Childhood spinal cord
astrocytomas are
rare diseases, and their management is controversial. We report here our successful experience using
irinotecan and
cisplatin in three consecutive infants with progressing intramedullary
astrocytomas. The first patient was a 16-month-old girl who presented with a grade III intramedullary
astrocytoma that rapidly progressed after surgery and
adjuvant chemotherapy. Weekly
irinotecan (50 mg/m(2)) and
cisplatin (30 mg/m(2)) for four consecutive weeks (one cycle) for a total of four cycles (I/C regimen) was used in order to avoid or delay
radiotherapy. Radiological complete remission was achieved 10 months after completion of
therapy, and 3.5 years after diagnosis the patient remains disease free. The second patient was a 19-month-old boy with a C3-T4 grade II intramedullary
astrocytoma who received up-front
vincristine and
carboplatin for two months but remained clinically symptomatic. A followup MRI showed a larger
tumor, and the patient was switched to the I/C regimen. A marked clinical improvement occurred after the first cycle, and MRI showed a very good partial remission at the end of
therapy. At 16 months after diagnosis, the patient remains disease free. The third patient was a 10-month-old girl with a C2-T3 grade II intramedullary
astrocytoma. She presented with severe
pain that became
steroid dependent during the month she was treated with the
vincristine-
carboplatin regimen. When she was switched to the I/C regimen, the clinical symptoms responded within days. MRI at the end of
therapy showed a significant reduction in
tumor size, and one year after diagnosis the patient remains symptom free. Using this I/C regimen for childhood intramedullary
astrocytoma, we obtained remarkable clinicoradiological responses while avoiding the use of
radiotherapy.