Journal of Clinical Oncology, Vol 15, 2939-2944, Copyright © 1997 by American Society of Clinical Oncology
Effective chemotherapy for advanced CNS embryonal tumors in adults
E Galanis, JC Buckner, PJ Schomberg, JE Hammack, C Raffel and BW Scheithauer
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
PURPOSE: Embryonal tumors of the CNS include, among others,
medulloblastoma, cerebral neuroblastoma, pineoblastoma, and primitive
neuroectodermal tumors (PNETs). Almost all data on the treatment of
embryonal CNS tumors are derived from the pediatric population, since these
tumors are uncommon in adulthood. The purpose of this study was to examine
the rate and duration of response to chemotherapy of advanced embryonal CNS
tumors in adults. PATIENTS AND METHODS: We retrospectively studied all
adult (> 18 years of age) patients with advanced embryonal tumors of the
CNS who received chemotherapy at our institution between 1976 and 1994.
Seventeen consecutive patients were treated with regimens that contained
either nitrosourea or cisplatin or both sequentially, with no patients
having received the combination of nitrosourea and cisplatin concurrently.
RESULTS: In patients who received cisplatin-based chemotherapy, responses
were observed in 84.5% (26% complete response [CR] rate), 10.5% remained
stable, and 5% progressed. The median time to progression was 18 months for
patients who had a CR, 6 months for those with partial response (PR), and
10 months for stable patients. Among patients who received nitrosourea-
based chemotherapy, PR was observed in 27%, 36.5% remained stable, and
36.5% progress. The median time to progression was 6 months for patients
who had a PR and 6.5 months for stable patients. CONCLUSION: In adults with
advanced embryonal CNS tumors, conventional-dose intravenous
cisplatin-based chemotherapy regimens are able to produce responses in the
majority of the patients (84.5%), even as second- or third-line regimens.
Nitrosourea-based regimens less frequently produce responses (27%).
