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Intensive chemotherapy improves survival in pediatric high‐grade glioma after gross total resection: results of the HIT‐GBM‐C protocol
Author(s) -
Wolff Johannes E.A.,
Driever Pablo Hernaiz,
Erdlenbruch Bernhard,
Kortmann Rolf D.,
Rutkowski Stefan,
Pietsch Torsten,
Parker Crystal,
Metz Monica Warmuth,
Gnekow Astrid,
Kramm Christof M.
Publication year - 2009
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.24730
Subject(s) - medicine , etoposide , chemotherapy , vincristine , glioma , carboplatin , ifosfamide , surgery , cisplatin , survival rate , gastroenterology , urology , cyclophosphamide , cancer research
BACKGROUND: The authors hypothesized that intensified chemotherapy in protocol HIT‐GBM‐C would increase survival of pediatric patients with high‐grade glioma (HGG) and diffuse intrinsic pontine glioma (DIPG). METHODS: Pediatric patients with newly diagnosed HGG and DIPG were treated with standard fractionated radiation and simultaneous chemotherapy (cisplatin 20 mg/m 2 × 5 days, etoposide 100 mg/m 2 × 3 days, and vincristine, and 1 cycle of cisplatin + etoposide + ifosfamide 1.5 g/m × 5 days [PEI] during the last week of radiation). Subsequent maintenance chemotherapy included further cycles of PEI in Weeks 10, 14, 18, 22, 26, and 30, followed by oral valproic acid. RESULTS: Ninety‐seven (pons, 37; nonpons, 60) patients (median age, 10 years; grade IV histology, 35) were treated. Resection was complete in 21 patients, partial in 29, biopsy only in 26, and not performed in 21. Overall survival rates were 91% (standard error of the mean [SE] ± 3%), 56%, and 19% at 6, 12, and 60 months after diagnosis, respectively. When compared with previous protocols, there was no significant benefit for patients with residual tumor, but the 5‐year overall survival rate for patients with complete resection treated on HIT‐GBM‐C was 63% ± 12% SE, compared with 17% ± 10% SE for the historical control group ( P = .003, log‐rank test). CONCLUSIONS: HIT‐GBM‐C chemotherapy after complete tumor resection was superior to previous protocols. Cancer 2010. © 2009 American Cancer Society.