Chemotherapy for spinal cord astrocytoma

Abstract

Background The optimal management of spinal cord astrocytomas remains to be defined, as aggressive surgery and radiotherapy are associated with a high risk of morbidity. The value of chemotherapy has not been assessed. Procedure The patient in the present report harbored an infiltrating spinal cord tumor causing paraplegia. A limited biopsy showed a grade II astrocytoma. Following biopsy, the patient received sequential chemotherapy with vincristine and carboplatin. Results Full neurological recovery and complete radiologically‐confirmed remission were achieved after eight months of treatment. Chemotherapy was discontinued after eleven months due to carboplatin hypersensitivity. No adjuvant radiotherapy was given, and the patient remains in complete remission fourteen months after completion of treatment. Conclusions Chemotherapy demonstrates a promising activity and could change the standard practice if its efficacy is confirmed in larger studies. It could be used alone or combined with radiotherapy when post‐operative treatment is recommended. Med. Pediatr. Oncol. 29:560–562, 1997. © 1997 Wiley‐Liss, Inc.

Outcome predictors and complications in the management of intradural spinal tumours

“…Salvage chemotherapy with oral etoposide in a small cohort of patients with recurrent medically and surgically refractory ependymomas has been shown to have a modest activity in maintaining stable disease [2]. There is also anecdotal evidence of a grade II astrocytoma in a child responding to chemotherapy alone [1], but this result is not duplicated elsewhere in the literature and palliative care is often a more appropriate option.…”

Carboplatin chemotherapy for progressive intramedullary spinal cord low-grade gliomas in children: Three case studies and a review of the literature

“…The role of radiotherapy in pediatric patients with intramedullary spinal cord low-grade gliomas remains a vexed issue because the data that is available does not have suf cient statistical power (Bouffet et al, 1997;DeSousa et al, 1979;Lowis et al, 1998;Reimer and Onofrio, 1985). The threshold for spinal cord toxicity is approximately 45 to 50 Gy (Bouffet et al, 1997;Hopewell, 1998;Linstadt et al, 1989).…”

“…The threshold for spinal cord toxicity is approximately 45 to 50 Gy (Bouffet et al, 1997;Hopewell, 1998;Linstadt et al, 1989). This is based on the concept that the still developing spinal cords of children have a tolerance that is 10% to 15% lower than in adults, resulting in a greater susceptibility to radiationinduced myelopathy (Constantini et al, 1996;Reimer and Onofrio, 1985;Schultheiss et al, 1984).…”

“…Only 2% to 10% of these tumors are intramedullary spinal cord tumors (Allen et al, 1998;Bouffet et al, 1997;Chun et al, 1990;Constantini et al, 1996;Lowis et al, 1998;Nadkarni and Rekate, 1999;Rossitch et al, 1990;Stiller and Nectoux, 1994). The overall incidence of CNS tumors is approximately 24 to 35 per million in both Australia and the United States (Cokgor et al, 1998;Stiller and Nectoux, 1994).…”

Chemotherapy for unresectable and recurrent intramedullary glial tumours in children

“…There are only a few case reports of this treatment modality in intramedullary astrocytoma. Bouffet et al (1997) reported the case of a 30-year-old woman with a grade II spinal cord astrocytoma treated first with carboplatin, who entered full neurological and radiological remission. The result was promising despite the short follow-up.…”