Vincristine and carboplatin chemotherapy for unresectable and/or recurrent low-grade astrocytoma of the brainstem.
BACKGROUND
Radiotherapy remains a widely accepted postoperative treatment modality for unresectable or recurrent low-grade glioma (LGG). However, there is increasing evidence to suggest that chemotherapy can delay and may obviate the need for radiotherapy in progressive/recurrent LGG. The majority of the published experience is in children with hypothalamic/optic chiasmatic lesions and little information is available regarding its use in LGG of the brainstem.


METHODS
We describe clinical characteristics and course of children with LGG of the brainstem who received carboplatin-based chemotherapy in two institutions over 10 years (1996-2006). This was a retrospective review of consecutively treated children with LGG of the brainstem (midbrain, pons, medulla, and upper cervical cord). Vincristine and carboplatin were first-line chemotherapy regimen used in all patients.


RESULTS
In this series, there were 16 children (9 males) with median age at diagnosis of 4.2 years (range 0.5-8). Eight children were treated at diagnosis while the remaining eight received chemotherapy after either radiological progression or clinical deterioration. After a median follow-up of 57 months (range 20-136) from initiation of chemotherapy all children are alive and 11 remain progression free (1 complete response, 8 with partial response + minor response, and 2 stable diseases).


CONCLUSIONS
The efficacy of this chemotherapy regimen in this series supports its role in children with progressive unresectable LGG of brainstem.
Ronghe
Milind
M
Pediatric Brain Tumor Program, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. milind.ronghe@ggc.scot.nhs.uk
Hargrave
Darren
D
Bartels
Ute
U
Tabori
Uri
U
Vaidya
Sucheta
S
Chandler
Chris
C
Kulkarni
Abhaya
A
Bouffet
Eric
E
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001254:Astrocytoma / Q000188:drug therapy* / Q000601:surgery; D001933:Brain Stem; D020295:Brain Stem Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D014750:Vincristine / Q000008:administration & dosage
D014750:Vincristine; D016190:Carboplatin