Abstract
INTRODUCTION: Pediatric high-grade gliomas (pHGGs) are represented primarily by anaplastic astrocytomas (AA, WHO-grade III) and glioblastomas (GBM, WHO-grade IV). Despite advances in treatments, the outcome is similar between children and adults, with a 5-year OS less than 20%. Consolidated treatment includes surgery, followed by radiotherapy and chemotherapy associated with temozolomide. MATERIALS AND METHODS: We considered 19 HGG patients admitted to our department to receive therapy between May 2012 and December 2014. Patients were enrolled in a temozolomide/vinorelbine chemotherapy protocol consisting of focal radiotherapy and concomitant chemotherapy (6 weeks) with vinorelbine (20 mg/sqm i.v weekly) and temozolomide (75 mg/sqm i.o daily). The adjuvant phase consisted in 12 months of treatment with chemotherapy with vinorelbine 30 mg/sqm i.v. days 1 and 14 and temozolomide 150 mg/sqm i.o. days 1–5 every 28 days. RESULTS: The median age at diagnosis was 10 years. Six patients (31,6%) had GBM and thirteen (68,4%) an AA. According to localization, 15 tumors (78.9%) were sovratentorial e and 4 (21.1%) were infratentorial. Radical surgery was performed in seven patients. Six patients (26,3%) had a disease progression during the adjuvant phase. One patient died after radiotherapy. One patient was lost during follow-up. Median follow-up was 41.1 months. At time of analysis 11 patients were still alive and without evidence of disease. CONCLUSION: The combination of vinorelbine/temozolomide seems to be safe, without significant adverse events for treatment of aggressive gliomas of pediatric age. Adjuvant chemotherapy is crucial for a better outcome. At 50 months of follow-up 6 patients are alive and without evidence of disease. There is no significant difference, either in PFS than in OS, between AA and GBM.