title: Successful Use of Dose Dense Neoadjuvant Chemotherapy and Sodium Valproate with Minimal Toxicity in an Infant with Medulloblastoma in Extremely Poor General Condition.
abstract: BACKGROUND
  Medulloblastoma is the most common malignant brain tumor in children. Infants are in the high-risk category. Complete surgical resection is the single most important determinant of prognosis and survival in nonmetastatic disease. Infants with large primaries after incomplete resection/biopsy and poor general condition have bad prognosis. They are considered poor candidates for intensive chemotherapy involving high dose methotrexate/autologous stem cell transplantation as they are often unable to tolerate these aggressive regimens.
  
  
  METHODS
  The patient, withinfantile medulloblastoma, was supposed to have complete resection but only a biopsy could be attempted because of increased tumor vascularity. He was in very poor general condition after surgery and his parents declined aggressive chemotherapy and shunt surgery. He was given dose dense neo-adjuvant chemotherapy along with the histone deactylase inhibitor valproate for 5 cycles, with minimal toxicity, after which the tumor was resected. The examination of the resected specimen revealed a complete pathologic response. He then received a total of 18 cycles of chemotherapy and valproate to complete 1 year of systemic treatment. The child is now 6.5 years of age, disease-free, without evidence of any neurocognitive or developmental abnormalities.
  
  
  CONCLUSIONS
  We suggest that the role of neoadjuvant chemotherapy should be explored in patients with infantile medulloblastoma in whom upfront complete resection is not possible, considering the gratifying results obtained in our case.
authors.affiliation: Asian Hospital, Faridabad, India; Medical Oncology, Max Hospital, Saket, New Delhi, India. Electronic address: ajayajaygupta2002@rediffmail.com.
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Radiology, Max Hospital, Saket, New Delhi, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Pathology, Max Hospital, Saket, New Delhi, India.
authors.forename: Andaleeb
authors.initials: A
authors.lastname: Abrari
authors.affiliation: Department of Neurosurgery, Max Hospital, Saket, New Delhi, India.
authors.forename: Rana
authors.initials: R
authors.lastname: Patir
authors.affiliation: Department of Neurosurgery, Max Hospital, Saket, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vaishya
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002528:Cerebellar Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004334:Drug Administration Schedule; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D056572:Histone Deacetylase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008527:Medulloblastoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods; D019965:Neurocognitive Disorders / Q000139:chemically induced / Q000517:prevention & control; D065886:Neurodevelopmental Disorders / Q000139:chemically induced* / Q000517:prevention & control; D016896:Treatment Outcome; D014635:Valproic Acid / Q000008:administration & dosage* / Q000009:adverse effects; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D056572:Histone Deacetylase Inhibitors; D014750:Vincristine; D014635:Valproic Acid; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin
keywords: Carboplatin; Chemotherapy; Etoposide; Infantile medulloblastoma; Valproate; Vincristine