Pediatric Oncology   

Questions discussed in this category


ACNS1123 classified patients as NGGCT if serum & CSF AFP >10 ng/mL or bHCG >100 mIU/ml irrespective of biopsy results & did not mandate ...

There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy. 

With the new COG leukemia studies, it is difficult to interpret these results in the context of their clinical status and conventional MRD 

Are there other practical tips for improving the patient setup in this patient population to minimize potential acute and late effects?

We have a patient with stage IIa Hodgkin's disease with a cluster of lymphadenopathy in the cervical area. The diameter of the cluster is 6.1cm per CT...

Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...

While L-glutamine has minimal side effects and would likely be added after hydrea, how do you decide between the use of voxelotor and crizanlizumab?

During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?

Do you give RT to the entire extent of disease at presentation or just regions with slow early response? Is it necessary to irradiate all known extent...

Do you radiate the paraaortic chain to 10.8Gy then boost gross residual with 1cm block edge margin to 19.8Gy or simply treat the entire paraaortic cha...

The NCI PDQ on pediatric NHL (https://www.cancer.gov/types/lymphoma/hp/child-nhl-treatment-pdq#_764_toc) indicates that bone marrow biopsy and aspirat...

Do you treat in a response adjusted fashion as per ACNS1123 Stratum 2: 18-24 Gy whole ventricle with 12 Gy boost? Are there any situations where you d...

Is there a role for dose escalation? Would you recommend sequential or SIB? Is there more of a role for surgery vs. dose escalated RT in EWSR1-non-ET...

The new mass was noted on imaging after primary tumor resection and 3 cycles of BEP chemotherapy.

-Are there settings where group II disease does not need RT?-Are there additional genetic alterations in fusion negative RMS patients that can be used...

I have heard <20% MRD. What about proceeding if patient is hypoplastic after chemotherapy?

If proton therapy is not available would you consider radiosurgery? How would your management differ if residual disease is present?

For example, if the patient was on dasatinib before relapse, would you consider other second generation or third generation TKIs?

Parameningeal disease with distant metastatic deposits to lymph nodes and lungs, fusion negative. What are the considerations for cyclophosphamide dos...

Should the goal always be to proceed to a second transplant? 

There is evidence that parents do not adequately understand the purpose of phase I pediatric cancer trials (https://pubmed.ncbi.nlm.nih.gov/23071225/)...

Are there general ages that you refer to in terms of risk of secondary malignancy or points dropped for IQ over time after treatment, or particular he...

Should they be context/disease specific?  Should use of chemotherapy before/after, or during radiotherapy modify these tolerances? Contexts: ex...

Stage 4/group 4 due to dissemination in peritoneal fluid. Translocation negative; treated per intermediate risk protocol on study arm ARST1431 VAC/VI ...

Would you recommend screening MRIs for children who have RB1 mutations but have not yet developed retinoblastoma?

Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?

If so, what dose would you consider in the setting of complete and incomplete repeat surgical resection? How would you sequence this with salvage sys...

Should this be based off of the response? or the site of disease such as bone vs soft tissue?What data are there to dictate that the prior (response, ...

I am considering every 6 week pembrolizumab dosing in patients >70 years old in whom I want to reduce clinic visits for, especially in the context ...

Assuming CBC w/ different and complete metabolic panel are within normal limits, what (if any) further evaluation or management is needed?

If you had to recommend two options, one of which was palliation, what would your second option be?

i.e. Should concurrent therapy be given?, Does MGMT matter? What are the current most promising therapeutic approaches? Should we always treat based o...

How are you changing your parent/visitor policies?  Are you testing for COVID-19 in all febrile patients? Has COVID-19 changed the care settings...

Would you manage this histology any differently relative to other low grade gliomas? Is a STR a definite indication for postoperative XRT?

What if the patient has a history of confirmed COVID-19 but has since recovered?

Discussion of treatment options for midline low-grade glioma causing life-altering symptoms in a pregnant patient to avoid teratogenicity.

At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...

Outcomes for these patients are dismal, so looking for any insight on how to optimize outcomes for these patients.

Do you limit it to post-pubertal patients? Do you offer it only if they will proceed with bone marrow transplantation after CAR-T?

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...

A case report (https://www.ncbi.nlm.nih.gov/pubmed/32149486) describes severe COVID-19 infection in a pediatric oncology patient. Have you seen simil...

Scanning beam only machines are being increasingly marketed, it could be problematic if you can't use them to treat the one site which is most appropr...

The more recent NWTS trials do not include these tumors, since rhabdoid are recognized to not be similar to Wilms, and the AREN0321 does not provide s...

Should the patient be admitted for observation which will risk exposing other immunocompromised patients to COVID-19, or should the patient be quarant...

How do you prevent early menopause in women? Please comment on freezing of eggs, oophopexy, supine vs prone position, vaginal dialator. 

Guidelines indicate RCHOPx3 +RT as category I and RCHOP x 6 below that; long term f/u for SWOG 8736 showed similar PFS and OS. Do you have and approac...

