Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What field and dose would you prescribe for a an extra-renal rhabdoid tumor of the pelvis?
Extrarenal, noncerebral rhabdoid tumors are relatively rare. However, the literature indicates an advantage for delivery of radiation therapy. Bourdeaut et al in 2008 reported on 26 patients with extrarenal, noncerebral rhabdoid tumors in whom the only surviving patient who had a proximal limb tumor...
How do you determine whether to offer whole lung radiation to children with favorable histology Wilms, lung metastases, and a CR on chemo, without knowledge of 1p16q status, as per the AREN0533 protocol?
With very small lung metastases to begin with , I would withhold whole lung radiation if a CR is achieved with chemotherapy.
Does the literature support a benefit for whole lung irradiation for high risk rhabdomyosarcoma with multiple lung metastases?
My opinion is that there are no direct data. The European investigators are talking about doing a randomized study to investigate the value in intermediate risk patients. In US it has been standard for stage 4 pulmonary cases with RMS since WLI was established for patients with Ewings Sarcoma in IES...
How would you treat a pediatric patient with Stage IVB Hodkin lymphoma who still has persistent PET+ disease after dose-escalated chemotherapy?
ISRT per Hodgson et al PRO 2015 to 21 Gy then boost the PETavid disease to 30Gy (Deauville 3) perhaps 36 Gy (Deauville 4).
Should post-op RT be delayed for children < 3yo after a GTR resection for a posterior fossa or supratentorial ependymoma?
Standard of care for a GTR posterior fossa ependymoma of any histologic grade is immediate adjuvant radiotherapy. If a STR is encountered, chemotherapy may be considered to try and facilitate a second look surgery. The current protocol allows patients with supratentorial ependymomas that have receiv...
What is the value and potential morbidity of second look surgery in patients with sub-totally resected ependymoma?
Since gross resection of ependymoma is associated with improved prognosis, chemotherapy is frequently used to render sub-totally resected ependymoma potentially resected totally during second look surgery (thereby improving prognosis). One of the main reasons that the tumor in the posterior fossa is...
Do you boost residual lung disease after chemotherapy after whole lung irradiation for patients with Ewings, Rhabdomyosarcoma or Wilms?
A patient who did not undergone a resection for the gross residual pulmonary metastatic disease in either Ewings or RMS may receive a boost at the completion of the whole lung portion of their radiotherapy. It is infrequent that this occurs at our institution as our bias is to resect the gross resid...
For extremity rhabdomyosarcomas (hand) with positive epitrochlear and axillary lymph nodes, do you treat the lymph nodes or just the primary?
Treatment of extremity RMS (either hand or foot) requires either resection or radiation for local treatment, in the setting of effective systemic therapy. There are good data in the literature showing that the primary tumor can be effectively irradiated, while retaining function and form so to avoid...
For high risk, stage I, non-seminomatous testicular germ cell tumors, are there particular circumstances under which RPLND is clearly preferred over chemotherapy or surveillance?
There are few indications for primary RPLND in pure nonseminomatous CSI. The only one I can currently think of is someone who has a strong contraindication to ever receiving chemotherapy.... renal failure or the like. The only time I consider it general is for patients with high risk Leydig or Serto...
When treating patients with immune checkpoint inhibitors, do you routinely check markers of endocrinopathies such as TSH/ACTH, or only when a patient has symptoms?
There are clearly defined parameters for routine monitoring that are outlined in the NCCN guidelines. We have incorporated these into our treatment plans. https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf