Recurrent Supratentorial Malignant Gliomas in Children

BACKGROUND: A long-term regimen of oral etoposide, a type of chemotherapy, is used in oncology and is effective in treating germ-cell tumors, lymphomas, Kaposi sarcoma, and primary brain tumors. OBJECTIVE: To examine the toxic effects and efficacy of long-term salvage chemotherapy using oral etoposide. PATIENTS AND METHODS: Fourteen children (8 boys and 6 girls) with recurrent supratentorial gliomas, ranging in age from 4 to 18 years (median age, 9 years), were treated with etoposide. Tumor histologic grades included Daumas-Duport grade 3 (10 children) and grade 4 astrocytomas (4 children). All children had been treated previously with radiotherapy (median dose, 60 Gy) and nitrosourea-based chemotherapy. Each cycle of therapy consisted of 21 days of etoposide (50 mg/m2 daily) followed by a 14-day period of rest and an additional 21 days of etoposide (50 mg/m2 daily). Measurements of complete blood cell counts were taken biweekly. A neurological examination and a magnetic resonance image of the brain with contrast medium were performed before each cycle of therapy. RESULTS: Treatment-related complications included the following partial alopecia (8 children); diarrhea (6 children); weight loss (4 children); anemia (4 children); neutropenia (4 children) and thrombocytopenia (4 children). Four children required transfusion (4 with packed red blood cells and 3 with platelets) and 2 children received antibiotic therapy for neutropenic fever. There were no treatment-related deaths. All children were examined for response. In 7 children (50%), the results of magnetic resonance imaging indicated either a partial response (3 children) or stable disease (4 children), with a median duration of response of 8 months. CONCLUSION: Oral etoposide is a well tolerated and relatively nontoxic chemotherapeutic agent with demonstrated activity in children with recurrent supratentorial gliomas.