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  • 1
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    Sudbury, Mass. : Jones and Bartlett Publishers
    Call number: QZ365WS200:41
    Keywords: Neoplasms ; Child ; Infant ; Adolescent
    Pages: xviii, 614, c-12 p. : ill., port.
    ISBN: 9780763731410
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  • 2
    ISSN: 1433-0350
    Keywords: Key words Brain tumor ; Children ; Treatment ; Neuropsychology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ten children (6 girls and 4 boys) who completed a protocol in which their localized brain tumors were successfully treated without cranial irradiation were referred for neuropsychological assessment. At the time of testing, they were disease free without any neuroaxis dissemination or leptomeningeal disease. Tumor types included pineoblastoma, glioblastoma, ependymoma, PNET and medulloblastoma. They had a mean age of 5 years and 8 months (SD = 1.86; range = 2.1–8.9 years) and were an average of 37.8 months post bone marrow transplant (SD = 16.42; range = 14–58 months). Neuropsychological data from this study reveal that the mean scores for this nonradiated group of children were within the average range for the following domains: academic achievement tests of reading, spelling and mathematics, verbal and visual memory, visual-motor integration, social-emotional and behavioral functioning. Furthermore, this group of children were performing within the low average range of overall Intelligence, as well as both verbal IQ/verbal reasoning and performance IQ/abstract visual reasoning. On tasks of fine motor dexterity, this group was within the low average range when using their dominant hand; however, they performed within the borderline range when using their non-dominant hand. Of note, this group of children demonstrated significant deficits within the borderline to impaired ranges on language tasks of expressive picture naming and receptive picture vocabulary.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Child's nervous system 15 (1999), S. 496-497 
    ISSN: 1433-0350
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1433-0350
    Keywords: Key words Adjuvant therapy ; Astrocytoma ; Chemotherapy ; Glioma ; Pediatric ; Radiotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Astrocytomas are the most common group of childhood brain tumors. Approximately 20% of these lesions are histologically malignant tumors that often prove fatal within 2 years of diagnosis, despite the use of surgery and conventional radiotherapy. During the last 15 years, considerable attention has been focused on evaluating the potential role of chemotherapy as a means of improving survival. Although several agents have been observed to have modest therapeutic activity against these tumors, the optimal strategies for improving disease control have yet to be defined. This article will review the results that have been achieved in previous studies using a variety of single and multi-agent chemotherapeutic regimens, and also the rationale for ongoing trials of the major cooperative groups, and will discuss the challenges that are inherent in designing and interpreting therapeutic studies for these tumors. Ways in which currently available approaches may be incorporated into future therapeutic strategies will also be discussed and a brief review of the extensive array of promising new treatment approaches will be presented.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Child's nervous system 10 (1994), S. 283-284 
    ISSN: 1433-0350
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1573-7373
    Keywords: anaplastic astrocytoma ; glioblastoma multiforme ; malignant gliomas ; children ; chemotherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Supratentorial malignant gliomas are among the most difficult tumors to treat in children. With a combination of surgery and irradiation, the median survival for children with malignant gliomas is only 9 months. Even among survivors, irradiation causes long-lasting neurological impairment, especially in young children. These disappointing results have stimulated interest in adjuvant chemotherapy as a more effective treatment for pediatric gliomas. In 1976, the first pediatric randomized trial of adjuvant chemotherapy incorporated CCNU, vincristine and prednisone. The addition of these agents to standard irradiation and surgery enhanced the 5-year survival rate from 18% to 43%. Other trials with multiple drug regimens, now considered to be suboptimal in dosing, have not further enhanced disease-free survival. Current trials of high-dose chemotherapy combined with autologous bone marrow rescue for children with recurrent malignant gliomas have produced some durable survivors, but long-term benefits for children with newly diagnosed malignant gliomas are yet to be realized.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1573-7373
    Keywords: low-grade astrocytoma ; chemotherapy ; vincristine ; etoposide ; tumors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Twenty patients, aged 6 months to 20 years, with low-grade astrocytoma (LGA) participated in a chemotherapy trial of vincristine (VCR) and etoposide (VP-16). Fourteen children had recurrent progressive disease at entry on study. Prior treatment consisted of surgical resection alone (6), surgical resection and irradiation (4), surgical resection, irradiation and chemotherapy (2), surgery and chemotherapy (1), and irradiation and chemotherapy (1). Six patients were treated at initial diagnosis of LGA because they were less than 5 years old (5) or for a second primary tumor (1). Four recurrent patients and 3 newly diagnosed patients underwent surgical debulking of their tumors immediately prior to study entry. Tumors were located in the optic nerve/chiasm/hypothalamus (8), brain stem/cerebellum (4), cerebral hemispheres (3), midline structures (3), and spinal cord (2). The treatment plan administered in an out-patient setting consisted of weekly