Preradiation chemotherapy in primary high-risk brainstem tumors: Phase II study CCG-9941 of the children's cancer group

Mark T. Jennings, Richard Sposto, James M. Boyett, L. Gilbert Vezina, Emi Holmes, Mitchell S. Berger, Carol S. Bruggers, Janet M. Bruner, Ka Wah Chan, Kathryn E. Dusenbery, Lawrence J. Ettinger, Charles R. Fitz, Deborah Lafond, David E. Mandelbaum, Vicky Massey, Warren McGuire, Lee McNeely, Thomas Moulton, Ian F. Pollack, Violet Shen

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77 Scopus citations

Abstract

Purpose: This Children's Cancer Group group-wide phase II trial evaluated the efficacy and toxicity of two chemotherapy arms administered before hyperfractionated external-beam radiotherapy (HFEBRT). Patients and Methods: Thirty-two patients with newly diagnosed brainstem gliomas were randomly assigned to regimen A and 31 to regimen B. Regimen A comprised three courses of carboplatin, etoposide, and vincristine; regimen B comprised cisplatin, etoposide, cyclophosphamide, and vincristine. Both arms included granulocyte colony-stimulating factor. Patients were evaluated by magnetic resonance imaging after induction chemotherapy and HFEBRT at a dose of 72 Gy. Results: Ten percent ± 5% of regimen A patients objectively responded to chemotherapy. For combined induction and radiotherapy, 27% ± 9% of patients improved. The neuroradiographic response rate for regimen B was 19% ± 8% for chemotherapy and 23% ± 9% after HFEBRT. Response rates were not statistically significant between regimens after induction or chemotherapy/HFEBRT. Event-free survival was 17% ± 5% (estimate ± SE) at 1 year and 6% ± 3% at 2 years. Survival was significantly longer among patients who responded to chemotherapy (P < .05). Among patients who received regimen A induction, grades 3 and 4 leukopenia were observed in 50% to 65%, with one toxicity-related death. For regimen B, severe leukopenia occurred in 86% to 100%, with febrile neutropenia in 48% to 60% per course. Conclusion: Neither chemotherapy regimen meaningfully improved response rate, event-free survival, or overall survival relative to previous series of patients with brainstem gliomas who received radiotherapy with or without chemotherapy.

Original languageEnglish (US)
Pages (from-to)3431-3437
Number of pages7
JournalJournal of Clinical Oncology
Volume20
Issue number16
DOIs
StatePublished - Aug 15 2002

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