Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood.

Packer, Roger J.; Lange, Beverly J.; Ater, J; Nicholson, H. Stacy; Allen, Jeffrey A.; Walker, Russell; Prados, Michael D.; Jakacki, Regina I.; Reaman, Gregory H.; Needles, Mark

doi:10.1200/jco.1993.11.5.850

Cited by 321 publications

(206 citation statements)

References 14 publications

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“…In a recent update of a study of 29 patients who were treated with the actinomycin-D-vincristine combination and who could be fully evaluated, 12 remained free of subsequent recurrence and radiation therapy was delayed a median of 51 months with more than 70% of patients not requiring radiation therapy until they were at least 5 years old. [11,17] A five-drug regimen consisting of procarbazine, 6-thioguanine, dibromodulcitol, lomustine, and vincristine was used in 42 children with newly diagnosed symptomatic or previously diagnosed progressive low-grade gliomas by a group at the University of California at San Francisco (R Prados, personal communication, 1996). [20] In this series the mean age of the patients was 5 years and the children had a variety of histological types of low-grade gliomas, similar to those treated in the carboplatin and vincristine series.…”

Section: Discussionmentioning

confidence: 99%

“…A variety of drugs have been used, including vincristine, actinomycin D, etoposide, carmustine, and carboplatin, as well as combination regimens consisting of these drugs (R. Prados, personal communication, 1996). [5,14,17,18,20,21,24] In 1989, a study was begun to evaluate the efficacy of combining carboplatin and vincristine in treating children with recurrent and newly diagnosed astrocytomas. The objective response rates of 60 children, including 37 with newly diagnosed astrocytomas, have been reported.…”

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confidence: 99%

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

Packer¹,

Ater²,

Allen³

et al. 1997

FOC

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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.Key Words * glioma * chiasmatic glioma * low-grade glioma * brainstem tumor * chemotherapy * children Gliomas comprise more than 50% of all childhood brain tumors and approximately 80% of these lesions

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Packer¹,

Ater²,

Allen³

et al. 1997

FOC

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“…These pilot trials reported regression or stability of tumors in 75-90% of patients. [82][83][84] At follow-up, children treated on the carboplatin/vincristine regimen before age 5 years, had a 75% 4-year PFS rate. 85 The outcome of a recently-closed COG phase III randomized trial comparing the latter two of these regimens is pending.…”

Section: Gliomas/astrocytomasmentioning

confidence: 99%

Advances in treatment of pediatric brain tumors

Robertson

2006

NeuroRX

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Summary:The long-term survival of children with brain tumor has improved considerably in the last three decades, owing to advances in neuroimaging, neurosurgical, and radiation therapy modalities, coupled with the application of conventional chemotherapy. MRI, MR spectroscopy and diffusion-weighted MRI have contributed to more accurate diagnosis, prognostication and better treatment planning. Neurosurgical treatment has been advanced by the use of functional MRI, and intraoperative image-guided stereotactic techniques and electrophysiologic monitoring. The use of 3-D conformal and intensitymodulated radiation therapy, stereotactic radiosurgery, and radiosensitizing agents has made radiation therapy safer and more effective. Conventional chemotherapy, administered either alone or combined with radiation therapy has improved survival and quality of life of children with brain tumors. These improved outcomes have also occurred, due, in part, to their treatment on collaborative national and international studies. Recent promising diagnostic and therapeutic strategies have resulted from advances in understanding molecular brain tumor biology. Important new approaches include the refinement of drug-delivery strategies, the evaluation of biologic markers to stratify patients for optimal treatment and to exploit these molecular differences using "targeted" therapeutic strategies. These approaches include blocking tumor cell drug resistance mechanisms, immunotherapy, inhibition of molecular signal transduction pathways important in tumorigenesis, anti-angiogenic therapy, and gene therapy. The thrust of such approaches for children with brain tumors is especially directed at reducing the toxicity of therapy and improving quality-of-life, as well as increasing disease-free survival.

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“…Carboplatin, cisplatin, vincristine, vinblastine, actinomycin D, lomustine, thioguanine, procarbazine, dibromodulcitol, etoposide, tamoxifen, and temozolomide, alone or in combination, as primary treatment or as adjuvant, have all been utilized. [10][11][12][13]19,[32][33][34][35][36][37][38][39][40] Although chemotherapy has emerged as promising therapy, no regimen has yet to be universally accepted, hence the current Children's Oncology Group trial.…”

Section: Treatmentmentioning

confidence: 99%

Optic glioma warranting treatment in children

Kaufman

Doroftei

2006

Eye

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Purpose To describe cases of optic pathway glioma (OPG) warranting treatment in children. Methods This is a retrospective review of pediatric patients treated for OPG. The clinical data and imaging studies were obtained from the medical records and radiology files of patients seen at the Pediatric NeuroOphthalmology Clinic at the University of Illinois, Chicago and the private office of the author (LMK). Results A total of seven cases with an age range of 3-48 months at presentation were reviewed. Three of the patients were also ultimately diagnosed with neurofibromatosis type 1. Presenting symptoms included proptosis, decreased vision, gaze deficit, and nystagmus. Four patients underwent biopsies that confirmed OPG. Six of the patients were treated with intravenous chemotherapy, with three patients requiring a second chemotherapy cycle. One patient was successfully treated with an en-bloc optic nerve excision. Two patients underwent unilateral enucleation owing to globe complications. Conclusion Although benign tumours, OPG can behave very aggressively in young children. Both chemotherapy and en-bloc excision can be employed for treatment.

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Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood.

Cited by 321 publications

References 14 publications

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

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

Advances in treatment of pediatric brain tumors

Optic glioma warranting treatment in children

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