Concomitant chemoradiotherapy for incompletely resected supratentorial low-grade astrocytoma in children: preliminary report.

BACKGROUND

In incompletely resected low-grade supratentorial astrocytoma, long-term survival is poor; the effect of any additional treatment to surgery still remains poorly defined. The aim of this study was to evaluate the response, the survival, and the benefit of concomitant chemoradiotherapy in eight children who had incompletely resected supratentorial low-grade astrocytoma.

PROCEDURE

There were six boys and two girls, aged 4-15 years. Four tumors were in the cerebral hemispheres, one in the hemisphere and thalamus, two in the third ventricle and/or thalamus, and one in the basal ganglia. Partial resection of the tumor was performed in four patients, biopsy in four; the extent of surgery was additionally evaluated with computed tomographic (CT) and/or magnetic resonance imaging (MRI) studies. A tumor dose of 50-56 Gy was delivered postoperatively in 1.8-2.1 Gy daily fractions five times per week. Chemotherapy was intercalated concomitantly in the radiotherapy protocol: cisplatin 20 mg/m2/2 weeks intravenously (IV) and vincristine 1.5 mg/m2/week IV (up to a maximum dose of 2 mg) were planned, starting on day 1 of irradiation. There were one to three cisplatin applications and one to seven vincristine applications.

RESULTS

Seven patients are alive 5.5-11.5 years (median, 8 years) after therapy. Six of seven are without evidence of tumor on CT and/or MRI. A residual mass is still visible in one patient, 11.5 years after therapy. He was treated at the age of 4; he is handicapped due to mental retardation and severe neurological impairment. One patient died 5 years after chemoradiotherapy, due to secondary glioblastoma multiforme, without recurrence at the site of the first tumor. Chemotherapy was discontinued in two patients because of severe nausea and vomiting; there was no hematologic or neurologic toxicity.

CONCLUSION

In view of the encouraging results, all patients with incompletely resected supratentorial low-grade astrocytomas will be treated as above.