Role of temozolomide in spinal cord low grade astrocytomas: results in two paediatric patients

Chamoun, Roukoz; Alaraj, Ali; Kutoubi, A. O. Al; Abboud, Mirna; Haddad, Ghassan

doi:10.1007/s00701-005-0694-0

Cited by 24 publications

(11 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition from surgery and radiotherapy, to our knowledge there are few data regarding the utility of chemotherapy in the treatment of spinal cord gliomas. [11][12][13][14][15][16] Trials of chemotherapy for recurrent spinal cord gliomas are challenging because these tumors are infrequent (10-fold less common than brain tumors), and consequently have not been considered by brain tumor consortia. Therefore, the literature regarding chemotherapy of spinal cord tumors is comprised of case reports that provide limited practical guidance.…”

Section: Discussionmentioning

confidence: 99%

“…Most often, these case reports, similar to the current study, use chemotherapy regimens used for intracranial gliomas. [11][12][13][14][15][16] Increasingly, stereotactic reradiation is administered for spinal cord tumors through the CyberKnife radiotherapy system, a therapy used in 2 patients in this series. To our knowledge, the role of reradiation of spinal cord tumors is unclear because there are no prospective trials that address this issue.…”

Section: Discussionmentioning

confidence: 99%

“…4 Less clear is the utility of chemotherapy in the management of intramedullary spinal cord gliomas, although anecdotal evidence exists for use at the time of tumor recurrence. [11][12][13][14][15][16] The majority of reports using chemotherapy in this context have used nitrosourea-based chemotherapy. Temozolomide (TMZ), an oral methylating chemotherapy, has profoundly altered the management of adult intracranial gliomas, and is now considered standard therapy for adults with newly diagnosed glioblastoma.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Temozolomide for recurrent low‐grade spinal cord gliomas in adults

Chamberlain

2008

Cancer

View full text Add to dashboard Cite

BACKGROUND.There is no standard therapy for surgery‐ and radiotherapy‐resistant, recurrent, low‐grade spinal cord gliomas. Therefore, a retrospective study of temozolomide (TMZ) in adults with recurrent low‐grade spinal cord gliomas with a primary objective of determining progression‐free survival (PFS) was performed.METHODS.Twenty‐two patients (11 men and 11 women) aged 20 years to 55 years (median, 35 years) with recurrent spinal cord gliomas (World Health Organization grade 2 astrocytoma in 19 patients and oligoastrocytoma in 3 patients) were treated. All had previously been treated with surgery and involved‐field radiotherapy. Thirteen patients underwent repeat surgery. All patients were chemotherapy–naive. TMZ was administered at a dose of 150‐200 mg/m2/day for 5 consecutive days every 4 weeks (operationally defined as a single cycle). Neurologic and neuroradiographic evaluations were performed every 8 weeks.RESULTS.All patients were evaluable for toxicity and response. A total of 266 cycles of TMZ (median, 14 cycles; range, 2 cycles‐24 cycles) was administered. TMZ‐related toxicity included constipation (9 patients, 1 with grade 3), lymphopenia (9 patients, 1 with grade 3), fatigue (7 patients, 1 with grade 3), neutropenia (6 patients, 2 with grade 3), and thrombocytopenia (6 patients, 2 with grade 3). Four (18%) patients demonstrated a partial radiographic response, 12 (55%) demonstrated stable disease, and 6 (27%) had progressive disease after 2 cycles of TMZ. Time to tumor progression ranged from 2 months to 28 months (median, 14.5 months). Survival ranged from 4 months to 39 months (median, 23 months). PFS at 6 months, 12 months, 18 months, and 24 months was 64%, 64%, 41%, and 27%, respectively.CONCLUSIONS.TMZ demonstrated modest efficacy with acceptable toxicity in this cohort of adult patients with recurrent low‐grade spinal cord gliomas. Cancer 2008. © 2008 American Cancer Society.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Temozolomide for recurrent low‐grade spinal cord gliomas in adults

Chamberlain

2008

Cancer

View full text Add to dashboard Cite

show abstract

“…There are few reports, and experience with chemotherapy in low-grade tumors is limited [24]. There is certainly a role for chemotherapy in high-grade tumor management [23], but it does not appear to provide a big survival benefit.…”

Section: Adjuvant Therapymentioning

confidence: 99%

“…Only the higher-grade glial tumors have been treated with a combination treatment which includes chemotherapy [23]. For the low-grade tumors little, if any, credible experience exists regarding the effect of medical treatment on these neoplasms [24]. Given the recent advances in the chemotherapeutic treatment of malignant gliomas of the brain [25], there may be chemotherapy for spinal cord neoplasms in the future.…”

Section: Introductionmentioning

confidence: 99%

Neurosurgical Management of Intramedullary Spinal Cord Tumors in Children

Kothbauer

2007

Pediatr Neurosurg

View full text Add to dashboard Cite

The majority of intramedullary spinal cord tumors in children are low-grade glial tumors. They become symptomatic with pain, neurologic deficits or spinal deformity. The diagnosis is most readily obtained using magnetic resonance imaging. The natural history is significant for slow progression of symptoms. Surgery is the best treatment and is also indicated to confirm the histological diagnosis. In case of a low-grade tumor or a vascular lesion such as hemangioblastoma or cavernoma, a total or near-total resection is attempted. For astrocytomas the resection almost always remains biologically incomplete, but a near-total resection is still associated with a long progression-free survival. Neurologic morbidity is relatively low during long-term follow-up but can be up to 30% for transient motor deficits. The risk for neurologic deterioration is higher for patients with pronounced dysfunction preoperatively. This is an important argument for early surgical resection. Surgery is performed using the spectrum of microsurgical techniques as well as advanced technology, e.g. lasers and intraoperative neurophysiological monitoring with motor evoked potentials. High-grade tumors are resected conservatively and treated with radiation and chemotherapy. The prognosis of high-grade glial tumors remains poor.

show abstract