title: High-dose methotrexate prior to simultaneous radiochemotherapy in children with malignant high-grade gliomas.
abstract: BACKGROUND
  Preradiation chemotherapy including methotrexate (MTX) was effective in children with completely resected high-grade gliomas (HGG). The specific role of MTX remains uncertain.
  
  
  METHODS
  Children with newly diagnosed HGG and diffuse intrinsic pontine gliomas (DIPG) were enrolled. Two cycles of HD-MTX (5 mg/m2) were given prior to simultaneous radiochemotherapy (SRCT). Response was evaluated two weeks after SRCT.
  
  
  RESULTS
  Of 26 children (17 males, median age: 10.3 years) tumor grading was WHO IV (n=9), III (n=10), II/I (n=4, DIPG), unknown (n=3, DIPG). Fourteen tumors were resected. III/IV toxicity after SRCT was: 10/19 anemia, 15/19 leukocytopenia, 12/19 thrombocytopenia, 8/18 infection. No IV infection, gastrointestinal, hepatic or dermal toxicity or toxic death was seen. Stable disease or better was seen in 95.3% (CCR:2, CR:1, PR:8, SD:9, PD:1, unknown:5).
  
  
  CONCLUSIONS
  HD-MTX prior to SRCT is well tolerated and feasible. A randomized trial evaluating the effect of HD-MTX on survival is justified.
authors.affiliation: Department of Pediatric Oncology, Krankenhaus der Barmherzigen Brüder Klinik St. Hedwig, Steinmetzstr. 1-3, D-93049 Regensburg, Germany. sabine.wagner@barmherzige-regensburg.de
authors.forename: Sabine
authors.initials: S
authors.lastname: Wagner
authors.forename: Christiane
authors.initials: C
authors.lastname: Reinert
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Schmid
authors.forename: Anne-Katrin
authors.initials: AK
authors.lastname: Liebeskind
authors.forename: Norbert
authors.initials: N
authors.lastname: Jorch
authors.forename: Alfred
authors.initials: A
authors.lastname: Längler
authors.forename: Norbert
authors.initials: N
authors.lastname: Graf
authors.forename: Monika
authors.initials: M
authors.lastname: Warmuth-Metz
authors.forename: Thorsten
authors.initials: T
authors.lastname: Pietsch
authors.forename: Ove
authors.initials: O
authors.lastname: Peters
authors.forename: Johannes E A
authors.initials: JE
authors.lastname: Wolff
mesh_terms: D000293:Adolescent; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D010865:Pilot Projects
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate