Outcome and long-term side effects after synchronous radiochemotherapy forchildhood brain stem gliomas

Between 1993 and 1999, 11 children with histologically confirmed diffuse an d exophytic brain stem glioma (BSG) were treated with intensive induction c hemotherapy and simultaneous external beam irradiation. Chemotherapy was pe rformed according to the German/Austrian Pediatric Brain Tumor Study HIT '9 1 and included two cycles of ifosfamide (days 1-3), etoposide (days 4-6), m ethotrexate (days 15 and 22), cisplatin (days 29-31) and cytarabine (days 2 9-31), separated by a 3-week interval. Maintenance chemotherapy with carmus tine, carboplatin and vincristine (8 cycles over a 1-year period) was given in those patients who responded clinically or radiographically to inductio n chemotherapy. Six of 11 patients showed an objective reduction in tumor s ize on magnetic resonance imaging and 4 of 11 are alive in good general con dition > 22, > 22, > 90 and > 92 months, respectively, after diagnosis with out radiographic evidence of tumor progression (1 complete remission, 2 par tial remissions, 1 stable disease), but suffer from moderate to severe long -term side effects. Three patients died due to disease progression after ha ving achieved a partial remission which lasted 5, 6 and 18 months, respecti vely, whereas only short-term stabilization was observed in 4 patients who died within 1 year after diagnosis. Acute hematologic toxicity was severe b ut manageable. This intensive combined modality treatment was toxic but yie lded objective responses in more than 50% and long-term survivors in one th ird of childhood BSG patients. Copyright (C) 2001 S, Karger AG, Basel.