title: Influence of valproic acid on outcome of high-grade gliomas in children.
abstract: BACKGROUND
  Chemotherapy has limited effects in the treatment of high-grade gliomas (HGGs). Valproic acid (VPA), a histone deacetylase (HDAC) inhibitor, may sensitize HGGs to radiochemotherapy. As the drug has been given frequently as an antiepileptic drug, a retrospective analysis was conducted to ensure relevant information was not missed before a prospective study was launched.
  
  
  METHODS
  An analysis of 66 pediatric patients (range, 1-19 years of age) with glioblastoma multiforme (GBM) (n=40) or anaplastic astrocytoma (AA) (n=26) was retrospectively conducted for predictors of survival and response and for effects of VPA on outcome or toxicity.
  
  
  RESULTS
  The overall survival (OS) was better for AA (p=0.0114) and complete resection (p<0.00005) and event-free survival (EFS) was better for complete resection (p=0.0049). Nine patients received VPA (for seizure) plus further oncological treatment. The most severe adverse effect was a pulmonary embolism (n=1); no other severe side-effects were noted. The response to nonsurgical treatment after 8 weeks was: complete response (CR): 0, partial response (PR): 3, stable disease (SD): 4, progressive disease (PD): 2. Some of the patients with SD responded later resulting in best response: CR:0, PR:5, SD:2, PD:2.
  
  
  CONCLUSIONS
  Treatment with VPA plus radiochemotherapy is well tolerated with an encouraging response rate.
authors.affiliation: Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
authors.forename: Amirhadi
authors.initials: A
authors.lastname: Masoudi
authors.forename: Marily
authors.initials: M
authors.lastname: Elopre
authors.forename: Elham
authors.initials: E
authors.lastname: Amini
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Nagel
authors.forename: Joann L
authors.initials: JL
authors.lastname: Ater
authors.forename: Vidya
authors.initials: V
authors.lastname: Gopalakrishnan
authors.forename: Johannes E A
authors.initials: JE
authors.lastname: Wolff