Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas

Abstract

The optimum treatment of nonresectable low-grade gliomas of childhood remains undecided. There has been increased interest in the use of chemotherapy for young children, but little information concerning the long-term efficacy of such treatment. Seventy-eight children with a mean age of 3 years (range 3 months-16 years) who had newly diagnosed, progressive low-grade gliomas were treated with combined carboplatin and vincristine chemotherapy. The patients were followed for a median of 30 months from diagnosis, with 31 patients followed for more than 3 years. Fifty-eight children had diencephalic tumors, 12 had brainstem gliomas, and three had diffuse leptomeningeal gliomas. Forty-four (56%) of 78 patients showed an objective response to treatment. Progression-free survival rates were 75 +/- 6% at 2 years and 68 +/- 7% at 3 years. There was no statistical difference in progression-free survival rates between children with neurofibromatosis Type 1 and those without the disease (2-year, progression-free survival 79 +/- 11% vs. 75 +/- 6%, respectively). The histological subtype of the tumor, its location, and its maximum response to chemotherapy did not have an impact on the duration of disease control. The only significant prognostic factor was age: children 5 years old or younger at the time of treatment had a 3-year progression-free survival rate of 74 +/- 7% compared with a rate of 39 +/- 21% in older children (p < 0.01). Treatment with carboplatin and vincristine is effective, especially in younger children, in controlling newly diagnosed progressive low-grade gliomas.

A Phase II Study of Antineoplastons A10 and AS2-1 in Children with Low-Grade Astrocytomas—Final Report (Protocol BT-13)

“…Clinical studies on LGG have been reviewed in the literature [8]. Despite considerable progress in basic research, the most attractive treatment is still older than the 15-year regimen of carboplatin and vincristine [4].…”

“…Packer, et al 1997 [4] Carboplatin, Vincristine Prados, et al 1997 [5] Nitrosourea and multiagent chemotherapy Gururangan, et al Note. *-No data were provided except that 5 patients were removed from the study because of allergic reaction, and occasional delays in treatment were caused by prolonged thrombocytopenia and neurotoxicity.…”

“…Due to the debilitating effects of RT on growth and neurological development, chemotherapy is commonly employed in young children to delay RT [4] [5]. A number of chemotherapy regimens have been tested, including carboplatin and vincristine as well as, nitrosourea-based multiagent regimens including procarbazine, 6-thioguanine, dibromodulcitol, lomustine and vincristine, and single agent temozolomide [4] [5] [6] [7].…”

Growth Hormone Hypersecretion in a Girl with Neurofibromatosis Type 1 and an Optic Nerve Glioma: Resolution following Chemotherapy

“…Moreover, there is evidence that children with NF-1 have an increased risk of developing vascular complications following cranial irradiation [15, 16]. The role of chemotherapy in low-grade gliomas is still ill defined, however there is evidence that these tumours respond to chemotherapy and that treatment with chemotherapy can delay or even avoid the need for irradiation [17]. …”

Synchronous Optic and Pineal Pilocytic Astrocytomas in a Paediatric Patient with Neurofibromatosis Type 1

“…Based on these concerns, there has been growing interest in chemotherapy for the treatment of these tumours. Packer et al [21]documented the efficacy of carboplatin and vincristine administration in children with low-grade gliomas including optic pilocytic astrocytomas. Of their 78 patients, 56% showed an objective response and the 3-year progression-free survival rate was 68%.…”