Avaliação retrospectiva de pacientes com tumores cerebrais recorrentes tratados com vimblastina ou temozolomida em um hospital infantil terciário

Abstract

Pediatric brain tumors treatment has evolved considerably in the last twenty years. However, prognosis for children with recurrent malignant brain tumors is usually dreadful. Invariably, the median survival is around 3-4 months. Children with recurrent low grade glioma after multiple chemotherapy/radiotherapy treatment represent a therapeutic challenge. Recently, a phase II clinical trial has shown the utility of weekly vinblastine in the treatment of such cases. Temozolomide is worldwide used as an active agent in patients who have recurrent brain tumors. In this study, a retrospective analysis of medical records was done to evaluate the response to the off-label treatment with vinblastine or temozolomide in patients aging 0-18 years olds with recurrent CNS neoplasms who were treated between January 2007 and December 2012 in a hospital located in Fortaleza, Brazil. Twelve patients received weekly vinblastine (6mg/m2). Median age was 6.2 years. Median follow-up was 44 months, overall survival was 34 months and progression-free survival was 7 months. To the end of this study three patients had not progressed with a follow-up of 30, 42 and 56 months. Additionally, three patients were alive at a follow-up of 41, 44 and 55 months, although they had shown disease progression. Fifteen patients were treated with temozolomide (150mg/ m2 for 5 days with 23 days pause between cycles). Median age was 6.7 years. Median follow-up, overall survival and progression-free survival were rated 36, 9 and 7 months, respectively. To the end of this study, 4 patients had not shown progression with a follow-up of 28, 32, 39 and 48 months. Vinblastine has exhibited activity in controlling recurrent brain tumors in children, especially low-grade glioma and brain stem tumors. One patient with anaplastic ependymoma has shown an incredible long survival. Temozolomide has shown activity against recurrent brain tumors in children. Two patients with recurrent malignant tumors demonstrated a prolonged overall survival. Patients response in this study were similar to those reported in other studies. However, more research is needed in order to determine better treatments to patients with such tumors.