High-dose methotrexate prior to simultaneous radiochemotherapy in children with malignant high-grade gliomas.
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.
Wagner
Sabine
S
Department of Pediatric Oncology, Krankenhaus der Barmherzigen Brüder Klinik St. Hedwig, Steinmetzstr. 1-3, D-93049 Regensburg, Germany. sabine.wagner@barmherzige-regensburg.de
Reinert
Christiane
C
Schmid
Hans-Jörg
HJ
Liebeskind
Anne-Katrin
AK
Jorch
Norbert
N
Längler
Alfred
A
Graf
Norbert
N
Warmuth-Metz
Monika
M
Pietsch
Thorsten
T
Peters
Ove
O
Wolff
Johannes E A
JE
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
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate