Multiagent Chemotherapy and Deferred Radiotherapy in Infants With Malignant Brain Tumors: A Report From the Children’s Cancer Group

Abstract

Intensified induction chemotherapy resulted in a high response rate of malignant brain tumors in infants. Survival was comparable to that of previous studies, and most patients who survived did not receive radiation therapy.

Current Treatment Approaches for Infants with Malignant Central Nervous System Tumors

“…In the CCG 9921 study, however, radiation therapy was only used in cases of tumor progression or relapse. OS was similar to previous studies, but, remarkably, 58% of patients alive 5 years after study entry had not received radiation therapy [31]. The effort to achieve cure without radiation therapy was strengthened.…”

“…Prolonged postoperative conventionally dosed chemotherapy was studied by the French Society of Pediatric Oncology (SFOP), the Australian and New Zealand Children's Cancer Study Group, and the Children's Oncology Group (COG, formed through the merger of POG and CCG). In these trials, different combinations and schedules of chemotherapy were used, but radiation therapy was reserved only for children with progressive disease or with persistent residual disease [31][32][33]. The German Society of Pediatric Oncology and Hematology (GPOH) used a new strategy in their "HIT-SKK" protocol of systemic high-dose methotrexate and intraventricular methotrexate to replace radiation [34].…”

“…In the first baby-POG study, the 5-year OS rate was 66% for patients whose tumors were gross totally resected, compared with 32% for those whose tumors were less than completely resected [28]. Gross total resection (GTR) did not reach significance in the contemporary CCG study, or did so only for the subset of patients with nonmetastatic disease [31,33,39].…”

Decreased morbidity and mortality of autologous hematopoietic transplants for children with malignant central nervous system tumors: the ‘Head Start’ trials, 1991–2009

“…[1][2][3][4][5] However, relapse was a significant issue and irradiation could not be avoided in most cases. Since the 'Head Start' trials began employing AuHCR with greater irradiation avoidance, we have documented improvements in quality of life by avoiding cranial irradiation, through prospectively conducted neuropsychological and quality of life follow-up studies.…”

“…[2][3][4][5] Overall, 2-3 year PFS for children on these studies ranged from less than 10 to 34% for medulloblastoma, less than 30% for high-grade gliomas and 0-19% for other primitive neuro-ectodermal tumors. The median time to relapse was 6-9 months from diagnosis.…”