Speciality
Spotlight

 




 


Oncology


 

 





Pediatric

   

  • Frederick B. Ruymann, and Alfred C. Grovas (Children’s Hospital, Columbus, Ohio; Intergroup Rhabdomyosarcoma Study Group, Omaha, Nebraska, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio)


    Progress in the Diagnosis and Treatment of Rhabdomyosarcoma (RMS) and Related Soft Tissue Sarcomas


    Cancer Investigation 2000 Vol. 18 (3) Pg. 223-241

          


    This malignant tumor arises from embryonal mesenchyme with the potential of differentiating into skeletal muscle. Soft tissue sarcomas (STS) rank fifth in children following leukemia, brain tumors, lymphoma and germ cell tumors. 60% of STS are rhabdomyosarcoma (RMS).

         


    Incidence slightly higher in males 1.5:1 than in females and in whites. Paratesticular with prostates are the common sites. The other associated conditions Gorlin’s nevoid basal cell carcinomas, neurofibromatosis, Li-Fraumeni Syndrome.

         


    A pathologic classification as per prognosis describes botryoid RMS with superior prognosis and anaplastic RMS the worst prognosis.

         


    The TNM staging defines the clinical group MRI and physical examination and when required pathologic evaluations are required to assign a clinical group. Bone marrow aspirate and biopsy are mandatory.

        


    Surgical management includes tumor margins to be negative microscopically. This confers a improved survival without local RT. 

        


    Surgical sampling of suspected lymph node is required. Those with microscopic residual disease will receive combination chemotherapy VAC with cyclophosphamide. Radiation is considered for residual disease.

        


    Tumor size nodal involvement and adjoining organ infiltration were prognostic factors. In patients with parameningeal primaries and with intracranial extension radiotherapy and chemotherapy are recommended to commence on day 0.

        


    Specific histologic and group IV patients with special pelvic sites require anthracycline. The IRSG V plans for low risk vincristine-actinomycin D regimen without radiotherapy in group I favorable histology and cyclophosphamide is required for unfavorable histology such as alveolar RMS, undifferentiated STS etc.

        


    In high risk group the use of primary doublets followed by VAC with cyclophosphamide at 2.2 gm/m2 is used. 

       


    Topotecan also has an outstanding response in alveolar RMS. The role of megatherapy such as autologous bone marrow transplantation remains to be defined.

         

  • Mullen CA, Petropoulos D, Roberts WM, et al (Univ of Texas, Houston)

    Outpatient Treatment of Fever and Neutropenia for Low Risk Pediatric Cancer Patients

    Cancer 86: 126-134, 1999

         


    The febrile neutropenia in pediatric patients undergoing chemotherapy were classified as low risk. Those children who were hemodynamically stable and without dehydration, mucositis, pneumonia, leukemia/lymphoma induction chemotherapy, bone marrow transplantation or other serious comorbidity.

         


    These patients received one dose of ceftazidime followed by oral ciprofloxacin or IV ceftazidime.

         


    Outpatient therapy required close scrutiny and was successful in 32 / 40 patients by ciprofloxacin and 31 / 33 with ceftazidime.

         


    For a select group of children, outpatient management of febrile neutropenia is possible.

          

  • Rosito P, Mancini AF, Rondelli R, et al (Univ of Bologna, Italy; Rizzoli Hosp, Bologna)

    Italian Cooperative Study for the Treatment of Children and Young Adults With Localized Ewing Sarcoma of Bone: A Preliminary Report of 6 Years of Experience


    Cancer 86: 421-428, 1999

          


    This multi-institutional Italian study of 165 patients, less than 30 years of age and localized Ewing’s sarcoma received high dose chemotherapy, vincristine, actinomycin-D, doxorubicin and cyclophosphamide plus ifosfamide and etoposide combined with hyperfractionated and accelerated radiation therapy.

