MOPP CHEMOTHERAPY WITHOUT IRRADIATION AS PRIMARY POSTSURGICAL THERAPYFOR BRAIN-TUMORS IN INFANTS AND YOUNG-CHILDREN

Infants and young children who have brain tumors have a poor rate of s urvival and high treatment associated morbidity. A trial of mechloreth amine, vincristine (oncovin), procarbazine, and prednisone (MOPP) was performed to test the hypothesis that replacing radiotherapy with chem otherapy would improve survival and decrease long term morbidity of in fants who have brain tumors. Between 1976 and 1988, 17 consecutive chi ldren less than 36 months old when diagnosed with medulloblastoma or e pendymoma were treated with MOPP chemotherapy as primary therapy follo wing surgical excision or biopsy of the tumor. Radiotherapy was reserv ed for recurrent disease. Ten of 17 children have survived without evi dence of disease: medulloblastoma, eight of 12 with median survival ti me of 10.6 years (range, 6.2 to 15.2 yrs); and ependymoma, 2 of 5 (at 13.0 and 16.0 yrs). Four of the 10 children with medulloblastoma and e pendymoma who relapsed are now disease free at 7.5, 11.7, 12.2 and 13. 5 yrs post relapse after receiving salvage therapy with cisplatin (n = 1) or irradiation (n = 3). All relapses occurred within 26 months of diagnosis. Data on growth demonstrated height less than the 5th percen tile in all children who received cranial irradiation compared to 25 t o 95th percentile for nonirradiated children. Intellectual ability for the group who did not require radiation was within normal range (mean IQ 100.1) and stable across annual assessments. Those who required ra diation had lower IQs which continued to decline over time (mean IQ 85 at mean age of 5.8 years, declining to 63 at 10 years). In young chil dren with brain tumors, primary chemotherapy with MOPP, omitting radio therapy, provides improved neurodevelopmental outcome and survival.