CARBOPLATIN AND VINCRISTINE CHEMOTHERAPY FOR CHILDREN WITH NEWLY-DIAGNOSED PROGRESSIVE LOW-GRADE GLIOMAS

The optimum treatment of nonresectable low-grade gliomas of childhood remains undecided. There has been increased interest in the use of che motherapy for young children, but little information concerning the lo ng-term efficacy of such treatment. Seventy-eight children with a mean age of 3 years (range 3 months-16 years) who had newly diagnosed, pro gressive low-grade gliomas were treated with combined carboplatin and vincristine chemotherapy. The patients were followed for a median of 3 0 months from diagnosis, with 31 patients followed for more than 3 yea rs. Fifty-eight children had diencephalic tumors, 12 had brainstem gli omas, and three had diffuse leptomeningeal gliomas. Forty-four (56%) o f 78 patients showed an objective response to treatment. Progression-f ree survival rates were 75 +/- 6% at 2 years and 68 +/- 7% at 3 years. There was no statistical difference in progression-free survival rate s between children with neurofibromatosis Type 1 and those without the disease (2-year, progression-free survival 79 +/- 11% vs. 75 +/- 6%, respectively). The histological subtype of the tumor, its location, an d its maximum response to chemotherapy did not have an impact on the d uration of disease control. The only significant prognostic factor was age: children 5 years old or younger at the time of treatment had a 3 -year progression-free survival rate of 74 +/- 7% compared with a rate of 39 +/- 21% in older children (p < 0.01). Treatment with carboplati n and vincristine is effective, especially in younger children, in con trolling newly diagnosed progressive low-grade gliomas.