DISEASE CHARACTERISTICS:
- Histologically confirmed newly diagnosed CNS tumor of the following types:
- High grade glioma (HGG) of one of the following histologies:
- Anaplastic astrocytoma (grade III)
- Glioblastoma multiforme (grade IV)
- Gliosarcoma
- Primary spinal cord malignant glioma
- Diffuse intrinsic pontine glioma (DIPG)
- Diagnosed by gadolinium-enhanced MRI
- At least 2/3 of tumor situated in the pons AND tumor clearly originated in
the pons
- No diffuse leptomeningeal disease
- No tumors with features not typical of diffuse intrinsic brainstem glioma,
including any of the following:
- Dorsally exophytic brainstem glioma
- Cervico-medullary junction tumor
- Focal low-grade glioma of the midbrain or brainstem
- No diffuse brainstem enlargement due to neurofibromatosis
- No primary brain stem malignant glioma
- No M+ disease (CSF positive for tumor or metastatic disease)
- Must begin study radiotherapy within 6 weeks after surgical resection (for HGG
patients) or diagnosis (for DIPG patients)
PATIENT CHARACTERISTICS:
Age:
- 3 to 21
Performance status:
- Karnofsky 50-100% OR
- Lansky 50-100%
Life expectancy:
- At least 2 months
Hematopoietic:
- Absolute neutrophil count at least 1,000/mm^3
- Platelet count at least 100,000/mm^3*
- Hemoglobin at least 10.0 g/dL* NOTE: *Transfusion independent
Hepatic:
- Bilirubin no greater than 1.5 times upper limit of normal (ULN)
- SGOT or SGPT less than 2.5 times ULN
Renal:
- Creatinine no greater than 1.5 times ULN
Other:
- No other concurrent malignancy
- Concurrent seizure disorder allowed if well controlled on anticonvulsants
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception during and for 2 months after
completion of study treatment
PRIOR CONCURRENT THERAPY:
Biologic:
- No concurrent routine cytokine support
Chemotherapy:
- Not specified
Endocrine therapy:
- No concurrent corticosteroids except for increased intracranial pressure in patients
with CNS tumors
Radiotherapy:
- See Disease Characteristics
Surgery:
- See Disease Characteristics
Other:
- No prior therapy for HGG or DIPG
OBJECTIVES:
- Compare the event-free survival of patients with newly diagnosed anaplastic
astrocytoma, glioblastoma multiforme, gliosarcoma, or diffuse intrinsic pontine glioma
(DIPG) treated with adjuvant temozolomide administered concurrently with postoperative
radiotherapy and then alone as maintenance therapy vs historical control cohorts
treated in prior Pediatric Oncology Group and Children's Cancer Group studies.
- Determine the toxicity of this regimen in these patients.
- Determine the efficacy of this regimen in patients with DIPG.
- Determine the toxicity of this regimen in patients with DIPG.
OUTLINE: This is a multicenter study.
- Adjuvant chemoradiotherapy: Beginning within 6 weeks after surgical resection or
diagnosis*, patients without gross residual disease undergo cranial irradiation 5 days
a week for 6 weeks. Beginning within 6 weeks after surgical resection, patients with
gross residual disease undergo radiotherapy as above followed by boost radiotherapy for
1 week. All patients receive oral temozolomide once daily beginning within 5 days after
initiation of radiotherapy and continuing for a total of 6 weeks in the absence of
disease progression or unacceptable toxicity.
- Adjuvant maintenance therapy: Beginning 4 weeks after completion of adjuvant
chemoradiotherapy, patients receive oral temozolomide on days 1-5. Treatment repeats
every 28 days for a total of 10 courses in the absence of disease progression or
unacceptable toxicity.
NOTE: *For patients with diffuse intrinsic pontine glioma only
Patients are followed every 3-6 months for 4 years and then annually thereafter.
PROJECTED ACCRUAL: A total of 50-60 patients will be accrued for this study within 12-14
months.
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