Randomized Study of Two Chemotherapy Regimens for Treatment of Low-Grade Glioma in Young Children: A Report From the Children's Oncology Group

被引:306
作者
Ater, Joann L. [1 ]
Zhou, Tianni [3 ]
Holmes, Emiko [3 ]
Mazewski, Claire M. [6 ]
Booth, Timothy N. [2 ]
Freyer, David R. [4 ]
Lazarus, Ken H. [7 ]
Packer, Roger J. [8 ]
Prados, Michael [5 ]
Sposto, Richard [4 ]
Vezina, Gilbert [8 ]
Wisoff, Jeffrey H. [9 ]
Pollack, Ian F. [10 ]
机构
[1] Univ Texas MD Anderson Canc Ctr, Div Pediat, Houston, TX 77030 USA
[2] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA
[3] Childrens Oncol Grp, Operat Ctr, Arcadia, CA USA
[4] Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA
[5] Univ Calif San Francisco, San Francisco, CA 94143 USA
[6] Childrens Hlth Care Atlanta, Atlanta, GA USA
[7] Indiana Univ, Med Ctr, Indianapolis, IN USA
[8] Childrens Natl Med Ctr, Washington, DC 20010 USA
[9] NYU, New York, NY USA
[10] Childrens Hosp Pittsburgh, Pittsburgh, PA 15213 USA
基金
美国国家卫生研究院;
关键词
CONFORMAL RADIATION-THERAPY; LONG-TERM SURVIVORS; BRAIN-TUMORS; CARBOPLATIN; CHILDHOOD; RECURRENT; TEMOZOLOMIDE; VINCRISTINE; ENDOCRINE; DURATION;
D O I
10.1200/JCO.2011.36.6054
中图分类号
R73 [肿瘤学];
学科分类号
100214 [肿瘤学];
摘要
Purpose Surgery is curative therapy for pediatric low-grade gliomas (LGGs) in areas of the brain amenable to complete resection. However, LGGs located in areas where complete resection is not possible can threaten both function and life. The purpose of this study was to compare two chemotherapy regimens for LGGs in children younger than age 10 years for whom radiotherapy was felt by the practitioner to pose a high risk of neurodevelopmental injury. Patients and Methods Previously untreated children younger than age 10 years with progressive or residual LGGs were eligible. Children were randomly assigned to receive carboplatin and vincristine (CV) or thioguanine, procarbazine, lomustine, and vincristine (TPCV). Children with neurofibromatosis are reported separately. Results Of 274 randomly assigned patients who met eligibility requirements, 137 received CV and 137 received TPCV. The 5-year event-free survival (EFS) and overall survival (OS) rates for all eligible patients were 45% +/- 3.2% and 86% +/- 2.2%, respectively. The 5-year EFS rates were 39% +/- 4% for CV and 52% +/- 5% for TPCV (stratified log-rank test P = .10; cure model analysis P = .007). On multivariate analysis, factors independently predictive of worse EFS and OS were younger age and tumor size greater than 3 cm(2). Tumor location in the thalamus was also associated with poor OS. Conclusion The difference in EFS between the regimens did not reach significance on the basis of the stratified log-rank test. The 5-year EFS was higher for TPCV on the basis of the cure model analysis. Differences in toxicity may influence physician choice of regimens.
引用
收藏
页码:2641 / 2647
页数:7
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