The management of a 12-year-old boy with hypothalamic
anaplastic astrocytoma is reported herein. The pediatric patient underwent a subtotal removal of his
brain tumor, and subsequently received
multimodal treatment comprising
radiotherapy (30.6 Gy to the whole brain and 50.4 Gy to the local lesion) and immunochemotherapy with
MCNU (80 mg/m2, day 1),
VP 16 (50 mg/day, days 2 to 6), and
interferon-beta (3 x 10(6) units/day, initiating on day 2 for 4 weeks). The immunochemotherapy was given as of 4 weeks after
radiotherapy. The administration of anti-
cancer drugs caused severe
nausea and
vomiting, the intra-carotid infusion of
MCNU being particularly emetogenic. The multi-modal treatment was then discontinued for a few weeks. A partial response was obtained, and the patient subsequently received 3 courses of maintenance
therapy at six-month intervals using the same protocol as for the initial immunochemotherapy. During maintenance
therapy,
granisetron (40 micrograms/kg) was given intravenously 30 minutes before and one day after the injection of
MCNU. Owing to the
anti-emetic management of this patient, there were no complications throughout the
chemotherapy. The patient has now survived for more than 3 years with a good quality of life, showing a Karnofsky performance score of 90.