Chemotherapy for progressive low-grade gliomas in children older than ten years: the Dana-Farber experience.

The purpose of this retrospective study was to examine the clinical and radiographic response rates to and toxicity of chemotherapy for low-grade gliomas in children older than 10 years of age. Between June 1999 and January 2001, seven consecutive children between the ages of 10 and 18 were treated with vincristine and carboplatin +/- thioguanine, procarbazine, CCNU [lomustine], and vincristine (TPCV) for progressive low-grade gliomas. All 7 children completed a 10-week induction course of vincristine and carboplatin; 3 were switched to TPCV during the maintenance phase of therapy after developing an allergic reaction to carboplatin. Overall, 4 patients had a radiographic response to treatment with chemotherapy (3 partial responses and 1 minor response: objective response rate of 57%), and 2 more showed stable disease. One patient progressed while on treatment and 1 patient progressed off treatment, and after 31 months had elapsed. The resulting progression-free survival at the time of this report was 71%. The median duration of follow-up was 32 months (range 25-42 months). Hematologic toxicity was common, but did not result in cessation of therapy. No other significant treatment-related toxicities were observed. The results suggest that the clinical response/disease stabilization rate in children older than 10 years of age does not differ markedly from that observed in younger children. A prospective clinical trial of chemotherapy for progressive low-grade gliomas in children older than 10 years is therefore warranted.