Recurrent supratentorial malignant gliomas in children. Long-term salvage therapy with oral etoposide
M. C. Chamberlain
Department of Neurosciences, University of California, San Diego, USA.
BACKGROUND: A long-term regimen of oral etoposide, a type of chemotherapy,
is used in oncology and is effective in treating germ-cell tumors,
lymphomas, Kaposi sarcoma, and primary brain tumors. OBJECTIVE: To examine
the toxic effects and efficacy of long-term salvage chemotherapy using oral
etoposide. PATIENTS AND METHODS: Fourteen children (8 boys and 6 girls)
with recurrent supratentorial gliomas, ranging in age from 4 to 18 years
(median age, 9 years), were treated with etoposide. Tumor histologic grades
included Daumas-Duport grade 3 (10 children) and grade 4 astrocytomas (4
children). All children had been treated previously with radiotherapy
(median dose, 60 Gy) and nitrosourea-based chemotherapy. Each cycle of
therapy consisted of 21 days of etoposide (50 mg/m2 daily) followed by a
14-day period of rest and an additional 21 days of etoposide (50 mg/m2
daily). Measurements of complete blood cell counts were taken biweekly. A
neurological examination and a magnetic resonance image of the brain with
contrast medium were performed before each cycle of therapy. RESULTS:
Treatment-related complications included the following partial alopecia (8
children); diarrhea (6 children); weight loss (4 children); anemia (4
children); neutropenia (4 children) and thrombocytopenia (4 children). Four
children required transfusion (4 with packed red blood cells and 3 with
platelets) and 2 children received antibiotic therapy for neutropenic
fever. There were no treatment-related deaths. All children were examined
for response. In 7 children (50%), the results of magnetic resonance
imaging indicated either a partial response (3 children) or stable disease
(4 children), with a median duration of response of 8 months. CONCLUSION:
Oral etoposide is a well tolerated and relatively nontoxic chemotherapeutic
agent with demonstrated activity in children with recurrent supratentorial
gliomas.
