• J Russell Geyer, Richard Sposto, Mark Jennings, James M Boyett, Richard A Axtell, David Breiger, Emmett Broxson, Bernadine Donahue, Jonathan L Finlay, Joel W Goldwein, Linda A Heier, Dennis Johnson, Claire Mazewski, Douglas C Miller, Roger Packer, Diane Puccetti, Jerilynn Radcliffe, May Lin Tao, Tania Shiminski-Maher, and Children's Cancer Group.
• Children's Hospital and Regional Medical Center, Department of Pediatric Hematology-Oncology, Seattle, WA 98105, USA. russ.geyer@seattlechildrens.org
• J. Clin. Oncol. 2005 Oct 20; 23 (30): 7621-31.

PurposeTo evaluate response rate, event-free survival (EFS), and toxicity of two chemotherapeutic regimens for treatment of children younger than 36 months with malignant brain tumors and to estimate control intervals without irradiation in children with no residual tumor after initial surgery and induction chemotherapy and with delayed irradiation in patients with residual tumor or metastatic disease at diagnosis.Patients And MethodsPatients were randomly assigned to one of two regimens of induction chemotherapy (vincristine, cisplatin, cyclophosphamide, and etoposide v vincristine, carboplatin, ifosfamide, and etoposide). Maintenance chemotherapy began after induction in children without progressive disease. Children with no residual tumors after induction therapy and no metastatic disease at diagnosis were not to receive radiation therapy unless their tumors progressed.ResultsTwo hundred ninety-nine infants were enrolled. Forty-two percent of patients responded to induction chemotherapy. At 5 years from study entry, the EFS rate was 27% +/- 3%, and the survival rate was 43% +/- 3%. There was no significant difference between the two arms in terms of response rate or EFS. For medulloblastoma, supratentorial primitive neuroectodermal tumor, ependymoma, and rhabdoid tumors, 5-year EFS rates were 32% +/- 5%, 17% +/- 6%, and 32% +/- 6%, and 14% +/- 7%, respectively. Fifty-eight percent of patients who were alive 5 years after study entry had not received radiation therapy.ConclusionIntensified 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.

47 keywords...

hide…