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

From the Children’s Hospital and Regional Medical Center, Seattle, WA; Children’s Oncology Group, Arcadia; Valley Radiotherapy Associates and University of California, Los Angeles, Los Angeles, CA; Vanderbilt Children’s Hospital, Nashville; St Jude Children’s Research Hospital, Memphis, TN; DeVos Children’s Hospital, Grand Rapids, MI; Children’s Medical Center–Dayton, Dayton, OH; New York University Medical Center; New York Hospital–Cornell University Medical Center, New York, NY; Children’s Hospital of Philadelphia, Philadelphia, PA; Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA; Children’s National Medical Center, Washington, DC; and University of Wisconsin Children’s Hospital, Madison, WI

Address reprint requests to J. Russell Geyer, MD, Children’s Hospital and Regional Medical Center, Department of Pediatric Hematology-Oncology, 4800 Sand Point Way NE, MS: CH-29, Seattle, WA 98105; e-mail: russ.geyer{at}seattlechildrens.org

PURPOSE: To 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 METHODS: Patients 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.

RESULTS: Two 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.

CONCLUSION: 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.

Supported by National Cancer Institute Grant No. CA 10382.

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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				V. Larouche, M. Capra, A. Huang, U. Bartels, and E. Bouffet Supratentorial Primitive Neuroectodermal Tumors in Young Children J. Clin. Oncol., December 10, 2006; 24(35): 5609 - 5609. [Full Text] [PDF]