Treatment > Carboplatin · Vincristine

Meeting Abstract

Carboplatinum (CBDCA), vincristine (V) therapy for CNS gliofibroma

C. R. Suarez, S. J. Bertolone

University of Louisville, Louisville, KY

Gliofibromas are neoplasms of dual glial and mesenchymal components.
Although composed of astrocytic and fibroblastic elements their histogenesis is not clear.
They have been classified as low or high grade based on morphology and labeling index.
Their clinical behavior and management remains unknown.
Although considered to be benign our review of 23 reported cases shows a 26% mortality rate.
Of all cases 78% occur in the first two decades (median 5 yrs, mean 28 yrs) and 61% and 48% are diagnosed before age 10 and 5 respectively.
Of all tumors 73% are intracrianal and 27% extracranial, the cerebral hemispheres, spinal cord and posterior fossa are the most common primary sites 52%, 26%, 9%, respectively, however, 35% have multiple sites involved at presentation.
Seizures, paralysis, weakness in 39%, 30%, 26% respectively are the most common presenting symptoms.
Therapy is not clearly defined and so far anecdotal.
Of reported cases 5 received RT alone ranging from 30-60 Gy with 4 dying of progressive disease.
Two pts including ours received chemotherapy alone, one unspecified therapy and died of progressive disease.
Our patient, a 4 mos old boy with suprasellar and cervicomedullary disease received 9 cycles of CBDCA/V.
Cycles were given q 4 wks: CBDCA(AUC of 4) wk 1 and V (0.05mg/kg) wks 1, 2, 3.
A very good response with over 75% suprasellar tumor regression and resolution of cervicomedullary disease was obtained.
Toxicity was minimal, one episode of grade 4 neutropenia was observed.
Two yrs after therapy there is no evidence of disease progression.
Gliofibromas may behave in aggressive way in particular incompletely resected ones and those with increased mitotic activity, nuclear pleomorphism and labeling index. CBDCA/V should be considered as front line therapy for gliofibromas.
RT alone at the doses reported appears to be inadequate therapy for gliofibromas.

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