© 2000 by Society
© 2000 by the Society forNeuro-Oncology
Phase II study of 6-thioguanine, procarbazine, dibromodulcitol,lomustine, and vincristine chemotherapy with radiotherapy for treatingmalignant glioma in children
Brain Tumor Center and the Departments ofNeuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston,TX 77030 (V.A.L.); Brain Tumor Research Center,Department Neurological Surgery, University of California, San Francisco, CA94143 (K.L., M.E., J.R., M.M., M.D.P.); Department ofRadiation Oncology, University of California, San Francisco, CA 94143 (W.W.);and Department of Pathology, University of California,San Francisco, CA 94143 (R.D.)
2 Address correspondence and reprint requests to Victor A. Levin, M.D.,Department of Neuro-Oncology - 100, U.T. M.D. Anderson Cancer Center, 1515Holcombe Blvd., Houston, TX 77030.
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Abstract |
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We conducted a single-arm phase II study to evaluate the efficacy andsafety of radiotherapy combined with 6-thioguanine, procarbazine,dibromodulcitol, lomustine, and vincristine (TPDCV) chemotherapy for treatingmalignant astrocytoma in children and anaplastic ependymoma in patients of allages. Between 1984 and 1992, 42 patients who had malignant astrocytomas(glioblastomas multiforme, anaplastic astrocytomas, or mixed anaplasticoligoastrocytomas) were treated with TPDCV chemotherapy and radiation therapy.Of these patients, 40 were younger than 18 years, but 2 were older (22 and 23years) when treated. Cranial radiation averaged 58 Gy. TPDCV chemotherapy wasgiven for 1 year or until progression. Between 1989 and 1991, 17 patients withmalignant ependymoma were treated with TPDCV chemotherapy and craniospinalradiation. Radiation was given at an average dose of 54 Gy to the tumor, 28 Gyto the whole brain, and 31 Gy to the spinal axis. TPDCV chemotherapy was givenfor 1 year or until tumor progressed. Of the patients with glioblastomamultiforme, 13 of 17 died; the median time to progression was 49 weeks, andmedian survival was 85 weeks. The four patients surviving at this writing werefollowed a median 537 weeks (range 364-635 weeks). Of the patients withnonglioblastoma malignant astrocytoma, 14 of 25 died; the median time toprogression was 224 weeks. Median survival was not reached in this group. Themedian follow-up for those surviving was 494 weeks. For the patients withependymoma, 11 of 17 died with a median time to progression of 141 weeks. Themedian follow-up for the eight who survive was 469 weeks. Nine patients diedwith a median survival of 183 weeks. The combination of TPDCV and radiotherapyhas activity against childhood anaplastic astrocytoma, glioblastomamultiforme, and anaplastic ependymoma. The results of this study for childrenwith glioblastoma were comparable to results in the literature, while theresults for children with anaplastic astrocytoma appeared better than mostreports. The combination of TPDCV chemotherapy and radiation therapy foranaplastic ependymomas appears to be active and at least as good as publishedreports using radiation therapy alone.
Received February 17, 1999; Accepted June 24, 1999
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