CHEMOTHERAPY IN LOW-GRADE ASTROCYTOMA MANAGEMENT

The role of chemotherapy (CHT) in the management of low-grade astrocyt oma (LGA) is still unclear. Nineteen children with nonresectable sympt omatic LGA were treated with carboplatin (CBDCA) and etoposide (E). Th ere were 15 newly diagnosed cases and 4 were relapses; 6 of the childr en were under 5 years old. In all children radiological evaluation by CT scan and/or MRI was performed after four courses of CHT. We observe d complete response (CR)+ minor response (MR) in 37% of these cases an d an improvement in neurological symptoms in 63%. Radiological evaluat ion performed in 6 patients who received CHT for longer periods (8-12 courses) showed major responses (CR+PR) in 67%. Local radiotherapy (40 Gy) was administered after CHT in 14 cases, but in 3 of these radioth erapy was delayed for 2 years. Five patients did not receive radiother apy. The overall survival was 58% after an average follow-up of 60 mon ths. All patients with brain stem tumors died of progressive disease e ven though 3 of these had shown clinical improvement after chemotherap y. In conclusion, in the treatment of nonresectable symptomatic LGA, C HT with CBDCA associated with E can be used to postpone radiotherapy i n young children and even to avoid radiotherapy in some cases.