Treatment of high-grade spinal cord astrocytoma of childhood with “8-in-1” chemotherapy and radiotherapy: a pilot study of CCG-945
215 NTRINSIC tumors of the spinal cord comprise 1 to 2% of primary central nervous system tumors that occur in the pediatric age group. Approximately 85% of these spinal cord tumors are of astrocytic lineage, and 10 to 15% of these will have histological features consistent with a high-grade astrocytoma (HGA) (that is, anaplastic astrocytoma [AA] or glioblastoma multiforme [GBM]).1,13,17 The histological grade of astrocytic tumors of the spinal cord has prognostic implications similar to those found in other central nervous system sites.8 Lowgrade spinal cord astrocytomas, in spite of their infiltrative behavior, are amenable to radical surgical resection. The median survival time of pediatric patients is usually longer than 6 years, and the pattern of relapse is local recurrence.5,14 Conversely, children with high-grade tumors of the spinal cord have a median survival time of less than 7 months.1 These patients develop not only local recurrences but frequently widespread leptomeningeal metastases.6,7,9 No uniform surgical, radiotherapeutic, or chemotherapeutic approach has been validated for such tumors. The Children’s Cancer Group (CCG) 945 High-Grade Astrocytoma Committee devised a pilot study to collect natural history information and explore the benefit of an experimental multimodality treatment in children with newly diagnosed high-grade astrocytomas arising within the spinal cord.4 The protocol included preand postradiotherapy and “8-drugs-in-1-day” (8-in-1) chemotherapy following maximum surgical resection. Craniospinal radiotherapy was recommended; however, it was not always delivered.