Abstract
BACKGROUND
Novel treatment options for pediatric patients with high grade glioma are urgently needed to improve the otherwise dismal prognosis. For adult patients suffering from glioblastoma multiforme (GBM) a new treatment modality using alternating electrical fields called tumor treating fields (TTFields), showed efficacy in a randomized clinical trial (Stupp R et. al 2015). These alternating electrical fields are applied via transducer arrays on the shaved scalp to disturb mitosis in dividing cells. Data on the use of TTFields in children so far are limited to singular case publications. We here present our experience with the first three pediatric glioma patients treated with TTFields in Germany.
CASE PRESENTATION
Three patients age 7, 9 and 11 years were treated for anaplastic astrocytoma WHO III (pt.1) and GBM (pt. 2 + 3). Tumors in pt. 1 and pt. 2 could only be partially resected prior to therapy with irradiation and concomitant temozolamide. Pt. 3 underwent complete resection and irradiation, but had to stop temozolamide treatment due to severe thrombocytopenia. This patient underwent a second surgery due to early relapse. All patients started treatment in March 2017 after informed consent and assent on a compassionate use basis. Assent by the children was an important issue and required extra time and additional explanations. Treatment was initiated within 44 days (mean) after the end of irradiation. Pt. 1 and 2 received temozolamide concomitantly, whereas pt. 3 received additional vaccination with tumor-lysate-pulsed dendritic cells. TTFields were implemented well into everyday life, as reported in structured interviews and quality of life assessment. There were no severe side effects observed so far. Average daily usage was high, namely 71%, 86% and 92% respectively.
CONCLUSION
TTFields may be a treatment option for high grade glioma even in young children. The data encourage evaluation of TTFields in children within clinical trials.