EFFECTIVE CHEMOTHERAPY FOR ADVANCED CNS EMBRYONAL TUMORS IN ADULTS

Purpose: Embryonal tumors of the CNS include, among others, medullobla stoma, cerebral neuroblastoma, pineoblastoma, and primitive neuroectod ermal tumors (PNETs). Almost all data on the treatment of embryonal CN S tumors are derived from the pediatric population, since these tumors are uncommon in adulthood. The purpose of this study was to examine t he rate and duration of response to chemotherapy of advanced embryonal CNS tumors in adults. Patients and Method's: We retrospectively studi ed all adult (> 18 years of age) patients with advanced embryonal tumo rs of the CNS who received chemotherapy at our institution between 197 6 and 1994. Seventeen consecutive patients were treated with regimens that contained either nitrosourea or cisplatin or both sequentially, w ith no patients having received the combination of nitrosourea and cis platin concurrently. Results: In patients who received cisplatin-based chemotherapy, responses were observed in 84.5% (26% complete response [CR] rate), 10.5% remained stable, and 5% progressed, The median time to progression was 18 months for patients who had a CR, 6 months for those with partial response (PR), and 10 months for stable patients. A mong patients who received nitrosourea-based chemotherapy, PR was obse rved in 27%, 36.5% remained stable, and 36.5% progress. The median tim e to progression was 6 months for patients who had a PR and 6.5 months far stable patients. Conclusion: in adults with advanced embryonal CN S tumors, conventional-dose intravenous cisplatin-based chemotherapy r egimens are able to produce responses in the majority of the patients (84.5%), even as second- or third-line regimens. Nitrosourea-based reg imens less frequently produce responses (27%). (C) 1997 by American So ciety of Clinical Oncology.