OncoLog Volume 54, Number 01, January 2009

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Common Pediatric Brain Tumor May Be Treatable with Chemotherapy Alone Unresectable or progressive low-grade pediatric glioma—the most common brain malignancy in children—may be treated ef- fectively with chemotherapy alone to spare the long-term effects of radiation therapy, a multi-institution study has found. The Children’s Oncology Group study, led by Joann Ater, M.D., a professor in the Children’s Cancer Hospital at M. D. Anderson, compared two chemotherapy regimens in glioma patients who did not receive radiation therapy. A combination of thioguanine, procarbazine, lomustine, and vincristine (TPCV) yielded a 5-year event-free survival rate of nearly 50%, with patients ages 5–10 years experiencing a mean progression-free survival duration of more than 8 years. Dr. Ater said the results of the phase III trial point to treatment alternatives for unresectable low-grade glioma, which has a worse prognosis than does resectable low-grade glioma. Among patients whose low-grade pediatric glioma is successfully removed with surgery, the overall survival rate is 95%. However, survival is worse when the tumor is in a location that pre- cludes surgery or when the malignancy progresses after surgery. Unresectable or progressive low-grade gliomas usually can be successfully treated with cranial radiation, but the long-term side effects of such therapy—including mental im-

pairment, hormonal deficiencies, and an increased risk of stroke later in life—lead some families and physicians to decide against treatment. Given the positive results of the trial, it may be acceptable to delay or avoid radiation therapy for some patients, Dr. Ater said. “The results have confirmed the ability of chemotherapy to control the disease,” she explained. “If we can delay radiation for our youngest patients until they further develop physically, we may decrease some of the long-term side effects of radiation treatment. This trial at least gives parents more information and op- tions when making decisions about their child’s treatment.” The study also found that the TPCV regimen yielded better survival than a combination of carboplatin and vincri- stine that smaller pilot studies reported to be effective against low-grade pediatric glioma. Also, study participants with neu- rofibromatosis had the best response among patients receiving TPCV. Results were presented at the 40th an- nual meeting of the International Society of Pediatric Oncology. ● “If we can delay radiation for our youngest low-grade glioma patients, we may decrease the long-term side effects.” – Dr. Joann Ater

The University of Texas M. D. Anderson Cancer Center President John Mendelsohn, M.D. Provost and Executive Vice President Raymond DuBois, M.D., Ph.D. Senior Vice President for Academic Affairs Stephen P. Tomasovic, Ph.D. Director, Department of Scientific Publications Walter J. Pagel Managing Editor John LeBas

Assistant Managing Editors Joe Munch Maude Veech

Contributing Editors

Melissa G. Burkett Stephanie P. Deming

Sunni Hosemann Karen Stuyck


Ann M. Sutton Design The Very Idea ® Photography

Jim Lemoine

Barry Smith

Editorial Board Michael Fisch, M.D., Chair Lyle Green, Vice Chair Therese Bevers, M.D.

Robert Gagel, M.D. Beverly Handy, M.D. Patrick Hwu, M.D. Charles Koller, M.D.

Maurie Markman, M.D. Shreyaskumar Patel, M.D. David Schwartz, M.D. Rena Sellin, M.D. Randal Weber, M.D. Christopher Wood, M.D. Physicians: To refer a patient or learn more about M. D. Anderson, please contact the Office of Physician Relations at 713-792-2202, 1-800-252-0502, or www.mdanderson.org/departments/physrelations. Patients: To refer yourself to M. D. Anderson or learn more about our services, please call 1-877-632-6789 or visit www.mdanderson.org. For questions or comments about OncoLog , please e-mail scientificpublications@mdanderson.org or call 713-792-3305. Current and previous issues are available online in English and Spanish at www.mdanderson.org/oncolog. Made possible in part by a gift from the late Mrs. Harry C. Wiess.

8 OncoLog • January 2009

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