           


    The 3-year survival rate was 83.6% and 3-year EFS was 77.78%. These satisfying results did not reveal any patients with secondary leukemia or myelodysplastic syndrome (MDS) as compared to the cooperative Ewing sarcoma study where out of 49 patients 2 developed MDS and 2 had acute leukemia.

              

  • Matsumoto M, Shinohara O, Ishiguro H, et al (Tokai Univ, Isehara-shi, Japan)

    Ovarian Function After Bone Marrow Transplantation Performed Before Menarche 

    Arch Dis Child 80: 452-454, 1999

        


    Seven gonadal impairment following bone marrow transplantation (BMT) is well known.

         


    This retrospective study of 18 girls following BMT before menarche and were long term survivors (disease free for over 6 years) were analyzed for menarche and basal follicle-stimulating hormone (FSH) concentration. BMT was with total body radiation (8-12 Gy) and chemotherapy.

          


    Menarche was possible in group of patients who underwent BMT at mean age of 7.2 years compared to 11.1 years who did not achieve menarche. Declining levels of FSH indicated a menarche. 

          

  • Moppett J, for the United Kingdom Children’s Cancer Study Group (Royal Hosp for Sick Children, Bristol, England) 

    Neonatal Neuroblastoma 

    Arch Dis Child Fetal Neonatal Ed 81: F134-F137, 1999

        


    The commonest neonatal tumor is neuroblastoma. This study of 33 patients with neonatal neuroblastoma revealed stage 4S as the commonest. The treatment was depending on tumor stage with various chemotherapy regimens.

         


    The survival rate was about 90%. Infants with stage 4S had good prognosis, but intraspinal tumor extension may have long term neurologic complications.

            

  • Shu XO, Linet MS, Steinbuch M, et al (Univ of Minnesota, Minneapolis; Natl Cancer Inst, Bethesda, Md; Univ of Southern California, Los Angeles; et al)

    Breast-Feeding and Risk of Childhood Acute Leukemia 

    J Natl Cancer Inst 91: 1765-1772, 1999

        


    This study was carried out by telephonic interviews with mothers of 1744 children with ALL and 1879 control subjects as well as 456 children with AML and 539 control subjects. 

         


    The interviews gathered information as regards breast-feeding history. The results determined that there was a decrease in 21% in risk of childhood acute leukemia and in individual group of AML and ALL in children who were breast fed. The association with reduced risk was stronger with increasing duration of breast-feeding. 

         


    The authors of this study do state additional epidemiologic studies are required to confirm these findings. 

         


    This association if confirmed then further work should focus on anti-infective, immune-stimulatory or immune-modulating effects of breast milk.

       

  • Pratico G, Caltabiano L, Ragusa R, et al (Univ of Catania, Italy)

    Bone Metabolism in Childhood Acute Lymphoblastic Leukemia (ALL) Off-Therapy 

    Int J Pediatr Hematol Oncol 5: 437-442, 1998

          


    Reduced bone mass is common in patients with ALL due to leukemia itself, and chemotherapeutic (steroids) agents.

         


    This study of 21 children diagnosed of acute lymphoblastic leukemia in first complete remission and off chemotherapy for at least 6 months were evaluated for total calcium, inorganic phosphate, magnesium, carboxy-terminal fragment of parathyroid hormone (PTH), calcitonin, 25 hydroxyvitamin D3 (25OHD), 1-25 dihydroxyvitamin D3 (1,25(OH)2D), osteocalcin (BGP) and other bone markers.

         


    The only difference was significant lower values of PTH in patients with ALL than control and 12 demonstrated hypoparathyroidism. This trend suggests re-establishment of bone mineralization, when off therapy. It may be useful to administer calcium to increase mineral anabolism. 

          

  • Matthey KK, for the Children’s Cancer Group (Univ of California, San Francisco; et al)

    Treatment of High-Risk Neuroblastoma With Intensive Chemotherapy, Radiotherapy, Autologous Bone Marrow Transplantation, and 13-cis-Retinoic Acid

    N Engl J Med 341: 1165-1173, 1999

        


    This study of 539 patients of neuroblastoma of which 129 underwent transplantation and 150 received chemotherapy.

         


    The 3 year event-free survival was significantly better for patients receiving high dose chemotherapy, radiotherapy and bone marrow transplantation than for patients receiving chemotherapy alone.

         


    In addition, among patients without progressive disease, 13-cis-retinoic acid further improved the outcome. 

         

  • Cushing B, Giller R, Ablin A, et al (Children’s Hosp of Michigan, Detroit; Children’s Hosp, Denver; Univ of California, San Francisco; et al)

    Surgical Resection Alone Is Effective Treatment for Ovarian Immature Teratoma in Children and Adolescents: A Report of the Pediatric Oncology Group and the Children’s Cancer Group 

    Am J Obstet Gynecol 181: 353-358, 1999

        


    This study of 44 patients aged 1.5 years to 20 years with completely resected ovarian immature teratoma (stage I, grades 1 and 2) did not receive chemotherapy and were followed up for recurrence.

         


    At median follow up of 4.2 years, the overall 4-year event-free survival was 97.7%. One patient, with large tumor and yolk sac involvement recurred. She received chemotherapy and is alive without recurrence for 57 months.

         


    Surgery is curative for most children with ovarian immature teratoma even when a-fetoprotein levels are elevated or microscopic
    foci of yolk sac tumors were found and postoperative chemotherapy to be reserved for recurrence. 

         

  • Perentesis JP, Katsanis E, DeFor TE, et al (Univ of Minnesota, Minneapolis)

    Autologous Stem Cell Transplantation for High-Risk Pediatric Solid Tumors

    Bone Marrow Transplant 24: 609-615, 1999

         

    This study done on 24 children and young adults with metastatic or relapse solid tumor underwent ASCT with two protocols MT 9408 consisting of phenytoin, busulfan, melphalan, thiotepa, and MT 8911 received etopside, thiotepa and cyclophosphamide.

        


    Survivors had Ewing sarcoma, desmoplastic small cell tumor, and relapsed or metastatic anaplastic Wilms tumor. 

        


    This report indicates improved salvage rate for high-risk Ewing’s in complete remission before ASCT; fewer patients with rhabdomyosarcoma were included in the study population. 

         

  • Cortes D, Visfeldt J, Mfller H, et al (Rigshospitalet, Copenhagen; Centre for Research in Health and Social Statistics, Copenhagen)

    Testicular Neoplasia in Cryptorchid Boys at Primary Surgery: Case Series 

    BMJ 319: 888-889, 1999

        

    Boys with cryptorchidism have a four fold high risk of testicular cancer than in general population.

        


    This study evaluated 1535 consecutive specimens of testicular tissue obtained from patients with undescended testes and recorded for malignant transformation. 

         


    In patients with intra-abdominal testes, there were abnormal external genitalia and abnormal karyotype.

        


    The risk of testicular neoplasia was significantly higher in patients with bilateral cryptorchidism (14.7%) than in unilateral cryptorchidism (9.7%).

         

  • Abramson DH, Frank CM, Dunkel IJ (New York Presbyterian Hosp; Mem Sloan-Kettering Cancer Ctr, New York)

    A Phase I/II Study of Subconjunctival Carboplatin for Intraocular Retinoblastoma 

    Ophthalmology 106: 1947-1950, 1999

         

    This study of eleven patients with retinoblastoma received subconjunctival carboplatinum 1.4 to 2.0 ml of a 10-mg/mL solution at 3 weekly interval adverse events included periorbital edema and optic atrophy.

         


    Major responses were noted in 3 of 5 eyes with vitreous disease. 2 out of 5 eyes with retinal tumors responded. This modality appears safe and effective for intraocular retinoblastoma however longer follow-up is required.

