Randomized phase III trial in childhood high-grade astrocytoma comparing vincristine, lomustine, and prednisone with the eight-drugs-in-1-day regimen. Childrens Cancer Group.

Finlay, Jonathan L.; Boyett, James M.; Yates, Allan J.; Wisoff, Jeffrey H.; Milstein, Jerrold M.; Geyer, J. Russell; Bertolone, Salvatore; McGuire, Peter; Cherlow, Joel M.; Tefft, Melvin

doi:10.1200/jco.1995.13.1.112

Cited by 336 publications

(283 citation statements)

References 23 publications

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“…Patients undergoing complete or near-complete resection (resection of more than 90% of the tumor) fare better than those for whom a lesser degree of tumor debulking is achieved. The prognosis also seems to be better for patients with AAs than for those with GBMs [18,20,21].…”

Section: Known Prognostic Factorsmentioning

confidence: 99%

“…The degree of surgical resection is the most important clinical prognostic factor for children with supratentorial high-grade astrocytomas, independent of other factors, such as tumor location, histologic grade, and age [18][19][20]. Patients undergoing complete or near-complete resection (resection of more than 90% of the tumor) fare better than those for whom a lesser degree of tumor debulking is achieved.…”

Section: Known Prognostic Factorsmentioning

confidence: 99%

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Supratentorial High-Grade Astrocytoma and Diffuse Brainstem Glioma: Two Challenges for the Pediatric Oncologist

2004

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Pediatric high-grade gliomas represent a heterogeneous group of tumors that accounts for 15%-20% of all pediatric central nervous system tumors. These neoplasms predominantly involve the supratentorial hemispheres or the pons, in which case the tumors are usually called diffuse brainstem gliomas. The diagnosis of supratentorial neoplasms is dependent on their histologic appearance. The maximum possible surgical resection is always attempted since the degree of surgical resection is the main prognostic factor for these patients. Older children (>3 years) with supratentorial neoplasms undergo a multimodality treatment comprised of surgical resection, radiation therapy, and chemotherapy. The addition of chemotherapy seems to improve the survival of a subset of these children, particularly those with glioblastoma multiforme. However, 2-year survival rates remain poor for children with supratentorial neoplasms, ranging from 10%-30%.The diagnosis of a diffuse brainstem glioma is based upon typical imaging, dispensing with the need for surgery in the majority of cases. Radiation therapy is the mainstay of treatment for children with diffuse brainstem gliomas. The role of chemotherapy for these children is not clear, and it is, in general, employed in the context of an investigational study. Less than 10% of children with diffuse brainstem gliomas survive 2 years. Hematology-Oncology, St. Jude Children's Research Hospital, 332 North Lauderdale Room C-6066 Mail Stop 260, Memphis, Tennessee 38105, USA. Telephone: 901-495-4925; Fax: 901-521-9005; e-mail: alberto.broniscer@stjude.org Received July 15, 2003; accepted for publication November 19, 2003. ©AlphaMed Press 1083-7159/2004 The Oncologist ® Pediatric Oncology The Oncologist LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Describe the known genetic alterations associated with pediatric supratentorial high-grade astrocytomas and diffuse brainstem gliomas.2. Discuss the clinical and biologic prognostic factors for children with supratentorial high-grade astrocytomas and diffuse brainstem gliomas.3. Explain the roles played by surgery, radiation therapy, and chemotherapy in the treatment of children with supratentorial high-grade astrocytomas and diffuse brainstem gliomas.Access and take the CME test online and receive one hour of AMA PRA category 1 credit at CME.TheOncologist.com CME CMEThis material is protected by U.S.

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Section: Known Prognostic Factorsmentioning

confidence: 99%

Section: Known Prognostic Factorsmentioning

confidence: 99%

Supratentorial High-Grade Astrocytoma and Diffuse Brainstem Glioma: Two Challenges for the Pediatric Oncologist

2004

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“…The prognosis at time of relapse is even worse (Finlay et al, 1995;Nieder et al, 2000;Brada et al, 2001;Tamber and Rutka, 2003;Rich et al, 2004). However, new treatment strategies are under development, one of them being immune therapy.…”

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confidence: 99%

Surgery and adjuvant dendritic cell-based tumour vaccination for patients with relapsed malignant glioma, a feasibility study

Rutkowski¹,

Vleeschouwer²,

et al. 2004

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Patients with relapsed malignant glioma have a poor prognosis. We developed a strategy of vaccination using autologous mature dendritic cells loaded with autologous tumour homogenate. In total, 12 patients with a median age of 36 years (range: 11 -78) were treated. All had relapsing malignant glioma. After surgery, vaccines were given at weeks 1 and 3, and later every 4 weeks. A median of 5 (range: 2 -7) vaccines was given. There were no serious adverse events except in one patient with gross residual tumour prior to vaccination, who repetitively developed vaccine-related peritumoral oedema. Minor toxicities were recorded in four out of 12 patients. In six patients with postoperative residual tumour, vaccination induced one stable disease during 8 weeks, and one partial response. Two of six patients with complete resection are in CCR for 3 years. Tumour vaccination for patients with relapsed malignant glioma is feasible and likely beneficial for patients with minimal residual tumour burden.

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“…92 The other phase III study, CCG 945, for pediatric high-grade gliomas compared two chemotherapy regimens, the prior CCNU/vincristine/prednisone regimen vs. the eightdrugs-in-one-day regimen, for which the overall 5-year EFS rates of 26% vs. 33%, respectively, did not differ. 93 A phase II German trial for pediatric high-grade gliomas determined that the pre-radiation and post-radiation chemotherapy significantly benefited those patients who also had a gross total resection, with 5.2 year vs. 1.9 year median survival. 94 Other chemotherapeutic agents, such as temozolomide, an orally administered alkylating agent, and irinotecan, a topoisomerase-I inhibitor have been tried for newly diagnosed high-grade gliomas with modest success.…”

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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Randomized phase III trial in childhood high-grade astrocytoma comparing vincristine, lomustine, and prednisone with the eight-drugs-in-1-day regimen. Childrens Cancer Group.

Cited by 336 publications

References 23 publications

Supratentorial High-Grade Astrocytoma and Diffuse Brainstem Glioma: Two Challenges for the Pediatric Oncologist

Supratentorial High-Grade Astrocytoma and Diffuse Brainstem Glioma: Two Challenges for the Pediatric Oncologist

Surgery and adjuvant dendritic cell-based tumour vaccination for patients with relapsed malignant glioma, a feasibility study

Advances in treatment of pediatric brain tumors

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