To minimize the likelihood of asymmetrical growth, when is it of sufficient concern to necessitate altering planning objects? When planning paediatri...

-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX. -Given that this is standa...

When covering with radiation what dose and technique do you favor, electrons, IMRT, brachytherapy, protons?

Some emerging data of improved up front therapy shifting recurrence to CNS as sanctuary site, is focal RT approach (i.e. SRS) reasonable or is CSI a s...

Assuming it has previously been treated with excision and steroid injections? Is it reasonable to treat a bothersome keloid in a pediatric patient aft...

With the recent publication of multi-institutional trial data, should this now become standard of care?

Would the translocation status influence your decision? Are there specific subsites where elective radiotherapy likely offers a higher therapeutic rat...

Would you consider radical cystectomy equivelant in terms of local control and how do you balance morbidity of radiation with morbidity of non-organ p...

In a patient with high risk rhabdomyosarcoma with significant marrow involvement (Stage IV), who has responded completely on imaging to all known site...

Would you treat this with whole-abdomen RT with a boost? What dose would you recommend? This would be Stage 1, Group 2 (R1 resection), low risk; but l...

Does the St. Jude's Experience (NEJM 2009, PMID: 19553647) provide sufficient justification for routine omission in high risk patients?

Is it recommended in every pediatric patient?  Are there any guidelines for organ-specific surveillance after XRT for children based on age, dose...

For example, if there was a common iliac node, does external iliac nodal region also need to be included? When, if ever, do you include the exter...

Assuming CSF is negative for neoplastic cells would you: Re-irradiate gross disease only? Re-irradiate posterior fossa only? Re-irradiate the entir...

Is there any role for consolidative RT/CRT to the lung and mediastinum after initial chemo? What dose and fractionation would be most appropriate for ...

We often see young women with favorable, early stage disease in the mediastinum who have had a complete response to chemotherapy. With current smaller...

 If so in what circumstances and what margin is acceptable? ACNS 0331 recently showed no difference in outcomes when comparing IFRTboost vs ...

After ABVE-PC X4 and Ifos/vinorelbine x 2 per AHOD 0831 (and is unable to have these sites biopsied), what dose would you treat to and what volume wou...

AREN0533 schema requires knowledge of 1p16q status, though this test is not available off-protocol. How does this affect management for patients treat...

It seems that with the arms up, you get better lung blocking but with arms akimbo, you might have a lower dose to the humeral head. 


Papers discussed in this category


Pediatric blood & cancer, 2010-01

Pediatr Blood Cancer, 2008-09-01

Pediatric blood & cancer, 2010-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-11-10

Br J Radiol,

Burns, 2014 Apr 24

Pediatrics, 2013-01

Pediatrics, 2016-02

Practical radiation oncology, 2015

Cancer, 2004-08-15

Br. J. Haematol., 2003-11-01

Br. J. Haematol., 1998-08-01

Cancer, 1990-11-15

Radiother Oncol, 1990-01-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2004-08-01

Nature, 2014-02-27

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-07-20

Cancer cell, 2015-05-11

Neuro-oncology, 2016-07-01

Pediatr Blood Cancer, 2011 Apr 07

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1991-04

Leukemia, 2003-11

Pediatric blood & cancer, 2007-12

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-04-01

Cancer Cell,

J. Radiat. Res., 2017-05-01

J. Neurooncol., 2003-01-01

International journal of radiation oncology, biology, physics, 2008-03-01

The Lancet. Oncology, 2006-10

International journal of radiation oncology, biology, physics, 2010-08-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 1999-03

Int. J. Radiat. Oncol. Biol. Phys., 2017-01-01

Journal of neuro-oncology, 2012-01

American journal of clinical oncology, 2012-02

Eur. J. Cancer, 2017-03-01

International journal of radiation oncology, biology, physics, 2012-10-01

Journal of neuro-oncology, 2014-05

Int J Radiat Oncol Biol Phys, 2000 May 1

Journal of neuro-oncology, 2015-05

Journal of neurosurgery. Pediatrics, 2016-04

Pediatric blood & cancer, 2016-03

International journal of radiation oncology, biology, physics, 2018-02-01

J. Pediatr. Hematol. Oncol., 1999 Sep-Oct

International journal of radiation oncology, biology, physics, 2017-12-01

The Lancet. Oncology, 2017-08

Pediatrics, 2010-04

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-03-20

Cancer, 1994-01-01

Med. Pediatr. Oncol.,

Arch. Dis. Child.,

Pediatric blood & cancer, 2018-05

Br. J. Haematol.,

International journal of radiation oncology, biology, physics, 2013-04-01

International journal of radiation oncology, biology, physics, 2008-06-01

Practical radiation oncology, 2016

Clin. Cancer Res.,

International journal of radiation oncology, biology, physics, 2004-07-15

International journal of radiation oncology, biology, physics, 2013-11-01

Ann. Oncol.,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-04-15

Cancer, 2011-06-15

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-09-20

The Lancet. Oncology, 2016-10

Fertil. Steril., 2013 Sep 05

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007-02-20

Acta Neuropathol., 2011 Jan 29

J. Neurol. Sci., 2006 Dec 26

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-09-01

International journal of radiation oncology, biology, physics, 2010-11-01

Pediatric hematology and oncology, 1997

Cancer, 2001-04-15

The Lancet. Oncology, 2017-07

Cancer, 2019-08-01

Cancer,

Cancer, 2011-11-01

Cancer, 2014-12-01

J. Neurooncol., 2016 Jul 16

J. Clin. Oncol., 2019 Sep 25

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-09-01

Blood,

J. Clin. Oncol., 2019 Sep 12

Pediatric blood & cancer, 2008-02

Pediatric blood & cancer, 2007-05

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2007-07-20

J. Clin. Oncol., 2020 Mar 05

Eur. J. Cancer, 2020 Jan 28

J. Pediatr., 2014 Oct 21

J. Pediatr. Hematol. Oncol.,

Neuro-oncology,

Neuro-oncology, 2014-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2002-07-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-07-20

Lancet Oncol., 2020 Feb 14

Ann. Oncol., 2020 Mar 26

Lancet, 2020 Mar 04

Intensive Care Med, 2020 Mar 03

Lancet, 2020 Jan 24

Pediatrics, 2020 Mar 16

J. Clin. Oncol., 2019 Sep 10

Acta Paediatr., 2020 Mar 23

Journal of the National Cancer Institute, 2005-09-21

Eur. J. Cancer,

Br. J. Cancer, 2007 Jan 30

J. Neurosurg., 2017 Mar 03

Acta Neurochir (Wien), 2019 Jan 29

J. Neurooncol., 2018 Apr 06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-08-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-04-01

The New England journal of medicine, 2005-03-10

Br. J. Haematol., 2020 Apr 30

JAMA Oncol, 2020 Jan 16

European journal of cancer (Oxford, England : 1990), 2019-05

Pediatr Blood Cancer, 2019 Jun 19

The Lancet. Oncology, 2018-08

Journal of neuro-oncology, 2018-12

J. Neurooncol., 2019 Mar 04

Mol. Cancer Ther., 2016 Jun 20

J. Neurooncol., 2017 Nov 15

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-07-01

J. Clin. Oncol.,

The American journal of surgical pathology, 2017-07

Pediatr Blood Cancer,

Pediatr Blood Cancer, 2014 Aug 31

Clin Cancer Res, 2018 May 15

Eur. J. Cancer, 2014 Dec 13

Am. J. Surg. Pathol.,

The Lancet. Oncology, 2013-09

Neuro-oncology,

Cancer Cell,

J. Clin. Oncol., 2018 Sep 06

J. Clin. Oncol., 2019 Sep 25

QJM, 2013 Feb 27

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-04-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-04-01

Proceedings of the National Academy of Sciences of the United States of America, 2015-11-03

Oncologist, 2020 Mar 10

Semin Diagn Pathol, 2016 Dec 23

J Clin Oncol, 2020 Feb 27

Cancer Med, 2016 May 26

British journal of haematology, 2012-05

Blood, 2018-05-17

Br J Haematol, 2020 Jan 24

Leukemia, 2014 Sep 02

The New England journal of medicine, 2007-01-25

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-01-20

World Neurosurg, 2017 Apr 28

Lancet Oncol., 2014 Aug 07

Haematologica, 2020

Nature, 2019-03

Blood, 2018 May 02

Blood, 2018-08-23

Pediatric blood & cancer, 2014-03

Pediatrics, 2009-01

Anticancer Res.,

Transplant. Proc.,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-11-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-01-10

International journal of radiation oncology, biology, physics, 2011-11-15

International journal of radiation oncology, biology, physics, 2013-07-01

Ann. Oncol.,

Sarcoma, 2014

Int. J. Radiat. Oncol. Biol. Phys., 2018 Aug 02

Blood, 2018 Jun 26

Blood, 2018-07-19

, 2019 Oct 29

, 2018 Feb 27

Nature genetics, 2014-06

The American journal of surgical pathology, 2016-02

International journal of radiation oncology, biology, physics, 2019-01-01

Acta Oncol, 2019 Oct

Int. J. Cancer, 2020 Jun 11

Nat Commun, 2015 Jul 03

Cancer, 1991-10-15

Neuro Oncol, 2013 Mar 03

Neuro Oncol, 2010 Aug 17

International journal of radiation oncology, biology, physics, 2016-09-01

International journal of radiation oncology, biology, physics, 2017-12-01

Clin Orthop Relat Res, 2020 Feb

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-09-10

Pediatr Blood Cancer, 2018 Apr 25

The New England journal of medicine, 2017-02-02

Blood, 2009 Nov 10

J Clin Oncol, 2020 May 13