TREATMENT OF INFANTS WITH MALIGNANT GLIOMAS - THE PEDIATRIC-ONCOLOGY-GROUP EXPERIENCE

Although survivals of infants with malignant brain tumors are worse th an any other age group, one possible exception to this rule are the ma lignant gliomas. Eighteen children less than 3 years of age with malig nant gliomas (glioblastoma multiforme, anaplastic astrocytoma and mali gnant glioma) were treated on the Pediatric Oncology Group regimen of prolonged postoperative chemotherapy and delayed irradiation, (1986-19 90). Of 10 children evaluable for neuroradiologic response, 6 had part ial responses (> 50% reduction) to two cycles of cyclophosphamide and vincristine. Progression free survivals at 1, 3 and 5 years were 54.25 % +/- 12, 43% +/- 16 and 43% +/- 23 respectively. Survivals at 5 years were 50% +/- 14. Four children were not irradiated after 24 months of chemotherapy due to parental refusal and none have developed recurren t disease. Neither degree of surgical resection, presence or absence o f metastases, nor pathology influenced survival but this may reflect s mall sample size. This study suggests that some malignant gliomas in i nfants are chemotherapy sensitive and may be associated with a good pr ognosis. Why infants with these high-grade gliomas fare better than ad ults is not clear. It is likely that there is something intrinsically different about them that cannot be identified on routine pathologic e xamination.