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The first two cycles of cyclophosphamide and vincristine produced complete of partial responses in 39 percent of the 102 patients who could be evaluated.The response rates were highest among patients with medullo- blastomas,malignant gliomas,or ependymomas.Patients with brain-stem gliomas or embryonal tumors(primitive neuroectodermal tumors)had little or no response.The progression-free survival rate was 41 percent at one year for children who were 24 to 36 months old at diagnosis and 39 percent at two years for those under 24 months of age at diagnosis.Multivariate analysis identified embryonal tumors as a significant adverse prognostic feature(relative risk,2.2;95 percent confidence interval,1.4 to 3.4)and complete resection as a favorable feature(relative risk,0.33;95 percent confidence interval,0.20 to 0.54).Complete responses to chemotherapy were associated with a progressive-free survival rate a approaching that achieved with gross total resection.A comparison of cognitive evaluations obtained at base line and after one year of chemotherapy revealed no evidence of deterioration in cognitive function.Chemotherapy appears to be an effective primary postoperative treatment for many malignant brain tumors in young children.Disease control for one or two years in a large minority of patients permitted a delay in the delivery of radiation and,on the basis of preliminary results,a reduction in neurotoxicity.For patients who had undergone total surgical resection or who had a complete response to chemotherapy,the results are sufficiently encouraging to suggest that radiation therapy may not be needed in this subgroup of children after at least one year of chemotherapy. |
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chemotherapy,CNS treatment and complications with
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cytoreductive surgery
neoplasm,primary intracerebral,resection
neoplasm,primary of CNS
neoplasm,primary of CNS-children
neoplasm,primary of CNS-infants
neoplasm,primary of CNS-treatment of
psychological testing
radiation therapy,CNS treatment and complications with
treatment of neurologic disorder
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