Carboplatin and etoposide with hyperfractionated radiotherapy in children with newly diagnosed diffuse pontine gliomas: A phase I/II study

Walter, Andrew W.; Gajjar, Amar; Ochs, Judith; Langston, J. William; Sanford, Robert A.; Kun, Larry E.; Heideman, Richard L.

doi:10.1002/(sici)1096-911x(199801)30:1<28::aid-mpo9>3.0.co;2-2

Cited by 58 publications

(19 citation statements)

References 34 publications

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“…6,13,44,54,74,83,97,114 One of these, a study that included 6 patients with diffuse brainstem gliomas, investigated concurrent radiotherapy and dose-intensive chemotherapy with procarbazine, lomustine, and vincristine. 54 The median overall survival was 11 months.…”

Section: Concomitant Chemotherapy and Radiotherapymentioning

confidence: 99%

“…Survival was not improved in a group of 9 patients treated with hyperfractionated radiotherapy and chemotherapy with carboplatin and etoposide. 114 Allen et al 6 found a median overall survival of 12 months in 34 patients treated with carboplatin and hyperfractionated radiotherapy. Disappointing results were obtained by Bernier-Chastagner et al, 13 in which 32 patients 109 did not demonstrate an increase in survival in 12 patients treated with thalidomide and conventional radiotherapy.…”

Section: Concomitant Chemotherapy and Radiotherapymentioning

confidence: 99%

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Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

Frazier¹,

Lee²,

Thomale

et al. 2009

PED

125

107

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Diffuse intrinsic pontine gliomas constitute ~ 60–75% of tumors found within the pediatric brainstem. These malignant lesions present with rapidly progressive symptoms such as cranial nerve, long tract, or cerebellar dysfunctions. Magnetic resonance imaging is usually sufficient to establish the diagnosis and obviates the need for surgical biopsy in most cases. The prognosis of the disease is dismal, and the median survival is < 12 months. Resection is not a viable option. Standard therapy involves radiotherapy, which produces transient neurological improvement with a progression-free survival benefit, but provides no improvement in overall survival. Clinical trials have been conducted to assess the efficacy of chemotherapeutic and biological agents in the treatment of diffuse pontine gliomas. In this review, the authors discuss recent studies in which systemic therapy was administered prior to, concomitantly with, or after radiotherapy. For future perspective, the discussion includes a rationale for stereotactic biopsies as well as possible therapeutic options of local chemotherapy in these lesions.

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Section: Concomitant Chemotherapy and Radiotherapymentioning

confidence: 99%

Section: Concomitant Chemotherapy and Radiotherapymentioning

confidence: 99%

Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

Frazier¹,

Lee²,

Thomale

et al. 2009

PED

125

107

View full text Add to dashboard Cite

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“…Many authors have treated patients diagnosed with brain stem glioma with a wide variety of antineoplastic agents, including methotrexate, nitrosourea, vincristine, cisplatin, carboplatin, procarbazine, cyclophosphamide, etoposide, 5-fluorouracil, busulfan, and thio-tepa [2,3,7,10,18,21]. No regimen, not even those including rescue with autologous bone marrow cells, has significantly improved survival.…”

Section: Chemotherapymentioning

confidence: 99%

“…Many clinicians have attempted to treat these tumors with various intensive therapies, including hyperfractionated radiotherapy [5,9,11,12,15,17] and high-dose chemotherapy [7,21]. These treatments, however, have not achieved sufficient effects on survival.…”

Section: Introductionmentioning

confidence: 99%

Case management of hydrocephalus associated with the progression of childhood brain stem gliomas

Amano

Inamura

Nakamizo

et al. 2002

Child's Nervous System

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“…Attempts to increase the efficacy of radiotherapy using higher doses of conventional radiotherapy or new techniques, such as hyperfractionated or accelerated radiotherapy, have failed to improve survival [4][5][6][7][8][9]. Multiple trials involving various regimens administered in conjunction with radiotherapy such as vincristine and oral etoposide [10,11], carboplatin and etoposide [11] or in adjuvant basis as high-dose busulfan and thiotepa with stem cell rescue [12] or high-dose tamoxifen [13], have not demonstrated any improvement in outcome.…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy with concurrent and adjuvant temozolomide in children with newly diagnosed diffuse intrinsic pontine glioma

et al. 2011

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The purpose of this study is to evaluate the efficacy and toxicity of radiation therapy (RT) with concurrent temozolomide (TMZ) chemotherapy followed by adjuvant TMZ in children with diffuse intrinsic pontine glioma (DIPG). Newly diagnosed patients younger than 18 years with histologically proven DIPG were treated with focal radiotherapy to a dose of 54 Gy in 30 fractions along with concurrent daily TMZ (75 mg/m(2)/day). Four weeks after completing the initial RT-TMZ schedule, adjuvant TMZ (200 mg/m(2)/day, days 1-5) was given every 28 days up to six cycles. Responses/progressions were assessed by clinical and 2-monthly MRI follow-up studies. Between September 2005 and September 2009, 21 patients with newly diagnosed histologically confirmed DIPG were eligible for this study. Median age at diagnosis was 6.4 years (range 4-16 years). At last update in August 2010, 17 children have died, 1 child was alive with progressive disease and 3 with stable disease. Metastatic relapse was documented in the cerebral site in two patients and in spinal cord in two cases. The median time to progression was 7.5 months (range 28 days-14.5 months) and the median survival was 11.7 months (range 26 days-17.5 months). The 1-year PFS and the 1-year OS were 33 and 50%, respectively. Five patients presented radiological findings compatible with pseudoprogression during the treatment. Haematological toxicity (Grade III/IV thrombocytopenia and leucopenia) was the most commonly found and led to dose reductions of TMZ in 58% of the patients. TMZ with radiation therapy has not yielded any significant improvement in outcome of children with DIPG and is associated with higher toxicity compared with radiotherapy alone. Novel treatment modalities are needed to improve the outcome of these patients.

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Carboplatin and etoposide with hyperfractionated radiotherapy in children with newly diagnosed diffuse pontine gliomas: A phase I/II study

Cited by 58 publications

References 34 publications

Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

Treatment of diffuse intrinsic brainstem gliomas: failed approaches and future strategies

Case management of hydrocephalus associated with the progression of childhood brain stem gliomas

Radiotherapy with concurrent and adjuvant temozolomide in children with newly diagnosed diffuse intrinsic pontine glioma

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