Combination chemotherapy for primitive neuroectodermal and other malignant brain tumours

The toxicity and efficacy of a chemotherapy schedule comprising vincristine and cyclophosphamide, alternating with carboplatin and etoposide, has been assessed in a group of 15 patients with medulloblastoma, supratentorial primitive neuroectodermal tumours (PNET) or other malignant brain tumours. The patients comprised four adults and 11 children. Chemotherapy was given for palliation of recurrent disease (six patients), as an adjuvant to radiotherapy and surgery in five poor prognosis patients, or to delay the need for radiotherapy in four children aged 2 years or less. The treatment was generally well tolerated, with the principal toxicity being myelo-suppression. Among the ten assessable patients, there were six complete responders and one partial, an overall response rate of 70%. Three patients had progressive disease. Responses, although associated with good symptomatic improvement, were short lived, with two patients relapsing while still receiving chemotherapy. Three of four very young children relapsed within 7 months of completing chemotherapy and then received radiotherapy. It is concluded that this schedule merits further evaluation and comparison with more protracted and toxic schedules.