PURPOSE: This study was undertaken to evaluate the radiographic response to two cycles of chemotherapy prior to irradiation in newly diagnosed children with high-grade astrocytomas. PATIENTS AND METHODS: One hundred and thirty children less than 21 years of age with newly-diagnosed high-grade astrocytoma were treated with the 'eight-drugs-in-one-day' chemotherapy regimen as part of a phase III multi-institutional Childrens Cancer Group (CCG) trial. Computerized Tomographic (CT) or Magnetic Resonance Image (MRI) scans, obtained after two cycles of chemotherapy had been administered, were compared with post-operative scans to determine treatment response. Scans were evaluated by institutional radiologists, and were reviewed centrally by a single neuroradiologist. RESULTS: Of 79 patients with evaluable post-operative residual tumor on CT or MRI scans, 26 (33%) were determined on institutional evaluation to have had an objective response. However, central review of scans documented responses on only 14/79 (18%). A significantly higher response rate on central review was observed for those children 36 months of age or less at study entry than for older children (33% v 11%; p < 0.001). However, a higher disease progression rate was also observed for those children 36 months of age or less than for older children (21% v 2.6%; p < 0.001). CONCLUSION: In this study, the largest yet reported in newly-diagnosed children with high-grade astrocytomas, the chemotherapy regimen has activity in younger children. The differences in response rates reported by institutional and central review highlight the difficulties inherent in assessing response to brain tumor therapy. However, the study does demonstrate the consistent ability of radiologists to identify disease progression within the institutional and central reviews.
RCT Entities:
PURPOSE: This study was undertaken to evaluate the radiographic response to two cycles of chemotherapy prior to irradiation in newly diagnosed children with high-grade astrocytomas. PATIENTS AND METHODS: One hundred and thirty children less than 21 years of age with newly-diagnosed high-grade astrocytoma were treated with the 'eight-drugs-in-one-day' chemotherapy regimen as part of a phase III multi-institutional Childrens Cancer Group (CCG) trial. Computerized Tomographic (CT) or Magnetic Resonance Image (MRI) scans, obtained after two cycles of chemotherapy had been administered, were compared with post-operative scans to determine treatment response. Scans were evaluated by institutional radiologists, and were reviewed centrally by a single neuroradiologist. RESULTS: Of 79 patients with evaluable post-operative residual tumor on CT or MRI scans, 26 (33%) were determined on institutional evaluation to have had an objective response. However, central review of scans documented responses on only 14/79 (18%). A significantly higher response rate on central review was observed for those children 36 months of age or less at study entry than for older children (33% v 11%; p < 0.001). However, a higher disease progression rate was also observed for those children 36 months of age or less than for older children (21% v 2.6%; p < 0.001). CONCLUSION: In this study, the largest yet reported in newly-diagnosed children with high-grade astrocytomas, the chemotherapy regimen has activity in younger children. The differences in response rates reported by institutional and central review highlight the difficulties inherent in assessing response to brain tumor therapy. However, the study does demonstrate the consistent ability of radiologists to identify disease progression within the institutional and central reviews.
Authors: T W Pendergrass; J M Milstein; J R Geyer; A F Mulne; E J Kosnik; J D Morris; R L Heideman; F B Ruymann; J T Stuntz; W A Bleyer Journal: J Clin Oncol Date: 1987-08 Impact factor: 44.544
Authors: N L Kobrinsky; R J Packer; J M Boyett; P Stanley; T Shiminski-Maher; J C Allen; J H Garvin; D J Stewart; J L Finlay Journal: J Neurooncol Date: 1999 Impact factor: 4.130
Authors: Bruce H Cohen; J Russell Geyer; Douglas C Miller; John G Curran; Tianni Zhou; Emi Holmes; Sue Ann Ingles; Ira J Dunkel; Joanne Hilden; Roger J Packer; Ian F Pollack; Amar Gajjar; Jonathan L Finlay Journal: Pediatr Neurol Date: 2015-04-09 Impact factor: 3.372
Authors: Stephen Alan Sands; Tianni Zhou; Sharon Helene O'Neil; Sunita K Patel; Jeffrey Allen; Patsy McGuire Cullen; Thomas A Kaleita; Robert Noll; Charles Sklar; Jonathan Lester Finlay Journal: J Clin Oncol Date: 2012-02-21 Impact factor: 44.544
Authors: Darren Hargrave; Birgit Geoerger; Didier Frappaz; Torsten Pietsch; Lyle Gesner; Laura Cisar; Aurora Breazna; Andrew Dorman; Ofelia Cruz-Martinez; Jose Luis Fuster; Xavier Rialland; Céline Icher; Pierre Leblond; David Ashley; Giorgio Perilongo; Martin Elliott; Martin English; Niels Clausen; Jacques Grill Journal: J Neurooncol Date: 2013-03-04 Impact factor: 4.130
Authors: Halldora K Thorarinsdottir; Mariarita Santi; Robert McCarter; Elisabeth J Rushing; Robert Cornelison; Alessandra Jales; Tobey J MacDonald Journal: Clin Cancer Res Date: 2008-06-01 Impact factor: 12.531
Authors: Vandana Batra; Stephen A Sands; Emi Holmes; Jeffrey Russell Geyer; Allan Yates; Lawrence Becker; Peter Burger; Floyd Gilles; Jeffrey Wisoff; Jeffrey C Allen; Ian F Pollack; Jonathan L Finlay Journal: Pediatr Blood Cancer Date: 2013-08-23 Impact factor: 3.167