title: Feasibility and efficacy of repeated chemotherapy for progressive pediatric low-grade gliomas.
abstract: BACKGROUND
  Chemotherapy is widely accepted as first-line therapy for pediatric low-grade gliomas (LGG). Treatment modalities for further progression are not clearly established. The aim of the study was to determine the feasibility and long-term outcome of repeated chemotherapy for children with recurrent LGG.
  
  
  METHODS
  The study group consisted of patients who received a second line of chemotherapy at progression of their LGG. We compared toxicity, progression-free survival (PFS), and overall survival (OS) of patients treated with chemotherapy at the time of initial diagnosis and patients who received another treatment with chemotherapy at further progression.
  
  
  RESULTS
  Between 1985 and 2009, 118 patients received chemotherapy as primary treatment for LGG, 38 had repeated chemotherapy at further progression. Chemotherapy was tolerated extremely well. Ninety-two percent of patients completed their second line protocol and toxicity was comparable between initial and second line chemotherapy. Five-year OS and PFS were 86 ± 6% and 37 ± 8%, respectively, which were similar to first-line chemotherapy (P = 0.14). Repeated chemotherapy courses were not associated with worsening of visual, neuroendocrine, or other long-term organ sequelae.
  
  
  CONCLUSIONS
  This study demonstrates high feasibility and low mortality of repeated chemotherapy treatment for progressive LGG. The chronic nature of LGG concerning tumor progression justifies consideration of non-toxic second-line treatment regimens at the time of recurrence. Prospective studies focusing on toxicity and long-term outcome are needed to substantiate this approach.
authors.affiliation: Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.
authors.forename: Katrin
authors.initials: K
authors.lastname: Scheinemann
authors.forename: Ute
authors.initials: U
authors.lastname: Bartels
authors.forename: Elena
authors.initials: E
authors.lastname: Tsangaris
authors.forename: Cynthia
authors.initials: C
authors.lastname: Hawkins
authors.forename: Annie
authors.initials: A
authors.lastname: Huang
authors.forename: Peter
authors.initials: P
authors.lastname: Dirks
authors.forename: Iris
authors.initials: I
authors.lastname: Fried
authors.forename: Eric
authors.initials: E
authors.lastname: Bouffet
authors.forename: Uri
authors.initials: U
authors.lastname: Tabori
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008130:Lomustine / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D011344:Procarbazine / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D013866:Thioguanine / Q000008:administration & dosage / Q000009:adverse effects; D014747:Vinblastine / Q000008:administration & dosage / Q000009:adverse effects; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D011344:Procarbazine; D014750:Vincristine; D014747:Vinblastine; D005047:Etoposide; D008130:Lomustine; D016190:Carboplatin; D013866:Thioguanine