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Sequential chemotherapy, high-dose
thiotepa, circulating progenitor cell rescue, and radiotherapy for
childhood high-grade glioma
Maura Massimino,
Lorenza Gandola, Roberto Luksch, Filippo Spreafico, Daria Riva, Carlo
Solero, Felice Giangaspero, Franco Locatelli, Marta Podda, Fabio
Bozzi, Emanuele Pignoli, Paola Collini, Graziella Cefalo, Marco Zecca,
Michela Casanova, Andrea Ferrari, Monica Terenziani, Cristina Meazza,
Daniela Polastri, Davide Scaramuzza, Fernando Ravagnani, and Franca
Fossati-Bellani
Pediatric Oncology Unit
(M.M., R.L., F.S., M.P., F.B., G.C., M.C., A.F., M.T., C.M., D.P.,
F.F.-B.), Radiotherapy and Physics (L.G., E.P.), Pathology (P.C.), and
Radiology (D.S.) Departments and Transfusional Service (F.R.),
Istituto Nazionale Tumori, Milan; Developmental Neurology (D.R.) and
Neurosurgery (C.S.) Units, Istituto Neurologico C. Besta, Milan;
Neuropathology Department, Universitą La Sapienza, Rome (F.G.);
Pediatric Department, Policlinico S. Matteo, University of Pavia
(F.L., M.Z.); Italy. Address correspondence to Maura Massimino,
Pediatric Oncology Unit, Istituto Nazionale Tumori, Via Venezian 1,
20133 Milano, Italy maura.massimino@istitutotumori.mi.it).
Childhood malignant gliomas are rare,
but their clinical behavior is almost as aggressive as in adults, with
resistance to therapy, rapid progression, and not uncommonly,
dissemination.
Our study protocol incorporated sequential chemotherapy and high-dose
thiotepa in the preradiant phase, followed by focal radiotherapy and
maintenance with vincristine and lomustine for a total duration of one
year.
The induction treatment consisted of two courses of cisplatin (30 mg/m2)
plus etoposide (150 mg/m2) × 3 days and of vincristine (1.4 mg/m2)
plus cyclophosphamide (1.5 g/m2) plus high-dose methotrexate (8 g/m2),
followed by high-dose thiotepa (300 mg/m2 × 3 doses), with
harvesting of peripheral blood progenitor cells after the first
cisplatin/etoposide course.
From August 1996 to March 2003, 21 children, 14 females and 7 males, with a
median age of 10 years were enrolled, 18 presenting with residual disease after
surgery.
Histologies were glioblastoma multiforme in 10, anaplastic astrocytoma in nine,
and anaplastic oligodendroglioma in two; sites of origin were supratentorial
areas in 17, spine in two, and posterior fossa in two.
Of the 21 patients, 12 have died (10 after relapse, with a median time to
progression for the whole series of 14 months; one with intratumoral bleeding
at 40 months after diagnosis; and one affected by Turcot syndrome for duodenal
cancer relapse).
Four of 12 relapsed children had tumor dissemination.
At a median follow-up of 57 months, overall survival and progression-free
survival at four years were 43% and 46%, respectively.
Sequential and high-dose chemotherapy can be afforded in front-line therapy of
childhood malignant glioma without excessive morbidity and rather encouraging
results.
© 2005 Duke University Press
Source: http://hermia.ingentaselect.com/cgi-bin/linker?ini=dup_no&reqidx=/cw/dup/15228517/v7n1/s5/p41&user_id=undefined
DOI: http://dx.doi.org/10.1215/S1152851704000304
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