Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Do you routinely use tumor lysis prophylaxis when starting chemotherapy for germ cell tumors?
THere is not reason to use tumor lysis prophylaxis. Hydration of course is required for the cisplatin. I am not aware of anyone using allopurinol or other TLS approaches
Is there a role for hyperbaric oxygen treatment concurrent with radiotherapy in the treatment of pediatric glioblastoma?
HBO has been used primarily in the treatment of radiation induced injury in patients with controlled intracranial disease. The application of HBO in the post-treatment setting has been limited by fears of latent reactivation of tumor metabolism and therefore progression. There are countless manuscri...
How do you manage severe cytarabine syndrome in AML patients, manifesting as severe hypotension, fevers, rash, and myalgias?
The cytarabine syndrome is a well-described (Castleberry et al. (1981) Medical and Pediatric Oncology 9:257) syndrome mediated by pro-inflammatory cytokines that are associated with fever, hypotension, rash, and often renal failure. In my experience, its most severe manifestations occur when a patie...
Would it be appropriate to treat an adult with a pure germinoma at 1.8 Gy/ fraction instead of the pediatric dose of 1.5 Gy/ fx when treating with radiation alone to the whole ventricle (with cone down to primary)?
We have utilized 1.8Gy per fraction as part of an institutional protocol for CNS germinomas since the 1990s with excellent results (Buckner J JCO 1999). Although the protocol was designed to examine the safety of focal radiotherapy in the setting of CR to induction chemotherapy, this protocol also i...
What is the risk of breast cancer that you quote to young women with early stage Hodgkin's lymphoma receiving involved field/site radiation therapy?
The risk depends on many different factors, including the amount of breast exposure to radiation, age of the patient, chemotherapy regimen, etc. Patients at greatest risk are likely those with axillary involvement who are < 30, where a large portion of their breast maybe unintentionally irradiated. ...
How do you manage a patient with a history of non-seminomatous germ cell tumor who has a rising AFP after primary chemotherapy without any imaging evidence of recurrence?
It would depend on the timing of the rise of AFP after chemotherapy, how elevated it is, whether they were good or poor risk patients at the time of chemotherapy, whether they had liver disease and whether the AFP was definitively elevated prior to chemo In most cases, we sort of ignore AFP < 25 or ...
Is there a benefit to metastatic & primary site RT in RMS w/ persistent marrow disease?
While I agree with the response by Dr Ermoian, I believe the case is more complicated than simply irradiating the gross disease at the primary site. Overall survival and Progression Free Survival for Stage 4, Group IV RMS has not changed substantially over the past almost 5 decades, despite many suc...
Would you give post operative radiation for a pT1N0 parotid low grade mucoepidermoid carcinoma with positive margin on the facial nerve to an adolescent?
Yes. Unfortunately, while the risk of second malignancy is not insignificant in an adolescent, the risk of recurrence on the facial nerve margins is expected to be quite high. Recurrence in the future along the nerve would most likely lead to sacrifice of the nerve and the need for adjuvant RT.
How would you treat a pediatric embryonal rhabdomyosarcoma of the kidney with preoperative rupture s/p nephrectomy and getting VAC/VI chemotherapy?
This is an uncommon clinical presentation. If there was diffuse abdominal spill, then whole abdominal radiotherapy would be indicated. Though recent COG study guidelines specify 24 Gy whole abdomen radiotherapy dose, that may not be adequate for microscopic tumor. In other tumors (ie, diffuse small ...
What is a standard field for LN+ paratesticular rhabdomyosarcoma (ie aorta + ivc + ipsi common iliac)?
Though there is some variation, most clinicians who have enrolled patients on the IRSG or COG studies use a "hockey-stick" field that parallels what would be used for seminoma. These would include the para-aortic and ipsilateral iliac nodes. A minority of clinicians exclude the iliac nodes if they a...