title: Treatment of children with diffuse intrinsic brain stem glioma with radiotherapy, vincristine and oral VP-16: a Children's Oncology Group phase II study.
abstract: BACKGROUND
  The prognosis for children with brain stem glioma remains grim. Based on studies suggesting efficacy of vincristine and oral VP-16, The Pediatric Oncology Group (POG, now part of the Children's Oncology Group) conducted a study using these agents in combination with standard external beam radiation for children with newly diagnosed brain stem glioma.
  
  
  METHODS
  Children were eligible for the study if they 3-21 years of age, had MRI-evidence of a diffuse intrinsic pontine glioma, and had neurologic deficits of <6 months duration. Patients received local radiotherapy to a dosage of 54 Gy. Chemotherapy consisted of two 28-day cycles of vincristine, 1.5 mg/m(2), days 1, 8, and 15 and oral VP-16, 50 mg/m(2), days 1-21, starting concurrent with radiation, and continuing for ten cycles following radiation.
  
  
  RESULTS
  Of the 31 children enrolled, 30 were eligible and evaluable for survival and toxicity. Their median age was 8 years (range 3-14 years). Seven patients (23%) had a partial response following radiation, 18 (60%) had stable disease, 2 (7%) had progressive disease, and response in 3 patients (10%) was not measured. All 30 children have died. Overall survival at 1 year was 27 +/- 7% and at 2 years, 3 +/- 2%. The median survival was 9 months (range 3-36 months). Hematologic toxicity was significant; other toxicities included constipation, mucositis, emesis, and infection.
  
  
  CONCLUSIONS
  The addition of vincristine and oral VP-16 to standard external beam radiation causes moderate toxicity and does not improve survival of children with diffuse intrinsic brain stem glioma.
authors.affiliation: University of Rochester Medical Center, Rochester, New York, USA. david_korones@urmc.rochester.edu
authors.forename: David N
authors.initials: DN
authors.lastname: Korones
authors.forename: Paul G
authors.initials: PG
authors.lastname: Fisher
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kretschmar
authors.forename: Tianni
authors.initials: T
authors.lastname: Zhou
authors.forename: Zhengjia
authors.initials: Z
authors.lastname: Chen
authors.forename: James
authors.initials: J
authors.lastname: Kepner
authors.forename: Carolyn
authors.initials: C
authors.lastname: Freeman
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D020295:Brain Stem Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D002648:Child; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005910:Glioma / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D011878:Radiotherapy / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014750:Vincristine; D005047:Etoposide