Over the past 25 years, we have treated 17 patients with chiasmo-hypothalamic
astrocytomas. Before 1988, the initial treatments consisted of surgery and/or
radiotherapy, while since 1989, 4 children (1 male, 3 females, aged 3-8 years) were treated primarily with
chemotherapy. None of them was associated with
neurofibromatosis. After a biopsy of the
tumor, the
intravenous administration of
ranimustine (
MCNU; 30-86 mg/m2) and/or
nimustine (
ACNU; 30.3-64.1 mg/m2) was given without
radiation therapy.
Chemotherapy was usually given as an out-patient, with a total of 5-13 courses. The total doses of
MCNU and
ACNU administered ranged from 150 to 570 mg and from 64.8 mg to 100 mg, respectively. After
chemotherapy 2 patients showed clinical improvement and
tumor regression on neuro-imaging, while one patient showed clinical improvement and
tumor size stabilization on neuro-imaging. The remaining one child, however, showed a clinical worsening and
tumor progression on neuro-imaging studies. He was thus treated with a second
chemotherapy regimen with
carboplatin and
etoposide, which brought about
tumor regression. The acute and subacute toxicity of
chemotherapy was mild. All patients are now leading almost normal lives with a median of 43 months after diagnosis. Although a longer and more careful clinical observation is required, the authors conclude that
chemotherapy with
MCNU and/or
ACNU may benefit patients with unresectable
pilocytic astrocytoma requiring treatment. The advantages of this
therapy include its mild side effects and the lack of any hospitalization in most patients. It may also delay the need for
radiation therapy, which can have a deleterious effect on the young developing brain.