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Titolo:
PRERADIATION CHEMOTHERAPY OF CHILDREN AND YOUNG-ADULTS WITH MALIGNANTBRAIN-TUMORS - RESULTS OF THE GERMAN PILOT TRIAL HIT88 89/
Autore:
KUHL J; MULLER L; BERTHOLD F; KORTMANN RD; DEINLEIN F; MAASS E; GRAF N; GNEKOW A; SCHEURLEN W; GOBEL U; WOLFF JEA; BAMBERG M; KAATSCH P; KLEIHUES P; RATING D; SORENSEN N; WIESTLER OD;
Indirizzi:
UNIV WURZBURG,CHILDRENS HOSP,JOSEF SCHNEIDER STR 2 D-97080 WURZBURG GERMANY UNIV WURZBURG,DEPT PEDIAT ONCOL WURZBURG GERMANY UNIV COLOGNE,DEPT PEDIAT ONCOL COLOGNE GERMANY UNIV HOMBURG,DEPT PEDIAT ONCOL D-6650 HOMBURG GERMANY UNIV DUSSELDORF,DEPT PEDIAT ONCOL D-4000 DUSSELDORF GERMANY UNIV MUNSTER,DEPT PEDIAT ONCOL D-4400 MUNSTER GERMANY UNIV CALGARY,DEPT PEDIAT ONCOL CALGARY AB CANADA UNIV STUTTGART,CHILDRENS HOSP,DEPT PEDIAT ONCOL D-7000 STUTTGART GERMANY UNIV AUGSBURG,DEPT PEDIAT ONCOL D-8900 AUGSBURG GERMANY UNIV MANNHEIM,DEPT PEDIAT ONCOL MANNHEIM GERMANY DEPT NEUROPATHOL LYON FRANCE DEPT NEUROPATHOL ZURICH SWITZERLAND DEPT NEUROPATHOL ZURICH SWITZERLAND DEPT NEUROPATHOL BONN GERMANY UNIV TUBINGEN,DEPT RADIOTHERAPY TUBINGEN GERMANY UNIV MAINZ,INST MED STAT & DOCUMENTAT D-6500 MAINZ GERMANY UNIV HEIDELBERG,DEPT PEDIAT NEUROL HEIDELBERG GERMANY UNIV WURZBURG,DEPT PEDIAT NEUROSURG WURZBURG GERMANY
Titolo Testata:
Klinische Padiatrie
fascicolo: 4, volume: 210, anno: 1998,
pagine: 227 - 233
SICI:
0300-8630(1998)210:4<227:PCOCAY>2.0.ZU;2-R
Fonte:
ISI
Lingua:
ENG
Soggetto:
PRIMITIVE NEUROECTODERMAL TUMORS; PROSPECTIVE RANDOMIZED TRIAL; PEDIATRIC-ONCOLOGY SIOP; HIGH-GRADE ASTROCYTOMA; INTERNATIONAL-SOCIETY; ADJUVANT CHEMOTHERAPY; PHASE-II; MEDULLOBLASTOMA; RADIATION; RADIOTHERAPY;
Keywords:
PRERADIATION CHEMOTHERAPY; MALIGNANT BRAIN TUMORS; CHILDREN AND YOUNG ADULTS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
34
Recensione:
Indirizzi per estratti:
Citazione:
J. Kuhl et al., "PRERADIATION CHEMOTHERAPY OF CHILDREN AND YOUNG-ADULTS WITH MALIGNANTBRAIN-TUMORS - RESULTS OF THE GERMAN PILOT TRIAL HIT88 89/", Klinische Padiatrie, 210(4), 1998, pp. 227-233

Abstract

Background Preradiation chemotherapy could be beneficial in malignantbrain tumors, because the blood-brain tumor-barrier is disrupted after surgery, bone marrow recovery - essential for intense chemotherapy -is still intact, and CNS toxicity and ototoxicity of active drugs arelower before irradiation of a child's brain. Patients and Methods A neoadjuvant phase 2 and a single arm pilot trial were initiated to investigate the efficacy and toxicity of an intense multidrug regimen before radiotherapy in 147 patients aged between 3 and 29;9 years with medulloblastoma (94), malignant glioma (22), ependymoma (21), and stPNET (10). They were treated with one or two cycles consisting of procarbazine, ifosfamide/mesna with etoposide, high dose methotrexate/CF, and cisplatin with cytarabine. Results Radiation therapy was delayed for 17-30 weeks (median 23 weeks) in 112 patients who received two cycles. Chemotherapy was well tolerated. Serious infections were observed in 20patients, with one fatal fungal septicemia. In 69 high risk patients with a residual tumor and/or solid CNS metastases an objective response (CR plus PR) was achieved in 67% medulloblastoma, 57% stPNET, 55% anaplastic ependymoma and 25% malignant glioma. Progression-free survival (PFS) at 5 years was 57% in 14 high risk patients with medulloblastoma, who achieved a complete response (CR). After a less than CR the PFS was 20% (p = 0.01). Overall survival at 5 years was 57% in medulloblastoma, 62% in ependymoma, 36% in malignant glioma and 30% in stPNET. Conclusion The HIT'88/'89 regimen was well tolerated and efficacious in regard to response rates and early PSF particularly in medulloblastoma and anaplastic ependymoma. Based on these results the prospectivelyrandomized trial HIT'91 was designed to investigate the optimal timing of chemotherapy. Preradiation chemotherapy according to the HIT'88/'89 regimen was compared with the standard regimen using CCNU, cisplatin, and vincristine after radiation therapy. Additionally, strict quality control of the three treatment modalities was instituted to help improve the survival rates in both trial arms.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 12/07/20 alle ore 12:49:49