[Chemotherapy of brain tumors in childhood. Review of the literature and pilot protocol]

Abstract

The evaluation of 29 phase II studies demonstrate a complete, partial, and unequivocal response (CR + PR/UR) in 36% of 739 reported patients. A response rate of 55% has been reached in studies with initial neoadjuvant chemotherapy. Regarding different histologic types chemotherapy produced response rates of 56% in PNETs (primitive neuroectodermale tumors), 49% in medulloblastomas, 32% in ependymomas, 31% in brain stem gliomas, and 30% in astrocytomas/glioblastomas. Concerning a variety of cytotoxic drugs the following response rates have been observed: 59% with cyclophosphamide (monotherapy + combinations), 52% with MOPP/COPP, 48% with "8 in 1", 46% with BCNU/CCNU combinations, 42% with procarbazine combinations, 32% with cisplatin (22% with monotherapy; 64% with combinations), and 24% with AZQ (monotherapy + combinations). Because of the poor outcome of children with malignant brain tumors, and concerning the present evaluation as well as few phase III studies the brain tumor study group of the german society of pediatric oncology (GPO) created a pilot multidrug regimen including procarbazine (or 5-fluorouracil), ifosfamide + VP 16, hd methotrexate, and cisplatin + cytosinarabinoside. We observed one unequivocal response and one stable disease in two children after one course of this regimen without complications.