PREIRRADIATION CHEMOTHERAPY WITH CARBOPLATIN AND ETOPOSIDE IN NEWLY-DIAGNOSED EMBRYONAL PEDIATRIC CNS TUMORS

Purpose: We evaluated the clinical efficacy of preirradiation carbopla tin (CARBO) and etoposide (VP-16) in 25 patients with newly diagnosed embryonal CNS tumors. Patients and Methods: Sixteen patients with high -risk medulloblastoma and nine with other embryonal tumors were treate d with two daily doses of CARBO 350 mg/m(2) and VP-16 100 mg/m(2) (CAR BO/VP) every 21 days for four cycles before standard craniospinol irra diation. Patients with disease progression (PD) before radiation thera py were additionally treated with intensive postirradiation cyclophosp hamide (CYCLO) and vincristine (VINC). Results: Among 23 assessable pa tients, 48% (95% confidence interval, 27% to 69%) herd a complete resp onse (CR) or partial response (PR) to CARBO/VP; eight had PD. Among th e subgroup of 15 assessable patients with medulloblastoma, 53% had a C R or PR (95% confidence interval, 27% to 79%) and five PD. The toxicit y of CARBO/VP was predominantly hematologic; although grade IV neutrop enia was common, only five episodes of febrile neutropenia occurred. O nly thrombocytopenia was a more common toxicity than in other reported chemotherapy regimens; ototoxicity wets less common than in cisplatin (CDDP) regimens. Conclusion: The responses and survival associated wi th neoadjuvant CARBO/VP are similar to those with CDDP-containing and other neoadjuvant drug regimens. Although the rate of progression with this regimen may be higher than with similar CDDP-containing regimens , the numbers of patients in other published studies of these agents a re too small to detect meaningful statistical differences, Future stud ies must balance the apparently comparable efficacy of CARBO and CDDP with their differing toxicities. (C) 1995 by American Society of Clini cal Oncology.