Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027947 (neutropenia)
 17,527 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Complications of chemotherapy in pediatric brain tumor patients tend to be acute and short-lived with some special exceptions such as permanent hearing impairment secondary to cisplatin, infertility and an increased risk of second primary neoplasms. Chemotherapy will be better tolerated and probably more effective in brain tumor patients following a major surgical resection, especially when agents such as cisplatin and cyclophosphamide are administered which require intensive intravenous hydration. Neoadjuvant or pre-radiotherapy chemotherapy administration may reduce chemotherapy-related side effects such as leukoencephalopathy secondary to high-dose intravenous methotrexate, neutropenia and thrombocytopenia following intensive chemotherapy, especially when craniospinal radiotherapy is required. The use of bone marrow ablative chemotherapy followed by autologous marrow rescue poses a new spectrum of organ toxicities. New supportive care measures significantly improved tolerance of chemotherapy such as mesna, a drug minimizing hemorrhagic cystitis following ifosfamide, ondonsetron, a highly effective antiemetic, and the hematopoietic growth factors such as G-CSF and GM-CSF which reduce the incidence and severity of symptomatic neutropenia. Chemotherapy may prolong life in patients with recurrent disease and contribute to curative therapy in newly diagnosed patients. The neurooncology community is becoming more familiar with the measures to improve its tolerance and thereby increase its efficacy.
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PMID:Complications of chemotherapy in patients with brain and spinal cord tumors. 182 40

Neuraxis radiation therapy (RT) for primary intracranial tumors is associated with major late effects if administered to very young children. To control residual tumor and to delay RT, we treated eight young children (median age 6.5 months) with primary central nervous system (CNS) tumors using combination chemotherapy: cisplatin, 20 mg/M2/day plus VP-16, 75 mg/M2/day i.v. for 5 days, given q. 3-6 weeks for 8 cycles. The tumors were medulloblastoma (one), malignant ependymoma (two), primitive neuroectodermal tumor PNET (two), malignant glioma (two), astrocytoma (one). Six had measurable disease; three had positive cerebrospinal fluid (CSF) cytopathology. All patients with measurable tumor had initial objective responses (three) complete response [CR], one partial response [PR], two minor response [MR], including cytopathology (three CR of three) and metastatic deposits (two CR of two). One patient relapsed during chemotherapy. Median time to disease progression was 17.5 months; median survival was 34 months. Three patients, none of whom received RT, have prolonged progression-free intervals of 47-67 months to date. Neurodevelopmental progress continued during and after chemotherapy. Chemotherapy toxicity was mild. Median neutrophil nadir was 312/mm3, platelets 72,000. Fever during neutropenia occurred in six of 61 courses. Moderate high-frequency auditory losses were detected in three patients, and mild renal injury (GFR less than 70 ml/min) was detected in two of seven evaluable children. This pilot study demonstrates the apparent efficacy and mild toxicity of 5 day courses of cisplatin plus VP-16, with delayed RT, in young children with CNS neoplasms. A POG treatment protocol that incorporates cisplatin plus VP-16 is evaluating primary chemotherapy with delayed radiotherapy in larger numbers of pediatric brain tumor patients.
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PMID:Efficacy of postoperative chemotherapy using cisplatin plus etoposide in young children with brain tumors. 199 Feb 53