VCR 1.5 mg/m2 for 7 to 8 weeks and VP-16100 mg/m2 for 5 days repeated every 6 weeks for a total of 18 months of therapy. Responses were evaluated by computerized tomography or magnetic resonance imaging. Of the 20 patients, l exhibited a partial response maintained for 12+ months, 3 exhibited minor responses maintained for a period of 10+ to 35 months, and 11 maintained stable disease for 10 to 42 months. Of the 11 patients with stable disease, 2 were withdrawn early from the study without further therapy. Five of the 20 patients developed progressive disease; for 4 of these 5, this occurred during the first course of therapy. Subsequently, these 5 died due to tumor. Vincristine and etoposide produced minimal hematological and neurological toxicity and appeared to offer some benefit in patients with LGA. The authors suggest the therapy potentially can produce prolonged disease stabilization, or perhaps help avoid irradiation in the young child with LGA.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1573-7373
    Keywords: high-grade astrocytoma ; chemotherapy ; children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Purpose This study was undertaken to evaluate the radiographie response to two cycles of chemotherapy prior to irradiation in newly diagnosed children with high-grade astrocytomas.Patients and methods. One hundred and thirty children less than 21 years of age with newly-diagnosed highgrade astrocytoma were treated with the ‘eight-drugs-in-one-day’ chemotherapy regimen as part of a phase III multi-institutional Childrens Cancer Group (CCG) trial. Computerized Tomographic (CT) or Magnetic Resonance Image (MRI) scans, obtained after two cycles of chemotherapy had been administered, were compared with post-operative scans to determine treatment response. Scans were evaluated by institutional radiologists, and were reviewed centrally by a single neuroradiologist. Results Of 79 patients with evaluable post-operative residual tumor on CT or MRI scans, 26 (33%) were determined on institutional evaluation to have had an objective response. However, central review of scans documented responses on only 14/79 (18%). A significantly higher response rate on central review was observed for those children 36 months of age or less at study entry than for older children (33% v 11%; p 〈 0.001). However, a higher disease progression rate was also observed for those children 36 months of age or less than for older children (21% v 2.6%; p 〈 0.001). Conclusion In this study, the largest yet reported in newly-diagnosed children with high-grade astrocytomas, the chemotherapy regimen has activity in younger children. The differences in response rates reported by institutional and central review highlight the difficulties inherent in assessing response to brain tumor therapy. However, the study does demonstrate the consistent ability of radiologists to identify disease progression within the institutional and central reviews.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1573-7373
    Keywords: brain tumor ; chemotherapy ; stem cell rescue ; medulloblastoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract High dose chemotherapy (HDCT) with autologous (bone marrow or peripheral blood) stem cell rescue (ASCR) has had success in the treatment of some malignant pediatric brain tumors. We report a series of adults enrolled in one of three HDCT and ASCR protocols for malignant primary brain tumors. Overall toxic mortality was 18%; chemotherapy regimen, tumor type, and prior treatment did not predict transplant-related mortality. Patients over the age of 30 had a higher rate of toxic mortality. Patients with recurrent medulloblastoma had a significant improvement in long-term survival (median: 34 months) as compared with historical reports; two patients with glioblastoma survive beyond four years without progression, but overall, a significant improvement in long-term survival could not be demonstrated for malignant gliomas.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1573-7373
    Keywords: brain stem tumors ; gliomas ; chemotherapy ; autologous bone marrow rescue
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose. Diffuse pontine tumors are highly lethal, and there are few long-term survivors with the standard treatment of external beam irradiation. We investigated the effectiveness of high-dose thiotepa and etoposide-based chemotherapy regimens with autologous bone marrow rescue (ABMR) in children with pontine tumors. Patients and methods. Sixteen children with diffuse pontine tumors were treated. Ten had resistant or recurrent tumors. All ten had previously received irradiation; five had also received chemotherapy and one, beta-interferon. Three high-dose chemotherapy regimens were employed. Six patients received three days of thiotepa (300 mg/m2/day) and etoposide (250–500 mg/m2/day) (TE); two received three days of carmustine (BCNU) (200 mg/m2/day divided every 12 hours) followed by TE (BTE); and two received three days of carboplatin (500 mg/m2/day) followed by TE (CTE). Six other patients had newly-diagnosed tumors and had not received any prior treatment. They all received the BTE regimen and subsequently were treated with hyperfractionated irradiation (7200–7800 cGy) beginning approximately six weeks post-ABMR. Results. There were two toxic deaths (13%), both in previously treated patients, due to multiorgan system failure and Candida septicemia in one case each. Median survival of the patients with resistant or recurrent disease was 4.7 months (range 0.1–18.7) from time of ABMR. Median survival of the newly-diagnosed patients was 11.4 months (range 7.6–17.1) from the time of ABMR. Conclusion. High-dose chemotherapy utilizing these regimens followed by ABMR did not appear to prolong survival compared to conventional therapy in these children with pontine tumors. Alternative strategies need to be developed for this highly lethal disease.
    Type of Medium: Electronic Resource
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