title: Survival of children with malignant brain tumors receiving valproate: a retrospective study.
abstract: OBJECTIVE
  The treatment of pediatric patients with malignant brain tumors has evolved considerably in the past decades. However, results are still unsatisfactory for some patients. Valproate has been shown to positively affect the survival of adult glioblastoma patients. We have been giving prophylactic antiepileptic drugs to newly diagnosed children with brain tumors. Since then, we noted a trend towards a better survival from our patients. In order to study this, we performed a retrospective evaluation in our institution.
  
  
  METHODS
  Standard survival analysis was used, calculating survival until death by all causes or censoring. Comparisons were made by Cox's proportional hazards model regression.
  
  
  RESULTS
  Between 2000 and 2010, 94 patients were treated (12 with high-grade gliomas, 56 medulloblastomas, and 26 ependymomas); median and mean ages were 7.7 and 7.8 years. Median follow-up was 60 months (35 for treated and 109 for untreated patients). Of these, 47 received valproate 10-15 mg/kg/day every 8-12 h and 47 did not. Patients who received valproate had a median survival of 34 months, whereas the other group had a median survival of 24 months (hazard ratios = 0.99, 0.57-1.75, p = 0.99).
  
  
  CONCLUSIONS
  These results do not prove that valproate prophylactic treatment in pediatric patients with malignant brain tumors had an influence on their survival. However, our cohort showed an effect of higher size than the recent European Organization for Research and Treatment of Cancer trial analysis, even though not significant. Clinical trials with valproate in pediatric malignant brain tumors should be carefully planned, in order to detect a possible effect of this drug in survival.
authors.affiliation: Pediatric Hemato-oncology Service, Hospital Infantil Albert Sabin, R Alberto Montezuma, 350, Vila Uniao, 60410-770 Fortaleza, Ceará, Brazil. heldercfelix@gmail.com
authors.forename: F H C
authors.initials: FH
authors.lastname: Felix
authors.forename: O L
authors.initials: OL
authors.lastname: de Araujo
authors.forename: K M
authors.initials: KM
authors.lastname: da Trindade
authors.forename: N M
authors.initials: NM
authors.lastname: Trompieri
authors.forename: J B
authors.initials: JB
authors.lastname: Fontenele
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid