Intensive chemotherapy improves survival in pediatric high-grade glioma after gross total resection: results of the HIT-GBM-C protocol.
BACKGROUND
The authors hypothesized that intensified chemotherapy in protocol HIT-GBM-C would increase survival of pediatric patients with high-grade glioma (HGG) and diffuse intrinsic pontine glioma (DIPG).


METHODS
Pediatric patients with newly diagnosed HGG and DIPG were treated with standard fractionated radiation and simultaneous chemotherapy (cisplatin 20 mg/m2 x 5 days, etoposide 100 mg/m2 x 3 days, and vincristine, and 1 cycle of cisplatin + etoposide + ifosfamide 1.5 g/m x 5 days [PEI] during the last week of radiation). Subsequent maintenance chemotherapy included further cycles of PEI in Weeks 10, 14, 18, 22, 26, and 30, followed by oral valproic acid.


RESULTS
Ninety-seven (pons, 37; nonpons, 60) patients (median age, 10 years; grade IV histology, 35) were treated. Resection was complete in 21 patients, partial in 29, biopsy only in 26, and not performed in 21. Overall survival rates were 91% (standard error of the mean [SE] +/- 3%), 56%, and 19% at 6, 12, and 60 months after diagnosis, respectively. When compared with previous protocols, there was no significant benefit for patients with residual tumor, but the 5-year overall survival rate for patients with complete resection treated on HIT-GBM-C was 63% +/- 12% SE, compared with 17% +/- 10% SE for the historical control group (P = .003, log-rank test).


CONCLUSIONS
HIT-GBM-C chemotherapy after complete tumor resection was superior to previous protocols.
Wolff
Johannes E A
JE
Department of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. jwolff@mdanderson.org
Driever
Pablo Hernaiz
PH
Erdlenbruch
Bernhard
B
Kortmann
Rolf D
RD
Rutkowski
Stefan
S
Pietsch
Torsten
T
Parker
Crystal
C
Metz
Monica Warmuth
MW
Gnekow
Astrid
A
Kramm
Christof M
CM
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D006801:Humans; D008297:Male; D016896:Treatment Outcome