Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
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...
How would you manage an osteosarcoma patient with local disease only and an R0 resection who could not tolerate neoadjuvant chemotherapy?
I wouldn't consider this an indication for radiotherapy, but I would proceed with an alternative chemotherapy. There are many places where the use of MAP is challenging due to limited resources and so alternative regimens are required. We evaluated carboplatin, ifosfamide, and doxorubicin in the abs...
For pre-menopausal female patients who present with acute leukemia in need of urgent anti-neoplastic therapy, what is your preferred approach in effort to preserve fertility?
This patient would be a good candidate for ovarian tissue cryopreservation (OTC), since time would be limited to stimulate and retrieve oocytes. One can complete OTC with line placement and other procedures and be able to start chemotherapy the day after OTC. I know not every center has access to OT...
Is cardiac sparing whole lung IMRT acceptable for Wilms Tumor?
I think we have enough dosimetry and clinical data to use cardiac sparing imrt off trial. We will be testing this modality further in future Wilms tumor clinical trials in COG. I routinely use this technique and know many others who do so too. John Kalapurakal
What is the role of targeted therapy in relapsed/refractory ALK+ anaplastic large cell lymphoma?
I recently had an ALCL patient with small cell pathology which, as you know, is a poor prognostic pathology. I asked the same question, and the response from the COG expert, based on the unpublished data from ANHL12P1, was not to add targeted therapy up front but to base the decision on response. I ...