Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
At what dose would you recommend future audiogram screening for pediatric patients treated with radiotherapy?
I would refer to the COG Late Effects report on Auditory Late Effects (PMID: 20194279). This reference has many relevant papers in its citation list that would aid the evaluation of hearing in specific childhood cancer patient populations. They recommend audiologic evaluation including air and bone ...
Does your institution omit prophylactic cranial irradiation in high risk ALL patients greater than 3 years of age?
The general trend worldwide has been to continue to reduce the proportion of patients receiving preemptive CNS directed radiotherapy, although some groups still utilize cranial radiotherapy in the front line setting for small subsets of patients with CNS3 disease at diagnosis, T-cell immunophenotype...
Is there any mature data about cognitive outcomes in 12 Gy vs 18 Gy in the setting of prophylactic cranial irradiation for ALL in children?
There is some data on AML showing some differences between 12 vs. 18 Gy, yet still quite a low incidence.https://www.ncbi.nlm.nih.gov/pubmed/214804694/134 (3%) of patients treated with 12 Gy versus 8/108 (7%) of patients treated with 18 Gy demonstrated behavioral disorders and cognitive impairment. ...
When would you consider treating a testicular relapse with definitive radiation in a child with ALL?
I would strongly advise against treating with testicular radiotherapy alone at relapse given that testicular relapse is often a harbinger for systemic relapse (depending on the length of first clinical remission) which radiotherapy alone strategies will fail to address (PMID: 8275428). Radiotherapy ...
What are the anesthesia risks for pediatric patients undergoing radiation treatments, given it's repetitive use throughout the treatment course?
Thankfully, the risk for anesthesia related complications during pediatric radiotherapy is very low. The high frequency of sedated procedures during radiotherapy for pediatric patients requires a comprehensive team approach to minimize that complication risk and discussion between parents, providers...
Is NF1 an absolute contraindication to intracranial radiation in pediatric gliomas?
I would consider a relative but not absolute contraindication. While we try to avoid radiation for NF1 patients with intracranial brain tumors because they tend to be more indolent, more responsive to systemic therapy and patients have pre-existing neurocognitive issues, radiation is sometimes the b...
What is the maximum number of metastatic sites you would treat with consolidative radiation for a patient with high-risk neuroblastoma?
5 sites, per ANBL 1531
How do you approach local control in intermediate risk bladder rhabdomyosarcoma in very young (<24 months) children ?
These two approaches are probably equivalent in qualified hands (cystectomy / prostatectomy or definitive RT) in terms of local control. This issue is balancing morbidity. The surgical approach in many cases will require a full cystectomy, necessitating the creation of a neobladder or some other re...
What is the standard of care (if any) for pediatric desmoplastic round cell tumor?
I am an adult oncologist and will defer to a pediatric oncologist if one is available to specifically address the question asked. Multidisciplinary evaluation in a sarcoma center is essential. For adults with this diagnosis, we manage desmoplastic small round cell tumors along the lines of Ewing sar...
Is there a role for extended treatment volumes (elective nodal) in the definitive treatment of parameningeal rhabdomyosarcoma in a young adult?
If by "extended treatment volumes" you are asking about cranial or craniospinal radiation therapy, the answer is an emphatic NO. We demonstrated by careful review of patterns of failure that cranial irradiation was unnecessary in PM-RMS (Michalski 2004). The IRS and subsequently the COG have abandon...