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Propranolol in pediatric tumors : Presentation of 4 cases

During the last SIOP meeting in Toronto, F. Sarialioglu and al. from the Baskent University Faculty of Medicine in Ankara Turkey preented their preliminary experience with propranolol in pedaitric solid tumours.

We copy bellow the abstract available in the dedicated volume of Pediatric Blood and Cancer


F. Sarialioglu, N. Yazici, A. Erbay, S. Demir, O. Alkan, N.E. Kocer, S. Ucka

Objectives: There is no more debate in use of propranolol in infantile hemangiomas but there is some question in efficacy in some of vascular lesions like tufted angioma, Kasabach Merrit syndrome, and hemangioendothelioma. On the other hand improved survival had been published in adult cancers with incidental use of beta blockers for other indications. Herein four cases with lesions other than infantile hemangiomas were presented with beta blocker treatment with interesting results.

Methods: A 9 year-old female with metastatic hemangioendothelioma to liver and bones A 2 year-old male with Noonan syndrome and progressive hypothalamic chiasmatic low grade glioma, A 4 month-old female with a giant retroorbital plexiform neurofibroma with neurofibromatosis type 1, A 22 months-old female with recurrent giant cell granuloma of the jaw were all trated with propranolol.

The parents of the patients with metastatic hemangioendothelioma and progressive glioma refused standard treatment after relapse. In recurrent giant cell tumor, the lesion was inoperable after three operations and steroid injections and the treatment was offered during the period for the procurement of calcitonin from the health care system.

In all patients, propranolol 2-3 mg/kg and prednisolon 1-2 mg/kg were used after informed consents were all obtained. Prednisolon duration was differed between patients.

Results: The patient with metastatic hemangioendothelioma responded well to propranolol and prednisolone with an Event Free Survival of 25 months after relapse. The patient with progressive glioma showed prominent neurocognitive developement and radiological regression of the tumor. In case of plexiform neurofibroma, MRI displayed regression of the retroorbital mass in the first three months of treatment and reamained stable course thereafter. The Giant cell tumor responded to treatment in approximately three weeks after the third relapse. No side effect was detected with prolonged use.

Conclusions Anti-angiogenesis is the probable mechanism in four different cases with borderline tumors. Acceptable responses to treatment with propranolol were achieved.