Treatment of pediatric low-grade gliomas with a nitrosourea-based multiagent chemotherapy regimen

Abstract

Between March 9, 1984 and January 29, 1992, 42 children with newlydiagnosed symptomatic or previously diagnosed progressive low-gradegliomas received outpatient chemotherapy as their primary treatment.This study was a single arm, phase II trial designed to estimate the time to tumor progression and toxicity of this regimen. Procarbazine, 6-thioguanine, and dibromodulcitolwere given before lomustine (CCNU) and vincristine was given 1and 3 weeks after CCNU. Patients were treated for six treatmentcycles or until the tumor progressed, whichever came first. Twenty-three patients had juvenile pilocytic astrocytomas, 11had astrocytomas, one had oligodendroglioma, one had ganglioglioma, and six had radiographically diagnosed low-grade gliomas. The mean age of the patients was 5 years (median, 3 years). The median time to treatment failure was 132 weeks (95% confidence interval:106, 186 weeks). Only eight patients have died; the estimated 5-yearsurvival rate is 78% (95% confidenceinterval, 60% 87%). There were two episodes of grade 4 neutropenia, and three episodes of grade 4 thrombocytopenia. Thisregimen was safe, able to be delivered in the outpatient setting, andproduced prolonged periods of disease stabilization in children with low-grade gliomas.