Carboplatin/etoposide/ifosfamide

Abstract

Various toxicities: case report A 6-year-old boy developed anaemia, thrombocytopenia, neutropenia, leucopenia and Varicella Zoster infection during treatment with ifosfamide, carboplatin and etoposide for spinal atypical teratoid/rhabdoid tumour [AT/RT; outcomes not stated]. The boy presented to a clinic with five months history of low back pain, difficulty in walking and weakness in bilateral lower limbs. After various examinations, a intradural ependymoma was suspected. He underwent D10-D12 laminectomy with gross total resection (GTR) of the tumour. Based on examinations of the resected specimen, he was diagnosed with AT/RT of the lower dorsal spine (D10–D12) with leptomeningeal drop metastasis. As improvement was noted after the procedure, and as the leptomeningeal drop metastasis was not causing any compression of adjoining neural structures, another resection surgery was not performed. Systemic chemotherapy was started with ICE regimen consisting of IV ifosfamide injection 2 g/m2 D1-D3, IV carboplatin 500 mg/m2 injection D3 and IV etoposide 100 mg/m2 injection D1-D3 repeated every three weeks along with mesna for uroprotection. After three cycles, improvement was noted in his condition. During the treatment, he developed chemotherapy-related toxicities in the form of grade 1 neutropenia, grade 2 anaemia and thrombocytopenia. After 6 weeks, he received craniospinal irradiation (CSI) and spinal radiotherapy (RT). After that, he received three more cycles of the ICE regimen with good subjective improvement. However, he developed toxicities in the form of grade 3 thrombocytopenia and grade 2 anaemia, neutropenia and leucopenia complicated by Varicella Zoster infection. One week after the completion of chemotherapy, a partial response was achieved with decrease in size of the leptomeningeal drop. He was then referred to a spinal surgeon for resection of the residual drop metastasis; however, a surgery was not performed and instead he was closely followed. Repeat examinations showed a gradual decrease in the size of the metastatic lesion. One year after completion of the treatment, a complete response was achieved. At the time of last follow-up (30 months after from the initial diagnosis), he was in complete radiological response and was asymptomatic.