title: Feasibility of metronomic maintenance chemotherapy following high-dose chemotherapy for malignant central nervous system tumors.
abstract: BACKGROUND
  Children less than 5 years of age with malignant central nervous system (CNS) tumors, continue to have a high rate of morbidity and mortality following administration of conventional therapy. In an attempt to avoid the neurologic sequelae associated with craniospinal radiation, strategies such as high-dose chemotherapy (HDCT) followed by peripheral stem cell rescue have been used successfully. Metronomic chemotherapy has also been reported as a potential new treatment strategy in solid tumors, particularly in adults.
  
  
  METHODS
  A retrospective chart analysis was performed on 10 patients less than 5 years of age with CNS tumors treated with metronomic chemotherapy shortly after HDCT as part of their clinical care.
  
  
  RESULTS
  Metronomic chemotherapy was associated with minimal toxicity and all patients maintained a good quality of life. At the time of this report, all 10 patients are alive. Two patients have relapsed, and the remaining eight, including six patients with metastatic disease, continue to have stable clinical and radiographic disease at a mean of 20 months from the time of diagnosis.
  
  
  CONCLUSIONS
  Metronomic chemotherapy in this patient population is feasible and shows encouraging preliminary results, especially in patients with metastatic disease who have not received craniospinal radiation. Further investigation of this strategy in newly diagnosed patients with CNS tumors is warranted.
authors.affiliation: Division of Hematology and Oncology, Children's National Medical Center, Washington, District of Columbia, USA.
authors.forename: L Mi Rim
authors.initials: LM
authors.lastname: Choi
authors.forename: Brian
authors.initials: B
authors.lastname: Rood
authors.forename: Naynesh
authors.initials: N
authors.lastname: Kamani
authors.forename: Deborah
authors.initials: D
authors.lastname: La Fond
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Packer
authors.forename: Maria Rita
authors.initials: MR
authors.lastname: Santi
authors.forename: Tobey J
authors.initials: TJ
authors.lastname: Macdonald
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005240:Feasibility Studies; D018303:Ganglioglioma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D006801:Humans; D007223:Infant; D008527:Medulloblastoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy; D018242:Neuroectodermal Tumors, Primitive / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D009837:Oligodendroglioma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D011788:Quality of Life; D012189:Retrospective Studies; D013852:Thiotepa / Q000008:administration & dosage; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D013852:Thiotepa; D016190:Carboplatin; D002945:Cisplatin