EVALUATION OF RESPONSE TO POSTRADIATION 8-IN-ONE CHEMOTHERAPY IN CHILDHOOD BRAIN-TUMORS

Ten children, 3 to 15 years of age with high risk primary brain tumors were treated with postradiation 'eight in one' chemotherapy; vincrist ine, lomustine, procarbazine, hydroxyurea, cisplatin, cytosine arabino side, cyclophosphamide and methylprednisolone. The tumors comprised of three medulloblastomas, two primitive neuroectodermal tumors, one epe ndymoblastoma and four anaplastic ependymomas. Treatment involved surg ery (two total resection, six subtotal and two biopsy only) followed b y conventional radiotherapy (primary tumor: 50-54 Gy, whole brain: 30- 45 Gy, and spinal axis: 25-36 Gy). Objective tumor response with radio therapy was achieved in 7 of 9 patients (78%) (6/8 patients with resid ual tumor and one patient with complete resection but positive cerebro spinal fluid cytology). Complete response was attained in 4 of 9 patie nts (44%). 'Eight in one' chemotherapy was initiated four weeks after radiation and repeated at 4 weekly intervals for 5-8 courses. Postradi ation 'eight in one' failed to show any additional effect on tumor res ponses. Median survival was 34 months (range 9-48 months) with five of ten patients alive: four in complete and one in partial remission. Al l the five survivors were among the patients who had achieved response to initial treatment. This result suggested that degree of response t o initial treatment might determine subsequent outcome and thus the ch oice of modality for initial therapy might be important.