TREATMENT OF PEDIATRIC LOW-GRADE GLIOMAS WITH A NITROSOUREA-BASED MULTIAGENT CHEMOTHERAPY REGIMEN

Between March 9, 1984 and January 29, 1992, 42 children with newly dia gnosed symptomatic or previously diagnosed progressive low-grade gliom as received outpatient chemotherapy as their primary treatment. This s tudy was a single arm, phase II trial designed to estimate the time to tumor progression and toxicity of this regimen. Procarbazine, 6-thiog uanine, and dibromodulcitol were given before lomustine (CCNU) and vin cristine was given 1 and 3 weeks after CCNU. Patients were treated for six treatment cycles or until the tumor progressed, whichever came fi rst. Twenty-three patients had juvenile pilocytic astrocytomas, 11 had astrocytomas, one had oligodendroglioma, one had ganglioglioma, and s ix had radiographically diagnosed low-grade gliomas. The mean age of t he patients was 5 years (median, 3 ye ars). The median time to treatme nt failure was 132 weeks (95% confidence interval: 106, 186 weeks). On ly eight patients have died; the estimated 5-year survival rate is 78% (95% confidence interval, 60% 87%). There were two episodes of grade 4 neutropenia, and three episodes of grade 4 thrombocytopenia. This re gimen was safe, able to be delivered in the outpatient setting, and pr oduced prolonged periods of disease stabilization in children with low -grade gliomas.