High-grade glioma in children under 5 years of age: A chemotherapy only approach with the BBSFOP protocol

Department of Pediatric and Adolescent, Institut Gustave Roussy, 39, rue Camille Desmoulins, 94805 Villejuif cedex, France. <>
European Journal of Cancer (Impact Factor: 5.42). 12/2006; 42(17):2939-45. DOI: 10.1016/j.ejca.2006.06.021
Source: PubMed


The aim of this study was to evaluate a chemotherapy strategy that avoids radiotherapy in first-line treatment of young children with high-grade glioma. A total of 21 children under 5 years of age received the BBSFOP protocol, comprising seven cycles of three drug pairs (carboplatin/procarbazine, cisplatin/etoposide and vincristine/cyclophosphamide) administered over a 16 month period. Radiotherapy was performed in case of recurrence/progression. Median age at diagnosis was 23 months. Histology was classified as World Health Organisation (WHO) grade III in 13 and grade IV in 8. Of the 13 children with a residual tumour, chemotherapy induced 2 partial responses (PR), 1 minor response (MR) and 1 stable disease (SD) with no recurrent disease. Five-year progression-free survival was 35% and 5-year overall survival was 59%, with a median follow-up of 5.2 years. At the last update, 12 children were alive (10 without radiotherapy). In conclusion, this study shows that an adjuvant chemotherapy first approach is safe and allows radiotherapy to be avoided in selected children.

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    • "Radiation therapy has become the mainstay of therapy, particularly for those children older than 3 y/o with newly diagnosed HGG. Since younger children are more susceptible to the negative deleterious effects associated with radiation therapy and they seem to harbor more indolent tumors, they are often treated with chemotherapy alone and radiationsparing approaches (Geyer et al., 1995; Duffner et al., 1996; Dufour et al., 2006; Sanders et al., 2007). For older children, focal radiotherapy with a margin around the tumor bed has become the standard. "
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