Chemotherapy of recurrent medulloblastoma with combined procarbazine, CCNU, and vincristine

Abstract

Patients (17) with recurrent medulloblastoma were treated with a combination of 3 drugs: procarbazine, CCNU [1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea], and vincristine (PCV). Tumor recurrence was documented at varying periods following surgery and radiotherapy. Among 16 evaluable patients, 10 showed a response to PCV on the basis of subjective neurological improvement and a decrease in tumor size by radiological criteria. Five patients were designated as having stable disease on the basis of no change in neurological status and tumor size. One patient showed uninterrupted progression of disease. The median time to progression for all patients was 45 wk. Significant myelotoxicity, exacerbated by prior spinal irradiation, compromised therapy. After an initial response, it was often necessary to reduce the higher doses of CCNU and procarbazine that caused concomitant bone-marrow toxicity; as a consequence of the lowered doses, tumor progression was frequently observed. PCV may be an effective form of palliative therapy for recurrent medulloblastoma.