Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas

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✓ The optimum treatment of nonresectable low-grade gliomas of childhood remains undecided. There has been increased interest in the use of chemotherapy for young children, but little information concerning the long-term efficacy of such treatment. Seventy-eight children with a mean age of 3 years (range 3 months—16 years) who had newly diagnosed, progressive low-grade gliomas were treated with combined carboplatin and vincristine chemotherapy. The patients were followed for a median of 30 months from diagnosis, with 31 patients followed for more than 3 years. Fifty-eight children had diencephalic tumors, 12 had brainstem gliomas, and three had diffuse leptomeningeal gliomas. Forty-four (56%) of 78 patients showed an objective response to treatment. Progression-free survival rates were 75 ± 6% at 2 years and 68 ± 7% at 3 years. There was no statistical difference in progression-free survival rates between children with neurofibromatosis Type 1 and those without the disease (2-year, progression-free survival 79 ± 11% vs. 75 ± 6%, respectively). The histological subtype of the tumor, its location, and its maximum response to chemotherapy did not have an impact on the duration of disease control. The only significant prognostic factor was age: children 5 years old or younger at the time of treatment had a 3-year progression-free survival rate of 74 ± 7% compared with a rate of 39 ± 21% in older children (p < 0.01). Treatment with carboplatin and vincristine is effective, especially in younger children, in controlling newly diagnosed progressive low-grade gliomas.

Article Information

Address reprint requests to: Roger J. Packer, M.D., Department of Neurology, Children's National Medical Center, 111 Michigan Avenue, NW, Washington, D.C. 20010.

© AANS, except where prohibited by US copyright law.

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Figures

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    Graph displaying overall progression-free survival rates in all eligible patients (AEP) from the time they were enrolled in the study (Years on Study).

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    Graph depicting progression-free survival rates for patients in the study. Upper: Comparison of patients with NF-1 (Yes) versus those without NF-1 (No). Lower: Comparison of patients with diencephalic (DIEN), brainstem (BSA), leptomeningeal (LMS), and other cranial tumors.

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    Graphs displaying the relationships between progression-free survival and response to treatment (upper) and progression-free survival and age in years (lower). CR = complete response; others = minor response or stable disease; PR = partial response.

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