname: Luksch
authors.forename: Filippo
authors.initials: F
authors.lastname: Spreafico
authors.forename: Daria
authors.initials: D
authors.lastname: Riva
authors.forename: Carlo
authors.initials: C
authors.lastname: Solero
authors.forename: Felice
authors.initials: F
authors.lastname: Giangaspero
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.forename: Marta
authors.initials: M
authors.lastname: Podda
authors.forename: Fabio
authors.initials: F
authors.lastname: Bozzi
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pignoli
authors.forename: Paola
authors.initials: P
authors.lastname: Collini
authors.forename: Graziella
authors.initials: G
authors.lastname: Cefalo
authors.forename: Marco
authors.initials: M
authors.lastname: Zecca
authors.forename: Michela
authors.initials: M
authors.lastname: Casanova
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferrari
authors.forename: Monica
authors.initials: M
authors.lastname: Terenziani
authors.forename: Cristina
authors.initials: C
authors.lastname: Meazza
authors.forename: Daniela
authors.initials: D
authors.lastname: Polastri
authors.forename: Davide
authors.initials: D
authors.lastname: Scaramuzza
authors.forename: Fernando
authors.initials: F
authors.lastname: Ravagnani
authors.forename: Franca
authors.initials: F
authors.lastname: Fossati-Bellani
mesh_terms: D000293:Adolescent; D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016913:Blood Component Transfusion; D001932:Brain Neoplasms / Q000401:mortality / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D015672:Erythroid Precursor Cells; D005260:Female; D005910:Glioma / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D018714:Radiotherapy, Adjuvant; D013852:Thiotepa / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D013852:Thiotepa