In a recent article published in Current Oncology entitled Metronomic Chemotherapy and Palliative Radiotherapy as Salvage Treatment of Refractory or Relapsed Pediatric Solid Tumors A.M. Ali and M.I. El-Sayed from the Department of Radiotherapy and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Al-methak Street, Assiut, Egypt reports on their expereince about the use of radiotherapy and metronomic chemotherapy in children with refractory cancers.

This prospective study enrolled patients with refractory or relapsed pediatric solid tumours from January 2013 to January 2015. Treatment consisted of 3–12 courses of mCTX in all patients, followed by RT in patients who experienced local recurrence, distant metastases, or both. Each course of mCTX consisted in the the metroSFCE01 regimen with :
 oral celecoxib 100–400 mg twice daily (days 1–42),
 intravenous vinblastine 3 mg/m2 weekly (weeks 1–6),
 oral cyclophosphamide 2.5 mg/m2 daily (days 1–21),
 oral methotrexate 15 mg/m2 twice weekly (days 21–42).

Statistical methods used were the log-rank test and binary logistic regression.

Results indicate that a favourable disease response (partial response or stable disease) was seen in 49 of 64 patients (76.6%), with mild acute toxicity occurring in 41 (64%). After a median follow-up of 14 months, 1-year overall survival was 62%. Pattern of disease relapse (p < 0.0001), time from initial treatment to relapse (p = 0.0002), and response to treatment (p < 0.0001) significantly affected survival. Age was the only factor that significantly correlated with treatment toxicity (p = 0.002; hazard ratio: 3.37; 95% confidence interval: 1.53 to 7.35)

Conclusions Combining mCTX with RT resulted in a favourable response rate, minimal toxicity, and 62% 1-year overall survival in patients with heavily pretreated recurrent disease. Patients with localized late recurrence or disease progression are the most likely to benefit from this regimen.

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