Background. The role of chemotherapy in recurrent ependymoma is poorly defined. This study was performed to help clarify the benefits of chemotherapy in this setting.
Patients and methods. We retrospectively reviewed the charts of patients with advanced ependymoma of the CNS who received chemotherapy in our institution between 1974 and 1993, inclusive. Sixteen consecutive patients were treated with regimens containing either nitrosourea, platinum, or other combinations exclusive of nitrosourea or platinum. No patient received nitrosourea and platinum concurrently. Two methods were used to define response. The first was a direct comparison of radiographic images before and after chemotherapy more than one month apart. A second broader definition of response that employed four other criteria in addition to imaging studies (symptoms, signs, performance status, and neurologic functional status) was also used.
Results. Results were as follows (response rate by imaging studies followed by response rate by scoring in parenthesis): Platinum-based chemotherapy resulted in a 67% (83%) response rate with 33% (0%) remaining stable. Nitrosourea-based regimens resulted in a 25% (60%) response rate with 50% (10%) remaining stable. When combinations other than platinum or nitrosourea were used, 11% (22%) responded and 56% (44%) remained stable. Relative differences in response rates between chemotherapy regimens persisted when the data were analyzed by grade. Median time to progression was 6, 10, and 3 months, respectively.
Conclusion. Platinum-based chemotherapy regimens appear to result in higher response rates with lower rates of progression than nitrosourea-based regimens. Other regimens that do not include cisplatinum or nitrosourea appear to be even less effective.
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- 1.Mork SJ, Loken AC: Ependymoma: a follow-up or 101 cases. Cancer 40: 907–915, 1997Google Scholar
- 2.Russell DJ, Rubinstein LJ: Pathology of Tumors of the Nervous System. 5th edn,Williams&Wilkins, Baltimore, 1989Google Scholar
- 3.Leibel SA, Sheline GE: Radiation therapy for neoplasms of the brain. J Neurosurg 66: 1, 1987Google Scholar
- 4.Kleihues P, Burger PC, Scheithauer BW: Histological Typing of Tumours of the Central Nervous System. 2nd edn, Springer-Verlag, Berlin, 1993, pp 17–18Google Scholar
- 5.Geyer JR, Zelter PM, Boyett JM, Rorke LB, Stanley P, Albright AL, et al.: Survival of infants with primitive neuroectodermal tumors or malignant ependymomas of the CNStreated with eight drugs in 1 day: a report from the Children's Cancer Group. J Clin Oncol 12: 1607–1615, 1994Google Scholar
- 6.Bertolone JS, Baum ES, Krivit W, Hammond GD: A phase II study of cisplatin therapy in recurrent childhood brain tumors: a report from the Children's Cancer Study Group. J Neuro-Oncol 7: 5–11, 1989Google Scholar
- 7.Goldwein JW, Glauser TA, Packer RJ, Finlay JL, Sutton LN, Curran WJ et al.: Recurrent intracranial ependymomas in children. Survival, patterns of failure, and prognostic factors. Cancer 66: 557–563, 1990Google Scholar
- 8.Sexauer CL, Khan A, Burger PC, Krischer JP, van Eys J, Vats T et al.: Cisplatin in recurrent pediatric brain tumors: a POG phase II study. Cancer 56: 1497–1501, 1985Google Scholar
- 9.MacDonald DR, Cascino TL, Schold SC Jr, Cairncross JG: Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 8(7): 1277–1280, 1990Google Scholar
- 10.Ettinger LJ, Ru N, Krailo M, Ruccione KS, Krivit W, Hammond GD: A phase II study of diaziquone in children with recurrent or progressive primary brain tumors: a report from the Children's Cancer Study Group. J Neuro-Oncol 9: 69–76, 1990Google Scholar
- 11.Gaynon PS, Ettinger LJ, Baum ES, Siegel SE, Krailo MD, Hammond GD: Carboplatin in childhood brain tumors: a Children's Cancer Study Group phase II trial. Cancer 66: 2465–2469, 1990Google Scholar
- 12.Levin VA, Edwards MS, Gutin PH, Vestnys P, Fulton D, Seager M et al.: Phase II evaluation of dibromodulcitol in the treatment of recurrent medulloblastoma, ependymoma, and malignant astrocytoma. J Neurosurg 61: 1063–1068, 1984Google Scholar
- 13.Levin VA. Chemotherapy of primary brain tumors. Neurologic Clinics 3: 855–865, 1985Google Scholar
- 14.De Vita VT, Stellman S, Rosenberg SA: Cancer: Principles and Practice of Oncology. 5th edn, Lippincott-Raven, Philadelphia, 1997Google Scholar