Objectives

The aim was:

• To determine whether pre- and postoperative 8-in-1 chemotherapy was superior to PCV as post-radiotherapy adjuvant treatment in high grade astrocytoma.

Figure 8.1 Schema for Children's Cancer Group Study CCG-945. © American Society of Clinical Oncology (full reference on p. 156).

Central pathology review revealed a high incidence of discordance. For anaplastic astrocytoma concordance was 63%, for glioblastoma multiforme 67%, but only 21% for other eligible tumor types. The radiotherapy planning volume was reviewed in 77% of patients, in whom 30% had inadequate margins.

Overall, the 5-year PFS was 33%, 26 ± 8% with PCV and 33 ± 7% with 8-in-1. Median survival was 14 months in both arms. Five-year PFS for anaplastic astrocytoma was 28%, 16% for glioblastoma multiforme and 64% for other pathology. Ninety-seven percent of failures were local.

Toxicity

Grade III or IV toxicity, predominantly neurotoxicity, was seen in 14% of those receiving PCV; 45% of these receiving the 8-in-1 chemotherapy had grade III or IV toxicity, predominantly myelosuppression. These were

Study 2

Mandell LR, Kadota R, Freeman C, Douglass EC, Fontanesi J, Cohen ME, Kovnar E, Burger P, Sanford RA, Kepner J, Friedman H, Kun LE. There is no role for hyperfractionated radiotherapy in the management of children with newly diagnosed diffuse intrinsic brainstem tumours: results of a Pediatric Oncology Group phase III trial comparing conventional v. hyperfractionated radiotherapy. Int J Radiat Oncol Biol Phys documented prior to radiotherapy. Following radiotherapy the degree of myelosuppression was comparable in the two arms.

Conclusion

It is concluded that the more intensive 8-in-1 chemotherapy was of no significant benefit.

Comment

A subsequent paper gives further details of the tumour resection rates in the study arm of CCG-945: Wisoff JH, Boyett JM, Berger MS, Brant C, Li H, Yates AJ, McGuire-Cullen P, Turski PA, Sutton LN, Allen JC, Packer RJ, Finlay JL. Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group trial CCG 945. J Neurosurg 1998;89:52-9.

1999;43:959-64. The study was carried out by the Pediatric Oncology Group between 1992 and 1996 (study POG-9239).

Objectives

The aim of the study was:

• To assess the value of hyperfractionated radiotherapy in brain stem glioma.

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