         

  • Asanuma H, Nakai H, Takeda M, et al (Tokyo Metropolitan Kiyose Children’s Hosp)

    Renal Cell Carcinoma in Children: Experience at a Single Institution in Japan 

    J Urol 162: 1402-1405, 1999

        


    Renal cell carcinoma (RCC) is rare in children as compared to Wilm’s tumor.

        


    This study of 4 Japanese children with RCC had presented with hematuria and abdominal mass and CT scan revealing characteristic classification in tumor and high density areas with microcalcification. Interferon appeared beneficial in selected patients. 

         

  • Dang NC, Siegel SE, Phillips JD (Children’s Hosp, Los Angeles; Univ of Southern California, Los Angeles)

    Malignant Chest Wall Tumors in Children and Young Adults 

    J Pediatr Surg 34: 1773-1778, 1999

        


    This study of 19 patients with chest wall tumor most common being malignant small round cell tumor (MSRCT) also known as Ewing’s family of tumors followed by rhabdomyosarcoma and other tumors.

         


    Some underwent upfront complete resection and 9 had initial biopsy followed by chemotherapy and radiotherapy. Overall survival at a median of 4 years was 42%. Localized disease had the best survival. 

         


    Most patients with MSRCT did not survive and all patients with RMS and 2 of 3 patients with embryonal RMS. The best survival was with other “malignant sarcomas”. 

        

  • Day N, for the UK Childhood Cancer Study Investigators (Univ of Cambridge, England; et al)

    Exposure to Power-Frequency Magnetic Fields and the Risk of Childhood Cancer

    Lancet 354: 1925-1931, 1999

         


    The UK childhood cancer study evaluated the electromagnetic field (EMF) measures of children and its association with acute lymphoblastic leukemia, all leukemia, CNS tumors and other malignant disease.

        


    There was no evidence that exposure to magnetic field associated with electricity supply increased risk of childhood cancers and
    leukemias.

      

  • Stark B, Sharon R, Rechavi G, et al (Tel Aviv Univ, Israel; Bruce Rappaport Technion, Haifa, Israel; Hebrew Univ, Jerusalem, Israel)

    Effective Preventive Central Nervous System Therapy With Extended Triple Intrathecal Therapy and the Modified ALL-BFM 86 Chemotherapy Program in an Enlarged Non-High Risk Group of Children and Adolescents With Non-B-Cell Acute Lymphoblastic Leukemia: The Israel National Study Report 

    Cancer 88: 205-216, 2000

         


    Preventive cranial radiotherapy (CRT) in children with acute lymphoblastic leukemia (ALL) although effective is complicated by neurologic problems and second malignancies. In a sub group of low risk ALL substituting CRT with intensified intrathecal is promising. 

          


    This study of 225 evaluated patients of ALL (non B-cell) on modified BMF 86 chemotherapy protocol for non-high risk children and adolescents required extended intrathecal methotrexate, cytosine arabinoside and hydrocortisone 18 times along with systemic therapy.

          


    This could provide adequate CNS protection and systemic leukemic control for this subgroup of patients. The addition of etoposide was not beneficial. 

          

  • Rodriguez-Galindo C, Ramsey K, Jenkins JJ, et al (St Jude Children’s Research Hosp, Memphis, Tenn; Univ of Tennessee, Memphis)

    Hemangiopericytoma in Children and Infants 

    Cancer 88: 198-204, 2000

          


    Hemangiopericytoma (HPC), a soft tissue neoplasm and has two distinct clinical syndrome involving adults and infants. In this study of 12 children, of which 3 infants, the results in infantile HPC were gratifying in spite of positive tumor margins. 

         


    In children older than 1 year, an aggressive behavior similar to older individuals was identified and requires aggressive treatment approach.

