Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
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 I asked the same question, and the response from the COG expert, based on the unpublished data from ANHL12P1, was not to add targeted therapy up front but to base the decision on response.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 ...
What are your indications for radiotherapy in children with pleomorphic xanthoastrocytoma?
Pleomorphic Xanthoastrocytoma is unique among other pediatric low grade gliomas in that it there is a high frequency of targetable alterations including BRAF V600E alterations and that there appears to be an increased risk of transformation relative to other pediatric low grade glioma histologies (P...
Would you offer whole abdominal irradiation to a pelvic recurrence of rhabdomyosarcoma with tumor rupture / spillage?
I would be less inclined to use a large field / volume approach like whole abdominal RT in the setting of recurrent disease. While I don't know if prior RT was delivered or not, the outcome for children with a pelvic recurrence (especially is a local recurrence) is overall very poor with only 20-30%...
What are the options of induction treatment of young AML patients who are on CRRT, continuous renal replacement therapy ?
Hypomethylating agent like decitabine and venetoclax will be good options. C1 decitabine for 10 days and venetoclax for 28 days. Then C2 decitabine for 5 days and venetoclax every 28 days. Bone marrow biopsy should be done on day 21. There is, however, no strong literature support regarding pharmaco...
What are indications for RT coverage of pleural cavity for margin positive resected Askin tumor after neoadjuvant chemotherapy?
Patients with malignant pleural effusion, pleural violation (2/2 chest tube placement through tumor) or pleural nodules at diagnosis should be considered for whole-pleural surface RT at the time of local RT to the chest wall. Of note, patients w/out + margins would also be considered for whole pleu...
How does the management of nasopharyngeal cancer in kids/young adults differ from adult patients?
The approach for managing pediatric patients with NPC has generally followed the recently published COG trial, at least in the United States. This approach uses induction chemotherapy with CDDP/5FU, followed by chemoradiation for the higher risk patients. Lower risk patients—Stage I/IIa or T2N0—can ...