Portal de Periódicos da CAPES

Adherence to standard therapy for the treatment of childhood CNS tumors in Argentina. An audit perspective

2004; Lippincott Williams & Wilkins; Volume: 22; Issue: 14_suppl Linguagem: Inglês

10.1200/jco.2004.22.90140.8573

1527-7755

Edgardo G. J. Rivarola, Guillermo Chantada, L. Ezcurdia, Alejandra Negro, Ernesto Gil Deza, D. Cascallar, Donna A. Santillan, S. Carnaval, Eduardo L. Morgenfeld, Felipe G. Gercovich,

Health Systems, Economic Evaluations, Quality of Life

8573 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. No significant financial relationships to disclose.