Low-Dose Cisplatin-Etoposide Regimen for Patients with Optic Pathway Glioma: A Report of Four Cases and Literature Review

Abstract

Optic pathway gliomas (OPGs) account for 5% of all childhood brain tumors. For years it has been discussed which was the best method of examining tumor progression when the magnetic resonance imaging (MRI) scan does not change. The role of chemotherapy in their treatment still remains controversial. We treated four consecutive patients affected by progressive OPG with lower cumulative doses of cisplatin/etoposide. The extension of disease was assessed by brain MRI scan. A complete ophthalmologic examination was performed. Ototoxicity was monitored. Our OPG patients had reduced visual acuity (VA) and/or visual field (VF) regardless of the MRI evaluation. All patients showed rapid visual recovery with improvement both in VA and in VF. At the time of writing, after a median follow-up of 34 months, all patients were alive and free from disease progression. Our results confirm the effectiveness and the low-toxicity profile of the cisplatin/etoposide regimen for treatment of children affected by OPG. We suggest that VA and VF can be considered as the most accurate parameters for defining the start of chemotherapy and tumor response.

Keywords

low-grade glioma - optic pathways - brain tumors - chemotherapy - visual acuity - visual field

• References

• 1 Davis FA. Primary tumors of the optic nerve (a phenomenon of Recklinghausen's disease). Arch Ophthal 1940; 23: 735-821
• 2 Halperin EC, Constine LS, Tarbell NJ. Pediatric radiation oncology. Philadelphia, PA: Lippincott, Williams & Wilkins; 1999: 47-50
• 3 Bianchi-Marzoli S, Brancato R. Tumors of the optic nerve and chiasm. Curr Opin Ophthalmol 1994; 5 (6) 11-17
• 4 Dutton JJ. Gliomas of the anterior visual pathway. Surv Ophthalmol 1994; 38 (5) 427-452
• 5 Shields JA, Bakewell B, Augsburger JJ, Flanagan JC. Classification and incidence of space-occupying lesions of the orbit. A survey of 645 biopsies. Arch Ophthalmol 1984; 102 (11) 1606-1611
• 6 Moreno L, Bautista F, Ashley S, Duncan C, Zacharoulis S. Does chemotherapy affect the visual outcome in children with optic pathway glioma? A systematic review of the evidence. Eur J Cancer 2010; 46 (12) 2253-2259
• 7 Listernick R, Darling C, Greenwald M, Strauss L, Charrow J. Optic pathway tumors in children: the effect of neurofibromatosis type 1 on clinical manifestations and natural history. J Pediatr 1995; 127 (5) 718-722
• 8 Astrup J. Natural history and clinical management of optic pathway glioma. Br J Neurosurg 2003; 17 (4) 327-335
• 9 Medlock MD, Scott RM. Optic chiasm astrocytomas of childhood. 2. Surgical management. Pediatr Neurosurg 1997; 27 (3) 129-136
• 10 Jenkin D, Angyalfi S, Becker L , et al. Optic glioma in children: surveillance, resection, or irradiation?. Int J Radiat Oncol Biol Phys 1993; 25 (2) 215-225
• 11 Massimino M, Spreafico F, Riva D , et al. A lower-dose, lower-toxicity cisplatin-etoposide regimen for childhood progressive low-grade glioma. J Neurooncol 2010; 100 (1) 65-71
• 12 Packer RJ, Lange B, Ater J , et al. Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood. J Clin Oncol 1993; 11 (5) 850-856
• 13 Gajjar A, Sanford RA, Heideman R , et al; Jude Children's Research Hospital. Low-grade astrocytoma: a decade of experience at St. J Clin Oncol 1997; 15 (8) 2792-2799
• 14 Petronio J, Edwards MS, Prados M , et al. Management of chiasmal and hypothalamic gliomas of infancy and childhood with chemotherapy. J Neurosurg 1991; 74 (5) 701-708
• 15 Laithier V, Grill J, Le Deley MC , et al; French Society of Pediatric Oncology. Progression-free survival in children with optic pathway tumors: dependence on age and the quality of the response to chemotherapy—results of the first French prospective study for the French Society of Pediatric Oncology. J Clin Oncol 2003; 21 (24) 4572-4578
• 16 Lafay-Cousin L, Holm S, Qaddoumi I , et al. Weekly vinblastine in pediatric low-grade glioma patients with carboplatin allergic reaction. Cancer 2005; 103 (12) 2636-2642
