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Common Pediatric Brain Tumor May Be Treatable with Chemotherapy Alone Unresectable or progressive low-grade pediatric glioma—the most common brain malignancy in children—may be treated effectively with chemotherapy alone to spare the long-term effects of radiation therapy, a multi-institution study has found. The Children’s Oncology Group study, led by Joann Ater, M.D., a professor in the Children’s Cancer Hospital at M. D. Anderson, compared two chemotherapy regimens in glioma patients who did not receive radiation therapy. A combination of thioguanine, procarbazine, lomustine, and vincristine (TPCV) yielded a 5-year event-free survival rate of nearly 50%, with patients ages 5–10 years experiencing a mean progression-free survival duration of more than 8 years. Dr. Ater said the results of the phase III trial point to treatment alternatives for unresectable low-grade glioma, which has a worse prognosis than does resectable low-grade glioma. Among patients whose low-grade pediatric glioma is successfully removed with surgery, the overall survival rate is 95%. However, survival is worse when the tumor is in a location that precludes surgery or when the malignancy progresses after surgery. Unresectable or progressive low-grade gliomas usually can be successfully treated with cranial radiation, but the long-term side effects of such therapy—including mental impairment, hormonal deficiencies, and an increased risk of stroke later in life—lead some families and physicians to decide against treatment. Given the positive results of the trial, it may be acceptable to delay or avoid radiation therapy for some patients, Dr. Ater said. “The results have confirmed the ability of chemotherapy to control the disease,” she explained. “If we can delay radiation for our youngest patients until they further develop physically, we may decrease some of the long-term side effects of radiation treatment. This trial at least gives parents more information and options when making decisions about their child’s treatment.” The study also found that the TPCV regimen yielded better survival than a combination of carboplatin and vincristine that smaller pilot studies reported to be effective against low-grade pediatric glioma. Also, study participants with neurofibromatosis had the best response among patients receiving TPCV. Results were presented at the 40th annual meeting of the International Society of Pediatric Oncology. For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789. Other articles in OncoLog, January 2009 issue:
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