Journal of Clinical Oncology, Vol 13, 112-123, Copyright © 1995 by American Society of Clinical Oncology
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
JL Finlay, JM Boyett, AJ Yates, JH Wisoff, JM Milstein, JR Geyer, SJ Bertolone, P McGuire, JM Cherlow and M Tefft
Memorial Sloan-Kettering Cancer Center, New York.
PURPOSE: In a previous randomized trial, the addition of adjuvant
chemotherapy to postoperative radiotherapy proved beneficial in the
treatment of childhood high-grade astrocytomas. The present study tests the
hypothesis that an eight-drug adjuvant chemotherapy regimen would improve
survival in such children compared with the three-drug regimen of the prior
study. PATIENTS AND METHODS: Between April 1985 and May 1990, patients
between the ages of 18 months and 21 years with newly diagnosed high-grade
astrocytomas were eligible for this study, as determined by the treating
institution's histopathologic diagnosis. Treatment consisted of
postoperative local-field radiotherapy and adjuvant chemotherapy, either
lomustine (CCNU), vincristine, and prednisone (control regimen) or
eight-drugs-in-1-day chemotherapy (experimental regimen). Two cycles of
postoperative preirradiation chemotherapy were administered in the
experimental regimen. Patients were evaluated radiographically every 3
months after irradiation. RESULTS: Eighty-five eligible patients were
randomized to the control regimen and 87 to the experimental regimen. The
progression-free survival (PFS) and overall survival (OS) at 5 years were
33% (SE = 5%) and 36% (SE = 6%), respectively. There was no statistical
difference in outcome between the two chemotherapy regimens. In patients
with confirmed diagnoses of anaplastic astrocytoma (AA) or glioblastoma
multiforme (GBM), anaplastic astrocytoma, greater than 90% resection, and
nonmidline tumor location were characteristics predictive of an improved
PFS. There was a difference in toxicity between the two chemotherapeutic
regimens, with greater myelosuppression and hearing loss in the
experimental regimen. Tumor recurrence occurred primarily within the
primary tumor site. CONCLUSIONS: There is no benefit to the treatment of
high-grade astrocytomas in children with eight-drugs-in-1- day chemotherapy
compared with CCNU, vincristine, and prednisone. Extent of tumor resection
and histopathologic diagnosis are significant prognostic variables. The
overall outcome for children with high-grade astrocytomas remains poor.
This article has been cited by other articles:
|
|
|
|
 
S. De Vleeschouwer, S. Fieuws, S. Rutkowski, F. Van Calenbergh, J. Van Loon, J. Goffin, R. Sciot, G. Wilms, P. Demaerel, M. Warmuth-Metz, et al.
Postoperative Adjuvant Dendritic Cell-Based Immunotherapy in Patients with Relapsed Glioblastoma Multiforme
Clin. Cancer Res.,
May 15, 2008;
14(10):
3098 - 3104.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. E. Warren
Pediatric High-grade Gliomas
ASCO Educational Book,
January 1, 2008;
2008(1):
472 - 477.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. F. Pollack, R. L. Hamilton, R. W. Sobol, J. Burnham, A. J. Yates, E. J. Holmes, T. Zhou, and J. L. Finlay
O6-Methylguanine-DNA Methyltransferase Expression Strongly Correlates With Outcome in Childhood Malignant Gliomas: Results From the CCG-945 Cohort
J. Clin. Oncol.,
July 20, 2006;
24(21):
3431 - 3437.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Massimino, L. Gandola, R. Luksch, F. Spreafico, D. Riva, C. Solero, F. Giangaspero, F. Locatelli, M. Podda, F. Bozzi, et al.
Sequential chemotherapy, high-dose thiotepa, circulating progenitor cell rescue, and radiotherapy for childhood high-grade glioma
Neuro-oncol,
January 1, 2005;
7(1):
41 - 48.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Broniscer and A. Gajjar
Supratentorial High-Grade Astrocytoma and Diffuse Brainstem Glioma: Two Challenges for the Pediatric Oncologist
Oncologist,
April 1, 2004;
9(2):
197 - 206.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. F. Pollack, J. M. Boyett, A. J. Yates, P. C. Burger, F. H. Gilles, R. L. Davis, J. L. Finlay, and for the Children's Cancer Group
The influence of central review on outcome associations in childhood malignant gliomas: Results from the CCG-945 experience
Neuro-oncol,
July 1, 2003;
5(3):
197 - 207.
[Abstract]
[PDF]
|
|
|
|
|
|
|
I. F. Pollack, S. D. Finkelstein, J. Woods, J. Burnham, E. J. Holmes, R. L. Hamilton, A. J. Yates, J. M. Boyett, J. L. Finlay, R. Sposto, et al.
Expression of p53 and Prognosis in Children with Malignant Gliomas
N. Engl. J. Med.,
February 7, 2002;
346(6):
420 - 427.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. F. Pollack, S. D. Finkelstein, J. Burnham, E. J. Holmes, R. L. Hamilton, A. J. Yates, J. L. Finlay, and R. Sposto
Age and TP53 Mutation Frequency in Childhood Malignant Gliomas: Results in a Multi-institutional Cohort
Cancer Res.,
October 1, 2001;
61(20):
7404 - 7407.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V.A. Levin, K. Lamborn, W. Wara, R. Davis, M. Edwards, J. Rabbitt, M. Malec, and M. D. Prados
Phase II study of 6-thioguanine, procarbazine, dibromodulcitol, lomustine, and vincristine chemotherapy with radiotherapy for treating malignant glioma in children
Neuro-oncol,
January 1, 2000;
2(1):
22 - 28.
[Abstract]
[PDF]
|
|
|
|
|
|
|
T. C. Comas, T. Tai, D. Kimmel, B. W. Scheithauer, P. C. Burger, D. K. Pearl, S. D. Jewell, and A. J. Yates
Immunohistochemical staining for ganglioside GD1b as a diagnostic and prognostic marker for primary human brain tumors
Neuro-oncol,
October 1, 1999;
1(4):
261 - 267.
[Abstract]
[PDF]
|
|
|
|
|
|
|
I. F. Pollack, M. Erff, D. Bom, T. G. Burke, J. T. Strode, and D. P. Curran
Potent Topoisomerase I Inhibition by Novel Silatecans Eliminates Glioma Proliferation in Vitro and in Vivo
Cancer Res.,
October 1, 1999;
59(19):
4898 - 4905.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Bredel, I. F. Pollack, R. L. Hamilton, and C. D. James
Epidermal Growth Factor Receptor Expression and Gene Amplification in High-Grade Non-Brainstem Gliomas of Childhood
Clin. Cancer Res.,
July 1, 1999;
5(7):
1786 - 1792.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. A. Levin
Chemotherapy for brain tumors of astrocytic and oligodendroglial lineage: The past decade and where we are heading
Neuro-oncol,
January 1, 1999;
1(1):
69 - 80.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. S LASHFORD and D. A WALKER
Improving care for central nervous system tumours: a mood for change
Arch. Dis. Child.,
February 1, 1997;
76(2):
88 - 90.
[Full Text]
|
|
|
|
