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Outcome of young children with high-grade glioma treated with irradiation-avoiding intensive chemotherapy regimens: Final report of the Head Start II and III trials.

Al's Comment:

 This study shows that it might be OK to avoid radiation therapy for high grade gliomas in young children, or at least delay it until they are older.  Radiation in young children can cause permanent problems like a lower IQ.  These results are still not good enough but are similar to the treatments that do include radiation, so the lucky few who survive are presumably in better condition. A better way needs to be found.

Posted on: 06/29/2016

Pediatr Blood Cancer. 2016 Jun 22. doi: 10.1002/pbc.26118. [Epub ahead of print]
Outcome of young children with high-grade glioma treated with irradiation-avoiding intensive chemotherapy regimens: Final report of the Head Start II and III trials.
Espinoza JC1, Haley K1, Patel N2, Dhall G1, Gardner S3, Allen J3, Torkildson J4, Cornelius A5, Rassekh R6, Bedros A7, Etzl M8, Garvin J9, Pradhan K10, Corbett R11, Sullivan M11, McGowage G12, Stein D13, Jasty R14, Sands SA15, Ji L16, Sposto R1, Finlay JL17.
Author information:
1Children's Hospital Los Angeles, Los Angeles, California.
2Department of pediatrics, University of Wisconsin, Madison, Wisconsin.
3Department of pediatrics, New York University Medical Center, New York, New York.
4Children's Hospital of Oakland, Oakland, California.
5DeVos Children's Hospital, Grand Rapids, Michigan.
6British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
7Department of pediatrics, Loma Linda University Medical Center, Loma Linda, California.
8Phoenix Children's Hospital, Phoenix, Arizona.
9Columbia Children's Hospital, New York, New York.
10Riley Children's Hospital, Indianapolis, Indiana.
11Department of pediatrics, University of Otago, Christchurch, New Zealand.
12Children's Hospital at Westmead, Sidney, Australia.
13Promedica Children's Hospital of Toledo, Ohio.
14Mercy Children's Hospital, Toledo, Ohio.
15Department of pediatrics, Columbia University Medical Center, New York, New York.
16USC Norris Comprehensive Cancer Center, Los Angeles, California.
17Department of pediatrics, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
To report the final analysis of survival outcomes for children with newly diagnosed high-grade glioma (HGG) treated on the "Head Start" (HS) II and III protocols with chemotherapy and intent to avoid irradiation in children <6 years old.
Between 1997 and 2009, 32 eligible children were enrolled in HS II and III with anaplastic astrocytoma (AA, n = 19), glioblastoma multiforme (GBM, n = 11), or other HGG (n = 2). Central pathology review was completed on 78% of patients. Patients with predominantly brainstem tumors were excluded. Patients were to be treated with single induction chemotherapy regimen C, comprising four cycles of vincristine, carboplatin, and temozolomide. Following induction, patients underwent marrow-ablative chemotherapy and autologous hematopoietic cell rescue. Irradiation was used for patients with residual tumor after consolidation or >6 years old or at the time of tumor progression.
The 5-year event-free survival (EFS) and overall survival (OS) for all HGG patients were 25 ± 8% and 36 ± 9%, respectively. The EFS at 5 years for patients with AA and GBM were 24 ± 11% and 30 ± 16%, respectively (P = 0.65). The OS at 5 years for patients with AA and GBM was 34 ± 12% and 35 ± 16%, respectively (P = 0.83). Children <36 months old experienced improved 5-year EFS and OS of 44 ± 17% and 63 ± 17%, compared with children 36-71 months old (31 ± 13% and 38 ± 14%) and children >72 months old (0% and 13 ± 12%).
Irradiation-avoiding treatment strategies should be evaluated further in young children with HGG given similar survival rates to older children receiving standard irradiation-containing therapies.
© 2016 Wiley Periodicals, Inc.


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