Radiation Therapy in Treating Young Patients With Gliomas
Condition: Brain Tumor; Central Nervous System Tumor
MeSH terms: Glioma; Nervous System Neoplasms; Central Nervous System Neoplasms
Intervention: radiation therapy
Intervention description: Undergo 3D-CRT Undergo proton radiation therapy Undergo IMRT
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 92.0
Sex: All
Minimum age: 3 Years
Maximum age: 20 Years
Healthy volunteers: No
Keywords: childhood oligodendroglioma; recurrent childhood cerebellar astrocytoma; recurrent childhood cerebral astrocytoma; childhood low-grade cerebral astrocytoma; recurrent childhood visual pathway and hypothalamic glioma; untreated childhood cerebellar astrocytoma; untreated childhood visual pathway and hypothalamic glioma

Summary:

      RATIONALE: Specialized radiation therapy that delivers radiation directly to the tumor may
      kill more tumor cells and cause less damage to normal tissue.

      PURPOSE: This phase II trial is studying how well radiation therapy works in treating young
      patients with gliomas.
    

Eligibility criteria:

        DISEASE CHARACTERISTICS:

          -  Histologically confirmed* low-grade glioma, including any of the following:

               -  Juvenile pilocytic astrocytoma (JPA) or pleomorphic JPA

               -  Diffuse astrocytoma, including any of the following subtypes:

                    -  Fibrillary astrocytoma

                    -  Gemistocytic astrocytoma

                    -  Subependymal giant cell astrocytoma

                    -  Pleomorphic xanthoastrocytoma

               -  Low-grade oligoastrocytoma

               -  Low-grade oligodendroglioma

               -  Low-grade glioma not otherwise specified NOTE: *Patients with chiasmatic lesions
                  who have contiguous extension of tumor into other regions of the visual pathway
                  by CT scan or MRI are eligible without histopathologic confirmation; repeat
                  biopsy required for patients with recurrent tumors that enhance but whose initial
                  tumor did not

          -  Measurable disease by radiography

          -  Meets any of the following criteria:

               -  Progressive nonresectable disease

                    -  Any location in the brain

               -  Patients with a less than gross total resection are eligible provided they are
                  symptomatic from their tumor OR the risk from neurologic impairment with
                  progression is high enough to warrant immediate treatment

               -  Has undergone biopsy only

          -  Must have received ≥ 1 course of prior chemotherapy (for patients < 10 years of age)

               -  Prior chemotherapy optional (for patients ≥ 10 years of age)

          -  No type-1 neurofibromatosis

          -  No evidence of leptomeningeal dissemination

        PATIENT CHARACTERISTICS:

        Age

          -  3 to 20

        Performance status

          -  ECOG 0-2 OR

          -  Karnofsky 50-100% (for patients > 16 years of age) OR

          -  Lansky 50-100% (for patients ≤ 16 years of age)

        Life expectancy

          -  At least 1 year

        Hematopoietic

          -  Absolute neutrophil count ≥ 1,000/mm^3

          -  Platelet count ≥ 100,000/mm^3 (transfusion independent)

          -  Hemoglobin ≥ 10.0 g/dL (transfusions allowed)

        Hepatic

          -  Not specified

        Renal

          -  Not specified

        Other

          -  Not pregnant

          -  Negative pregnancy test

          -  Fertile patients must use effective contraception

          -  Not in status epilepticus, coma, or requiring assisted ventilation prior to study
             entry

          -  Patients with a seizure disorder are eligible provided they are on anticonvulsants AND
             disease is well controlled

        PRIOR CONCURRENT THERAPY:

        Biologic therapy

          -  Not specified

        Chemotherapy

          -  See Disease Characteristics

          -  Recovered from prior chemotherapy

          -  No concurrent chemotherapy

        Endocrine therapy

          -  Concurrent dexamethasone allowed provided patient has been on a stable dose for ≥ 2
             weeks prior to study entry

          -  Concurrent dexamethasone allowed for symptoms of increased intracranial pressure

        Radiotherapy

          -  No prior radiotherapy

        Surgery

          -  See Disease Characteristics

        Other

          -  No other concurrent anticancer therapy