Neoadjuvant chemotherapy for symptomatic non operable grade II fibrillary astrocytoma in adults

We collected 6 case-reports of symptomatric non removable low grade fibrillary astrocytoma of adults treated with a procarbazine-CCNU-vincristine chemotherapy regimen. All patients had drug-resistant epilepsy but brain imaging was stable. Total gross resection was rejected because of volume or tumor location. After 4 to 7 cycles of chemotherapy, 2 patients had partial response and one minor response on brain MRI. All of them were seizure-free. Progression free survival was not reached at 5 years. Up-front chemotherapy for low-grade astrocytomas may be useful and has to be prospectively evaluated.