          

  • Mora J, Filippa DA, Thaler HT, et al (Mem Sloan-Kettering Cancer Ctr, New York)

    Large Cell Non-Hodgkin Lymphoma of Childhood: Analysis of 78 Consecutive Patients Enrolled in 2 Consecutive Protocols at the Memorial Sloan-Kettering Cancer Center 

    Cancer 88: 186-197, 2000

          


    Large cell lymphomas compromise 15-30% of childhood non-Hodgkin’s lymphomas. This study of 78 patients with stage III and IV diffuse large cell lymphoma (DLCL) received 2 consecutive regimens LSA2-L2 and LSA4.

           


    The recurrence rate was higher with CD30+ anaplastic large cell lymphoma (ALCL). 72% disease-free survival rate was noted.

          


    The authors recommended DLCL with CD30+ ALCL receive aggressive induction therapy as for B-cell lymphomas along with prolonged period maintenance without CNS prophylaxis.

          

  • Hovi L, Saarinen-Pihkala UM, Vettenranta K, et al (Univ of Helsinki; Univ of Oulu, Finland)

    Growth in Children With Poor-Risk Neuroblastoma After Regimens With or Without Total Body Irradiation in Preparation for Autologous Bone Marrow Transplantation 

    Bone Marrow Transplant 24: 1131-1136, 1999

          


    This study of 31 patients of poor risk neuroblastoma treated with myeloablative preparative regimens and autologous BMT of which, group I were 15 patients without TBI and group II with TBI.

          


    Those who received TBI have poor growth after ABMT and those without TBI had growth close to normal. Clinicians should evaluate the need for growth hormone therapy early to maximize final height

           

  • Hasle H, Clemmensen IH, Mikkelsen M (Aarhus Univ, Denmark; Danish Cancer Society, Copenhagen; John F Kennedy Inst, Glostrup, Denmark)

    Risks of Leukaemia and Solid Tumors in Individuals With Down’s Syndrome 

    Lancet 355: 165-169, 2000

          


    The association of Down’s Syndrome (DS) with leukemia is well known. This study of 2814 individuals with DS, from Danish Cytogenetic Register and linked with the Danish Cancer Registry were evaluated.

          


    Sixty cancer cases occurred among these patients and 97% of cases of malignant diseases in children. The cumulative risk of leukemia was 2.1% by 5 years of age and 2.7% by 30 years of age.

          


    No leukemia cases occurred beyond 29 years of age. Of the great interest was the fact there was a decreased risk of solid tumors in all age groups.

           

  • Welch Dinauer CA, Tuttle RM, Robie DK, et al (Walter Reed Army Med Ctr, Washington, DC; Uniformed Services Univ of the Health Sciences, Bethesda, Md)

    Extensive Surgery Improves Recurrence-Free Survival for Children and Young Patients With Class I Papillary Thyroid Carcinoma 

    J Pediatr Surg 34: 1799-1804, 1999

          


    Papillary thyroid cancer (PTC) in children is rarely fatal but with multifocality, the risk of recurrence is high.

            

    This study of 37 patients with class I PTC who were 21 years or younger were evaluated. Those treated with lobectomy with or without isthmusectomy had higher recurrence than patients with subtotal or total thyroidectomy.

          


    The incidence of complications was comparable and hence more extensive surgery in children with class I PTC is associated with lower risk of
    recurrence.

          

  • Dubois J, Hershon L, Carmant L, et al (Universite de Montreal)

    Toxicity Profile of Interferon (IFN) Alfa-2b in Children: A Prospective Evaluation 


    J Pediatr 135: 782-785, 1999

          


    This study of 53 children treated with IFN alfa-2b for diseases such as hemangiomas, juvenile laryngeal papillomatosis and occasionally for chronic viral hepatitis.

         


    However, most patients had more than one event of grade I toxicity, neurologic toxicity with somnolence was most significant. In general, children tolerate IFN-alfa therapy well.

