Journal of Neuro-Oncology

, Volume 110, Issue 2, pp 287–291

Concurrent cyclophosphamide and craniospinal radiotherapy for pediatric high-risk embryonal brain tumors

  • Cynthia J. Campen
  • Joanna Dearlove
  • Sonia Partap
  • Patricia Murphy
  • Iris C. Gibbs
  • Gary V. Dahl
  • Paul Graham Fisher
Clinical Study

DOI: 10.1007/s11060-012-0969-2

Cite this article as:
Campen, C.J., Dearlove, J., Partap, S. et al. J Neurooncol (2012) 110: 287. doi:10.1007/s11060-012-0969-2

Abstract

Embryonal tumors are an aggressive subtype of high-grade, pediatric central nervous system (CNS) tumors often with dismal survival rates. The 5-year survival for highest-risk embryonal tumors may be as low as 10 %. We report feasibility and efficacy from our experience using intravenous (IV) cyclophosphamide concurrently with craniospinal radiation (CSI) in high-risk embryonal CNS tumors of childhood. Ten consecutive children (aged: 3.5–15.5 years, median: 10.2 years, six male) with high-risk embryonal tumors, including: large cell/anaplastic medulloblastoma (6), atypical teratoid rhabdoid tumor (1), and leptomeningeal primitive neuroectodermal tumor (3), were treated with IV cyclophosphamide 1 g/M2 on days 1 and 2 of CSI. Following a median of 36 Gy CSI plus tumor boosts, adjuvant treatment consisted of 21 doses of oral etoposide (7) and alkylator based chemotherapy from five to eight cycles in all. Of the ten patients thus treated, six remain alive with no evidence of disease and four are deceased. Median survival was 3.3 years, with a 3-year progression-free survival of 50 % (5/10). Median follow-up was: 3.3 years (range: 5 months—12.9 years) in the five patients with progression, median time-to-progression was: 1.3 years (range: 1 month—3 years). Median follow-up in the patients without progression is 8.8 years (range: 3–12.9 years). Complications due to adjuvant chemotherapy were typical and included myelosupression (10), necessitating shortened duration of chemotherapy in three, and hemorrhagic cystitis (1). In high-risk embryonal CNS tumors, cyclophosphamide given concurrently with CSI is well tolerated. Early results suggest that a phase II trial is warranted.

Keywords

Childhood CNS tumorsEmbryonal CNS tumorsConcurrent chemotherapyRadiation

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Cynthia J. Campen
    • 1
  • Joanna Dearlove
    • 2
  • Sonia Partap
    • 1
  • Patricia Murphy
    • 1
  • Iris C. Gibbs
    • 3
  • Gary V. Dahl
    • 4
  • Paul Graham Fisher
    • 1
  1. 1.Division of Child Neurology, Department of NeurologyStanford UniversityPalo AltoUSA
  2. 2.Department of NeurologyUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Department of Radiation OncologyStanford Cancer Center, Stanford UniversityStanfordUSA
  4. 4.Division of Oncology, Department of PediatricsStanford UniversityPalo AltoUSA