Childhood brainstem gliomas (BSGs) are rare but can be very difficult to treat successfully and they tend to have poor survival rates.
However, a team of Spanish researchers have found that a chemotherapy regimen of irinotecan and cisplatin (I/C) produced rapid clinical responses and shrank the tumours by more than 20 percent in all six children enrolled in a clinical trial.
Dr Jaume Mora told the European Cancer Conference (ECCO 14) in Barcelona today (Tuesday) that this was the first time that such a response had been achieved in children with high grade gliomas, while in low grade gliomas the response was comparable with the best achieved by other chemotherapies. All six children were still alive at one year, although the disease had progressed in three children with the most life-threatening tumours. The usual average survival rate for BSGs is between 4-15 months.
Dr Mora, who is head of the department of paediatric oncology at Hospital Sant Joan de Deu, Barcelona, Spain, explained: “The main treatment for BSGs is radiotherapy. Surgery is not really an option because of the way the tumour is situated in life-threatening anatomical structures situated in the brain stem. However, for children the long-term adverse consequences of radiotherapy have meant that doctors have looked to clinical trials to see if chemotherapy could be substituted for radiotherapy. However, most of these trials have failed; at present, many centres use radiation therapy for high-grade gliomas and diffuse intrinsic pontine tumours, the deadliest of all BSGs. For low-grade gliomas in children few combination regimens have shown significant changes in the long-term natural history of this disease: vincristine and carboplatin is the current protocol and was pioneered by the Duke's University group in the USA. The Italians have tested cisplatin and VP-16 with very good results for low-grade gliomas.”
BSGs are rare, but are amongst the commonest cancers to occur in children aged between about six and ten years old. The cause is unknown and the survival rates are poor: high-grade BSGs (diffuse and non-diffuse intrinsic tumours) are uniformly fatal, while children with low-grade gliomas have a more prolonged survival.