• 17 McLaughlin ME, Robson CD, Kieran MW, Jacks T, Pomeroy SL, Cameron S. Marked regression of metastatic pilocytic astrocytoma during treatment with imatinib mesylate (STI-571, Gleevec): a case report and laboratory investigation. J Pediatr Hematol Oncol 2003; 25 (8) 644-648
• 18 Gnekow AK, Kortmann RD, Pietsch T, Emser A. Low grade chiasmatic-hypothalamic glioma-carboplatin and vincristine chemotherapy effectively defers radiotherapy within a comprehensive treatment strategy — report from the multicenter treatment study for children and adolescents with a low grade glioma — HIT-LGG 1996 — of the Society of Pediatric Oncology and Hematology (GPOH). Klin Padiatr 2004; 216 (6) 331-342
• 19 Yalon M, Rood B, MacDonald TJ , et al. A feasibility and efficacy study of rapamycin and erlotinib for recurrent pediatric low-grade glioma (LGG). Pediatr Blood Cancer 2013; 60 (1) 71-76
• 20 Silva MM, Goldman S, Keating G, Marymont MA, Kalapurakal J, Tomita T. Optic pathway hypothalamic gliomas in children under three years of age: the role of chemotherapy. Pediatr Neurosurg 2000; 33 (3) 151-158
• 21 Chamberlain MC. Recurrent chiasmatic-hypothalamic glioma treated with oral etoposide. Arch Neurol 1995; 52 (5) 509-513
• 22 Listernick R, Ferner RE, Liu GT, Gutmann DH. Optic pathway gliomas in neurofibromatosis-1: controversies and recommendations. Ann Neurol 2007; 61 (3) 189-198
• 23 Campagna M, Opocher E, Viscardi E , et al. Optic pathway glioma: long-term visual outcome in children without neurofibromatosis type-1. Pediatr Blood Cancer 2010; 55 (6) 1083-1088
• 24 Schmandt SM, Packer RJ, Vezina LG, Jane J. Spontaneous regression of low-grade astrocytomas in childhood. Pediatr Neurosurg 2000; 32 (3) 132-136
• 25 Parsa CF, Hoyt CS, Lesser RL , et al. Spontaneous regression of optic gliomas: thirteen cases documented by serial neuroimaging. Arch Ophthalmol 2001; 119 (4) 516-529
• 26 Ater JL, Zhou T, Holmes E , et al. Randomized study of two chemotherapy regimens for treatment of low-grade glioma in young children: a report from the Children's Oncology Group. J Clin Oncol 2012; 30 (21) 2641-2647
• 27 Gnekow AK, Falkenstein F, von Hornstein S , et al. Long-term follow-up of the multicenter, multidisciplinary treatment study HIT-LGG-1996 for low-grade glioma in children and adolescents of the German Speaking Society of Pediatric Oncology and Hematology. Neuro-oncol 2012; 14 (10) 1265-1284
• 28 Bouffet E, Jakacki R, Goldman S , et al. Phase II study of weekly vinblastine in recurrent or refractory pediatric low-grade glioma. J Clin Oncol 2012; 30 (12) 1358-1363
• 29 Jakacki RI, Bouffet E, Adamson PC , et al. A phase 1 study of vinblastine in combination with carboplatin for children with low-grade gliomas: a Children's Oncology Group phase 1 consortium study. Neuro-oncol 2011; 13 (8) 910-915
• 30 Gururangan S, Fisher MJ, Allen JC , et al. Temozolomide in children with progressive low-grade glioma. Neuro-oncol 2007; 9 (2) 161-168
• 31 Gururangan S, Cavazos CM, Ashley D , et al. Phase II study of carboplatin in children with progressive low-grade gliomas. J Clin Oncol 2002; 20 (13) 2951-2958
• 32 Massimino M, Spreafico F, Cefalo G , et al. High response rate to cisplatin/etoposide regimen in childhood low-grade glioma. J Clin Oncol 2002; 20 (20) 4209-4216
• 33 Prados MD, Edwards MS, Rabbitt J, Lamborn K, Davis RL, Levin VA. Treatment of pediatric low-grade gliomas with a nitrosourea-based multiagent chemotherapy regimen. J Neurooncol 1997; 32 (3) 235-241
• 34 Janss AJ, Grundy R, Cnaan A , et al. Optic pathway and hypothalamic/chiasmatic gliomas in children younger than age 5 years with a 6-year follow-up. Cancer 1995; 75 (4) 1051-1059
• 35 Gayre GS, Scott IU, Feuer W, Saunders TG, Siatkowski RM. Long-term visual outcome in patients with anterior visual pathway gliomas. J Neuroophthalmol 2001; 21 (1) 1-7
• 36 Tow SL, Chandela S, Miller NR, Avellino AM. Long-term outcome in children with gliomas of the anterior visual pathway. Pediatr Neurol 2003; 28 (4) 262-270