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Adherence to standard
therapy for the treatment of childhood CNS tumors in Argentina. An audit
perspective
E. G. Rivarola, G. L. Chantada, L. Ezcurdia, A. Negro, E. Gil Deza, D.
Cascallar, D. Santillán, S. Carnaval, E. Morgenfeld, F. G. Gercovich
Instituto Henry Moore, Buenos Aires, Argentina
Background.
There are no national protocols for the treatment of children
with CNS tumors in Argentina, so patients receive individualized treatment at
each center.
The aim of this study was to evaluate, from an audit perspective, the treatment
prescribed to children with CNS tumors belonging to a large health insurance
organization in Argentina.
Methods.
The files of all patients with CNS tumors for whom their
oncologists requested chemotherapy from 2000 to 2003 were retrieved.
All patients were treated at prestigious institutions.
The PDQ Cancer Information Treatment Summaries posted at the National Cancer
Institute of USA web site was used to define standard therapy.
Results.
Requests of chemotherapy for 24 children treated at 8 different
referral centers were received.
There were 10 cases of medulloblastoma, 7 gliomas, 5 ependymomas, 1 malignant
rhabdoid-teratoid tumor and 1 anaplastic tumor not otherwise specified.
This case was excluded because no standard therapy is available.
Overall, 9/10 children younger than 3 years of age received standard Baby´s
combination.
Seventeen out of 23 patients received standard combinations as first line
treatment while in 6/23 patients experimental treatment was prescribed.
These included 1 children with brainstem glioma, 3 children with ependymoma and
1 one year old child with glioma that received an experimental
combination.
Even though the role of temozolomide is not clear in children, this drug was
requested for 3 patients with glioma (1 baby) as first line and 2 for second
line therapy (ependymoma and glioma).
Topotecan was requested for 2 patients with ependymoma.
All patients with medulloblastoma received standard therapy.
Conclusions.
Despite all patients were treated at prestigious centers,
46% of children with CNS tumors other than medulloblastoma received unproven
first line therapy.
″Off guidelines″ treatments with unproven agents outside a clinical
trial such as temozolomide and topotecan were requested for 30% of the
cases.
According to ethical principles, it is our feeling that all children with
malignancies outside a controlled clinical trial should receive standard
therapies.
Copyright 2004 American Society of Clinical Oncology All rights
reserved worldwide.
Source: http://www.asco.org/ac/1,1003,_12-002636-00_18-0026-00_19-003929,00.asp
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