Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?
I utilize the Endocrine Society's guidelines for identifying secondary erythrocytosis secondary to gender affirming hormone therapy (GAHT) (PMID 28945902). For initial monitoring, at baseline and then every 3 month hematocrit for the first year and 1-2 times yearly thereafter is typically implemente...
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
This is challenging due to the sensitivity of Fanconi anemia patients to DNA-damaging treatment. I would maximize resection if possible and then treat with radiation, since it is a mainstay of therapy, despite the risk. I would opt for proton radiation if possible to minimize exposure of normal tiss...
Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?
It probably is. Although not proven by randomized trial/s in pediatric patients, the practice is accepted in adults. In children where long term morbidity of radiation therapy is of greater concern, it would not be unreasonable to use involved nodal field in combination with chemotherapy.
Is it feasible to treat craniospinal fields with new generation scanning beam-only proton machines?
Yes, it is feasible to treat craniospinal fields with scanning beam-only technology. Scanning beam proton therapy delivers one discrete Bragg peak "spot" at a time. Large fields require many spots; so treating large fields such as craniospinal fields with scanning beam techniques requires more time ...
Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?
We will be moving towards involved site radiotherapy for pediatric Hodgkin lymphoma. Consequently, you may want to match the simulation with the set up of their pre-treatment PET/CT scan (arms up vs arms down). This will allow you to have more certainty regarding the location of axiallary and subpec...
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...