Treatment of paediatric pontine glioma with oral trophosphamide and etoposide.

ABSTRACT

To evaluate the overall survival of paediatric patients with pontine gliomas treated with oral trophosphamide and etoposide. Patients between 3 and 17 years of age with either typical diffuse pontine glioma on MRI or histologically proven anaplastic astrocytoma/glioblastoma multiforme located in the pons, were eligible. Treatment consisted of oral trophosphamide 100 mg x m(-2) x day(-1) combined with oral etoposide at 25 mg x m(-2) x day(-1) starting simultaneously with conventional radiation. Twenty patients were enrolled (median age 6 years, male female=9 11). Surgical procedures included no surgery five, open biopsy three, stereotactic biopsy six, partial resection three, and sub-total resection three. Histological diagnoses included pilocytic astrocytoma one, astrocytoma with no other specification three, anaplastic astrocytoma three, glioblastoma multiforme eight, no histology five. The most frequent side effects were haematologic and gastrointestinal. There was no toxic death. The response to combined treatment in 12 evaluable patients was complete response 0, partial response three, stable disease four, and progressive disease five. All tumours progressed locally and all patients died. The overall median survival was 8 months. The overall survival rates at 1 and 4 years were 0.4 and 0.05 respectively. This was not different from a control group of patients documented in the same population. Oral trophosphamide in combination with etoposide did not improve survival of pontine glioma patients. The treatment was well tolerated and should be evaluated for more chemoresponsive paediatric malignancies.