Treatment of childhood diffuse brain stem tumors: comparison of results in different treatment modalities.
BACKGROUND
Diffuse brainstem tumors in children are rare and its treatment is controversial. Although radiotherapy (RT) used to be the treatment of choice, results remained unsatisfactory. The association of RT with other therapies is common, but lacks scientific data regarding its efficacy. Comparison of results of irradiation alone versus combined treatment modalities is crucial in improving survival.


METHODS
The authors reviewed twenty-four patients with diffuse brainstem tumors, with mean age of 7 years, treated from December 90 to November 99, at the University of Sao Paulo, Brazil. These patients were subdivided in four groups according to the treatment option at the onset of symptoms. Four patients were treated with radiation alone (total dose of 50 Gy to 62.4 Gy), 6 patients with chemotherapy and radiation, 8 with tamoxifen and radiation and 6 with tamoxifen, radiation and chemotherapy. The results of the different groups were them compared.


RESULTS
Clinical response was observed in 83.3% of our children, briefly followed by progressive disease. Mean survival was 17 months with no statistically significant differences among the groups. Four patients were alive at the end of the study, with a mean survival of 32.4 months, all of them received combined therapy, but with no statistically significant differences.


CONCLUSIONS
Neither the association of radiation therapy with chemotherapy, tamoxifen nor both have showed survival improvement. The prognosis of these patients remains very poor and only investigational trials would justify a highly aggressive approach.
de Aquino Gorayeb
Melissa M
MM
Department of Radiotherapy, Hospital das Clínicas, University of São Paulo, São Paulo, SP- Brazil. melisaquino@yahoo.com
Aisen
Salim
S
Nadalin
Wladimir
W
Panico Gorayeb
Rodrigo
R
de Andrade Carvalho
Heloisa
H
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001254:Astrocytoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D020295:Brain Stem Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D001938:Brazil / Q000453:epidemiology; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D015993:Life Tables; D008297:Male; D011379:Prognosis; D011882:Radiotherapy, High-Energy; D012074:Remission Induction; D016879:Salvage Therapy; D016019:Survival Analysis; D013629:Tamoxifen / Q000627:therapeutic use; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen; D014750:Vincristine; D016190:Carboplatin