title: Temozolomide and radiation for aggressive pediatric central nervous system malignancies.
abstract: This study describes the outcomes of children treated with combinations of temozolomide and radiation therapy for various aggressive central nervous system malignancies. Their age at diagnosis ranged from 1 to 15 years. Patients with focal disease were treated with concomitant temozolomide (daily 75 mg/m) and three-dimensional conformal radiotherapy in a dose that ranged from 50 to 54 Gy, followed by temozolomide (200 mg/m/d x 5 days/month in three patients, 150 mg/m x 5 days/ month in one patient). Patients with disseminated disease were treated with craniospinal radiation (39.6 Gy) before conformal boost. One patient received temozolomide (200 mg/m x 5 days/month) before craniospinal radiation, and one patient received temozolomide (daily 95 mg/m) concomitant with craniospinal radiation and a radiosurgical boost, followed by temozolomide (200 mg/m x 5 days/month). Three patients achieved a partial response during treatment, with two of these patients dying of progressive disease after treatment. One patient has no evidence of disease. Three patients achieved stable disease, with one of these patients dying of progressive disease after treatment. Toxicities observed included low-grade neutropenia, thrombocytopenia, and lymphopenia. The combination of temozolomide and radiotherapy appears to be well tolerated in a variety of treatment schemas for aggressive pediatric central nervous system malignancies. This information is of particular use in designing future studies, given the recent positive results in a randomized study examining the use of temozolomide concomitant with radiation in the treatment of adult glioblastoma.
authors.affiliation: Department of Radiation Oncology, UCSD Cancer Center, University of California at San Diego, San Diego, California 92103, USA.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Loh
authors.forename: Jennifer
authors.initials: J
authors.lastname: Willert
authors.forename: Hal
authors.initials: H
authors.lastname: Meltzer
authors.forename: William
authors.initials: W
authors.lastname: Roberts
authors.forename: Bryce
authors.initials: B
authors.lastname: Kerlin
authors.forename: Richard
authors.initials: R
authors.lastname: Kadota
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
authors.forename: Greg
authors.initials: G
authors.lastname: White
authors.forename: Amy
authors.initials: A
authors.lastname: Geddis
authors.forename: Deborah
authors.initials: D
authors.lastname: Schiff
authors.forename: Laura
authors.initials: L
authors.lastname: Martin
authors.forename: Alice
authors.initials: A
authors.lastname: Yu
authors.forename: Faith
authors.initials: F
authors.lastname: Kung
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Spear
mesh_terms: D000293:Adolescent; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide