Does chemotherapy have a role in low‐grade astrocytoma management? a report of 13 cases

Abstract

Surgery is the treatment of choice for low-grade astrocytoma while radiotherapy is carried out only when total resection is not possible. This study assessed the effectiveness of chemotherapy in nonresectable cases. Thirteen children with nonresectable astrocytoma were treated with carboplatin and etoposide and after four cycles the response to treatment was evaluated according to radiologic criteria. The results were: one with complete response (CR), three with minor response (MR), six with stable disease (SD), and three with progressive disease (PD). Moreover, in 77% there was an improvement in the neurologic picture. In particular, two cases with hypothalamic astrocytoma showed a regression of the diencephalic syndrome following chemotherapy. In six cases chemotherapy was carried out, at reduced dosage, after the first four cycles either because there was clinical improvement or because it was necessary to postpone radiotherapy in very young patients. After a follow-up period ranging between 11 and 63 months (average: 30 months), nine of the 13 patients are alive (69%) while four died of disease progression. Further studies would be useful to evaluate the role of chemotherapy in the management of low-grade astrocytoma.

Spinal Seeding of a Pilocytic Astrocytoma following Multiple Subtotal Resections

“…Despite the proven efficacy of radiotherapy, the application is limited due to undesired effects such as neurocognitive disabilities, endocrinological disturbances, de novo tumor formation and malignant transformation [10, 14, 26, 27]. Therefore, some authors focus on chemotherapy as first-choice therapy, independent of the patient age, to delay radiotherapy when tumor progression or LMD occurs [1, 2, 13,28,29,30,31,32,33]. …”

Concomitant chemoradiotherapy for incompletely resected supratentorial low-grade astrocytoma in children: Preliminary report

“…First, there is a certain amount of chemosensitivity observed in low-grade astrocytoma which could be exploited as a valid alternative to radiotherapy in young children in whom this is being withheld in order to limit radiation damage to the brain. Second, drugs active against high-grade gliomas also seem to be effective in low-grade tumors [7][8][9][10].…”

A Phase 2 Feasibility Study of Sequential, Dose Intensive Chemotherapy to Treat Progressive Low-grade Gliomas in Children

“…Of note, children who were less than 5 years of age when diagnosed had a 3-year progressionfree survival of 74% compared with 39 ± 21% in children older than 5 years when diagnosed. 25 Other studies demonstrating chemotherapy responsiveness include vincristine and etoposide, 21 cyclophosphamide, 32 concomitant radiation and vincristine combined with cisplatin, 33 vincristine and actinomycin D, 34 etoposide and carboplatin, 22,35 oral etoposide, 36 cisplatin and etoposide, 24 and temozolomide. 37 Increasing dose intensity can be achieved by escalating the dose per meter squared given at each administration over a defined period of time.…”

“…15,16,18 Several single agent and multiagent chemotherapy regimens have shown encouraging clinical results in the treatment of symptomatic or progressive LGG in children, thus allowing radiation to be delayed and possibly omitted. 6,10,11,[21][22][23][24][25] However, although encouraging, children with large centrally located tumors, and children diagnosed at a young age have been shown to be at higher risk for death from progressive tumor growth. 6,10,11 In addition, most children have disease stabilization, and not objective response to chemotherapy.…”