Treatment of chiasmatic/hypothalamic gliomas of childhood with chemotherapy: An update

Abstract

Chiasmatic/hypothalamic gliomas (CHG) of childhood may cause progressive neurological and visual deterioration. Radiotherapy results in at least transient stabilization of tumor growth in most patients but may also have adverse long-term effects, especially in young children. Since 1977, children with progressive CHG under 5 years of age at diagnosis have been treated with combination chemotherapy (actinomycin D and vincristine) without radiotherapy. Twenty-four patients, a median of 1.6 years of age at diagnosis, have been treated and followed for a median of 4.3 years (range, 0.3-10 years). All patients are alive. Nine have developed radiographic or clinical progression, occurring a median of 3 years (range, 2-6.5 years) after initiation of treatment. Fifteen of 24 (62.5%) have remained free of progressive disease and have received no other therapy. Tumor shrinkage was documented in 9 of 24 patients but did not clearly relate to long-term outcome. Full-scale intelligence quotient (IQ) obtained a median of 3.5 years after diagnosis in patients who received only chemotherapy was a mean of 103 (range 84-133). We conclude that chemotherapy can significantly delay the need for radiotherapy in children with CHG and such a delay may be beneficial regarding long-term outcome.

Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas

“…[18] In the previous report, 12 of 23 children with recurrent disease had an objective response to the drug regimen, and 23 of 37 newly diagnosed patients also demonstrated objective tumor shrinkage. The 56% objective response rate seen in the expanded series of 78 children was essentially identical.…”

“…A variety of drugs have been used, including vincristine, actinomycin D, etoposide, carmustine, and carboplatin, as well as combination regimens consisting of these drugs (R. Prados, personal communication, 1996). [5,14,17,18,20,21,24] In 1989, a study was begun to evaluate the efficacy of combining carboplatin and vincristine in treating children with recurrent and newly diagnosed astrocytomas. The objective response rates of 60 children, including 37 with newly diagnosed astrocytomas, have been reported.…”

“…The objective response rates of 60 children, including 37 with newly diagnosed astrocytomas, have been reported. [18] However, because of the short length of the follow-up review, this report did not address the primary goals of therapy: the duration of disease stability or improvement and the delay of the need for further types of potentially more toxic treatment. In addition, therapy was initially limited to children 60 months of age or younger with newly diagnosed disease.…”

Optic glioma warranting treatment in children

“…Carboplatin, cisplatin, vincristine, vinblastine, actinomycin D, lomustine, thioguanine, procarbazine, dibromodulcitol, etoposide, tamoxifen, and temozolomide, alone or in combination, as primary treatment or as adjuvant, have all been utilized. [10][11][12][13]19,[32][33][34][35][36][37][38][39][40] Although chemotherapy has emerged as promising therapy, no regimen has yet to be universally accepted, hence the current Children's Oncology Group trial.…”

“…Multiple studies have been reported on the advantage of chemotherapy for OPG in young children, but no widely accepted protocol yet exists. [11][12][13] Each patient with OPG requires a team approach, with individualized treatment.…”