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Journal of Neuro-Oncology
Published in: Journal of Neuro-Oncology 3/2018

01-12-2018 | Clinical Study

Pre-irradiation intensive induction and marrow-ablative consolidation chemotherapy in young children with newly diagnosed high-grade brainstem gliomas: report of the “head-start” I and II clinical trials

Authors: Diana S. Osorio, Neha Patel, Lingyun Ji, Richard Sposto, Joseph Stanek, Sharon L. Gardner, Jeffrey C. Allen, Albert Cornelius, Geoffrey B. McCowage, Amanda Termuhlen, Ira J. Dunkel, Melanie Comito, James Garvin, Jonathan L. Finlay

Published in: Journal of Neuro-Oncology | Issue 3/2018

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Abstract

Background

The dismal outcome in children with high-grade brainstem gliomas (BSG) accentuates the need for effective therapeutic strategies. We investigated the role of intensive, including marrow-ablative, chemotherapy regimens in the treatment of young children with newly-diagnosed high-grade BSG.

Methods

Between 1991-and-2002, 15 eligible children less than 10 years of age with a diagnosis of high-grade BSG were treated on “Head-Start” I and II protocols (HSI and HSII). Treatment included Induction with 4–5 cycles of one of three intensive chemotherapy regimens followed by Consolidation with one cycle of marrow-ablative chemotherapy (thiotepa, carboplatin and etoposide) with autologous hematopoietic cell rescue (AHCR). Irradiation was required for children over 6 years of age or for those with residual tumor at the end of Consolidation.

Results

We had two long-term survivors who were found retrospectively to harbor low-grade glial tumors and thus were not included in the survival analysis. Of the remaining 13 patients, the 1-year event-free (EFS) and overall (OS) survival for these children were 31% (95% CI 9–55%) and 38% (95% CI 14–63%), respectively. Median EFS and OS were 6.6 (95% CI 2.7, 12.7) and 8.7 months (95% CI 6.9, 20.9), respectively. Eight patients developed progressive disease during study treatment (seven during Induction and one at the end of Consolidation). Ten children received focal irradiation, five for residual tumor (three following Induction and two following Consolidation) and five due to disease progression.

Conclusions

Children with high-grade BSG did not benefit from this intensive chemotherapy strategy administered prior to irradiation.
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Metadata
Title
Pre-irradiation intensive induction and marrow-ablative consolidation chemotherapy in young children with newly diagnosed high-grade brainstem gliomas: report of the “head-start” I and II clinical trials
Authors
Diana S. Osorio
Neha Patel
Lingyun Ji
Richard Sposto
Joseph Stanek
Sharon L. Gardner
Jeffrey C. Allen
Albert Cornelius
Geoffrey B. McCowage
Amanda Termuhlen
Ira J. Dunkel
Melanie Comito
James Garvin
Jonathan L. Finlay
Publication date
01-12-2018
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 3/2018
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-018-03003-z

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