Treatment of children with progressive or recurrent brain tumors with carboplatin or iproplatin: a Pediatric Oncology Group randomized phase II study.

PURPOSE: The Pediatric Oncology Group (POG) conducted a randomized phase II study to evaluate the activity of carboplatin and iproplatin in children with progressive or recurrent brain tumors. PATIENTS AND METHODS: The study was designed to evaluate the activity of these agents and to compare the toxicities associated with their use. Treatment consisted of carboplatin 560 mg/m2 at 4-week intervals or iproplatin 270 mg/m2 at 3-week intervals. RESULTS: The major toxicity observed was myelosuppression, particularly thrombocytopenia, for both agents. Ototoxicity (grade 1 or 2) was seen in 2.5% of patients treated with carboplatin and 1.3% of patients treated with iproplatin. The majority of patients with low-grade astrocytic neoplasms treated with carboplatin (nine of 12 patients) or iproplatin (eight of 12 patients) demonstrated tumor response or prolonged stable disease that persisted off-therapy. The duration of stable disease produced by carboplatin was particularly striking, ranging from 2 months to 68 + months (median, 40 + months). Neither drug demonstrated appreciable activity in the treatment of medulloblastoma (two of 26 responses to carboplatin, one of 14 responses to iproplatin), ependymoma (two of 17 responses to carboplatin, none of seven responses to iproplatin), high-grade glioma (two of 19 responses to carboplatin, one of 14 responses to iproplatin), or brain-stem tumors (one of 23 responses to carboplatin, none of 14 responses to iproplatin). CONCLUSION: Carboplatin is active against low-grade gliomas. Further evaluation of the role of carboplatin in the preirradiation treatment of children with low-grade gliomas of the optic pathway is currently underway in a clinical trial.

Lung function in tetralogy of Fallot after intracardiac repair.

Earlier studies have shown significant restrictive lung volume patterns in virtually all patients after shunt palliation and/or subsequent intracardiac repair (ICR) of tetralogy of Fallot. We have studied lung volumes and capacities, maximum voluntary ventilation (MVV), and maximum mid-expiratory flow (MEF[25-75]) at least 1 year after ICR in 123 patients, 91 males and 32 females, which included 54 who underwent primary ICR. All were evaluated by stress testing and 61 were studied serially from two to eight times at 12 to 18 months intervals. In contrast to the previous studies, we found a lower incidence and lesser degrees of restrictive lung volume patterns. Lung volumes may be entirely normal particularly after primary ICR but also when ICR is preceded by shunt palliation. After reoperation for ICR normal lung volumes are uncommon. These is a high correlation between abnormal lung volumes and poor surgical results of ICR as manifested by residual cardiac disease, notably pulmonic valve insufficiency and increased heart size. In primary repair we found no correlation between the presence of abnormal lung volumes and the age at ICR (range 1.87 to 15.4 years). Abnormal lung volumes correlate with reduced exercise performance, but the latter is limited by cardiovascular rather than pulmonary factors. Serial studies show stable lung volume patterns with time, and we found no evidence that the increased level of physical activity usually present after ICR results in increases of lung volumes in excess of those predicted from somatic growth. We conclude that an excellent surgical repair of tetralogy is the best guarantee against a significant restrictive lung volume pattern after repair.

From early to late adolescence: alcohol use and anger relationships.

PURPOSE: To evaluate the longitudinal relationship of alcohol use in early adolescence to anger in late adolescence. METHODS: Data were collected in Indianapolis, Indiana, from 1987 to 1993 as part of a large drug abuse prevention trial. Fifty percent of the 1201 students were female, 75%, white, and 69%, low socioeconomic status, who were surveyed in grades 6/7, 9/10, and 11/12. Subjects were asked four anger-related questions: "When I have a problem, I get mad at people," "When I have a problem, I do bad things or cause trouble," "When I have a problem, I say or do nasty things," and "I am a hotheaded person." Two additional items asked subjects to report the number of alcoholic drinks consumed and frequency of drunkenness in the past 30 days. Odds ratios (OR) were used to assess the predictive relationship of alcohol use in early adolescence to anger in late adolescence. RESULTS: Early use of alcohol increased the odds of later anger. Specifically, alcohol use in the past month in grade 6/7 increased the odds in grade 11/12 of saying or doing nasty things (OR = 8.23, p < .01), self-reported hotheadedness (OR = 9.72, p < .01), and high anger on a composite anger scale (OR = 4.84, p < .05). Drunkenness in the past month in grade 6/7 increased the odds of self-reported hotheadedness (OR = 6.17, p <.05) and high anger on the anger scale (OR = 3.20, p < .05) in grade 9/10 and doing something bad to cause trouble in grade 11/12 (OR = 24.97, p < .01). For subjects in grade 9/10, alcohol use in the past month increased the odds in grade 11/12 of doing something bad to cause trouble (OR = 2.79, p < .05), saying or doing nasty things (OR = 2.02, p < .05), and self-reported hotheadedness (OR = 2.51, p < .05). CONCLUSIONS: The present study showed that alcohol use in early adolescence was associated with increased anger, both in middle and late adolescence, controlling for gender, age, and socioeconomic status. The findings suggest that alcohol and drug prevention programs delivered in early adolescence may have the capacity to prevent risk for later anger and related violent behavior.

Factors in marijuana cessation among high-risk youth.

The rise in marijuana use among high school students has generated considerable concern. The apparent failure of current marijuana control efforts may be due in part to ignorance about why students use marijuana and what influences them to consider quitting. This article utilized both open-ended and multiple-choice surveys as well as health educator-led focus groups to assess issues related to marijuana use and cessation among a population of high-risk youth. A total of 842 students participated, assessed as two separate samples from eleven continuation high schools in southern California. Approximately 70 percent of the students are current marijuana users. Interpreting results across both samples, it is apparent that interest in quitting marijuana use among continuation high school students is high. Over half of the marijuana users surveyed have tried to quit and failed. Still, several social images associated with marijuana smokers are positive and subjects express a lack of confidence in the efficacy of marijuana cessation clinic programs. Subjects believe that either self-help or punitive methods are the most effective types of marijuana cessation activities. A reportedly high rate of failed quit attempts suggests that effective marijuana cessation programs are needed in this population. Future programs must address both reasons users resist change, including use of marijuana as a stress reliever, and the particular motivations that subjects report regarding why they desire to quit using marijuana, including legal, vocational, and health consequences.