Temozolomide after radiotherapy for newly diagnosed high-grade glioma and unfavorable low-grade glioma in children

Alberto Broniscer, Murali Chintagumpala, Maryam Fouladi, Matthew J. Krasin, Mehmet Kocak, Daniel C. Bowers, Lisa C. Iacono, Thomas E. Merchant, Clinton F. Stewart, Peter J. Houghton, Larry E. Kun, Davonna Ledet, Amar Gajjar

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Chemotherapy is commonly used in the treatment of children with high-grade glioma, although its usefulness is uncertain. We conducted a multi-institutional study to evaluate the efficacy of temozolomide given after radiotherapy in children with newly diagnosed high-grade glioma and unfavorable low-grade glioma (gliomatosis cerebri or bithalamic involvement). Optional window therapy of intravenous irinotecan (10 doses of 20 mg/m2 per cycle × 2) was given over 6 weeks. The 5-day schedule of temozolomide (200 mg/m2 per day) started 4 weeks after the completion of radiotherapy and continued for a total of 6 cycles. Thirty-one eligible patients (median age: 12.3 years) participated. Tumors most commonly involved cerebral hemispheres (n = 13, 42%) and thalamus (n = 14, 45%). Whereas six patients underwent radical resection, the remainder had limited surgery, including biopsy (n = 14, 45%). The predominant histologic diagnoses were glioblastoma multiforme (n = 15, 48%) and anaplastic astrocytoma (n = 10, 32%). Two patients had bithalamic grade II astrocytoma. Twenty-seven patients received radiotherapy (median dose: 59.4 Gy), including craniospinal irradiation in 3 because of leptomeningeal spread. Four patients did not receive radiotherapy in this study because of consent withdrawn (n = 2), toxicity during window therapy (n = 1), or at the physician's discretion (n = 1). Twenty-three patients received 112 cycles of temozolomide therapy. The 2-year progression-free and overall survival estimates were 11±5% and 21±7%, respectively. Although the heterogeneity of prognostic factors in our patients made assessment of treatment outcome more difficult, the addition of 6 cycles of temozolomide after radiotherapy did not seem to alter the poor outcome of these patients.

Original languageEnglish (US)
Pages (from-to)313-319
Number of pages7
JournalJournal of Neuro-Oncology
Issue number3
StatePublished - 2006


  • Bithalamic
  • Children
  • Glioma
  • Gliomatosis cerebri
  • High-grade
  • Radiotherapy
  • Temozolomide

ASJC Scopus subject areas

  • Clinical Neurology
  • Cancer Research
  • Oncology
  • Neuroscience(all)


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