           

  • Garaventa A, Bellagamba O, Lo Piccolo MS, et al (Giannina Gaslini Children’s Hosp, Genova, Italy; Galliera Hosp, Genova, Italy) 

    131I-Metaiodobenzylguanidine (131I-MIBG) Therapy for Residual Neuroblastoma: A Mono-institutional Experience With 43 Patients 


    Br J Cancer 81: 1378-1384, 1999


           

    This study on 43 children with stage 3 or stage 4 neuroblastoma treated and had failed to respond completely after first line protocol received 131I-MIBG.

          


    This improved the cure rate of stage 3 and response in those with stage 4 neuroblastoma however, with long-term toxicity such as acute leukemia and poor thyroid reserve.

           


 



 

 

Speciality Spotlight

 

 

Pediatric
   

  • Frederick B. Ruymann, and Alfred C. Grovas (Children’s Hospital, Columbus, Ohio; Intergroup Rhabdomyosarcoma Study Group, Omaha, Nebraska, Comprehensive Cancer Center, Ohio State University, Columbus, Ohio)
    Progress in the Diagnosis and Treatment of Rhabdomyosarcoma (RMS) and Related Soft Tissue Sarcomas
    Cancer Investigation 2000 Vol. 18 (3) Pg. 223-241
          
    This malignant tumor arises from embryonal mesenchyme with the potential of differentiating into skeletal muscle. Soft tissue sarcomas (STS) rank fifth in children following leukemia, brain tumors, lymphoma and germ cell tumors. 60% of STS are rhabdomyosarcoma (RMS).
         
    Incidence slightly higher in males 1.5:1 than in females and in whites. Paratesticular with prostates are the common sites. The other associated conditions Gorlin’s nevoid basal cell carcinomas, neurofibromatosis, Li-Fraumeni Syndrome.
         
    A pathologic classification as per prognosis describes botryoid RMS with superior prognosis and anaplastic RMS the worst prognosis.
         
    The TNM staging defines the clinical group MRI and physical examination and when required pathologic evaluations are required to assign a clinical group. Bone marrow aspirate and biopsy are mandatory.
        
    Surgical management includes tumor margins to be negative microscopically. This confers a improved survival without local RT. 
        
    Surgical sampling of suspected lymph node is required. Those with microscopic residual disease will receive combination chemotherapy VAC with cyclophosphamide. Radiation is considered for residual disease.
        
    Tumor size nodal involvement and adjoining organ infiltration were prognostic factors. In patients with parameningeal primaries and with intracranial extension radiotherapy and chemotherapy are recommended to commence on day 0.
        
    Specific histologic and group IV patients with special pelvic sites require anthracycline. The IRSG V plans for low risk vincristine-actinomycin D regimen without radiotherapy in group I favorable histology and cyclophosphamide is required for unfavorable histology such as alveolar RMS, undifferentiated STS etc.
        
    In high risk group the use of primary doublets followed by VAC with cyclophosphamide at 2.2 gm/m2 is used. 
       
    Topotecan also has an outstanding response in alveolar RMS. The role of megatherapy such as autologous bone marrow transplantation remains to be defined.
         

  • Mullen CA, Petropoulos D, Roberts WM, et al (Univ of Texas, Houston)
    Outpatient Treatment of Fever and Neutropenia for Low Risk Pediatric Cancer Patients
    Cancer 86: 126-134, 1999
         
    The febrile neutropenia in pediatric patients undergoing chemotherapy were classified as low risk. Those children who were hemodynamically stable and without dehydration, mucositis, pneumonia, leukemia/lymphoma induction chemotherapy, bone marrow transplantation or other serious comorbidity.
         
    These patients received one dose of ceftazidime followed by oral ciprofloxacin or IV ceftazidime.
         
    Outpatient therapy required close scrutiny and was successful in 32 / 40 patients by ciprofloxacin and 31 / 33 with ceftazidime.
         
    For a select group of children, outpatient management of febrile neutropenia is possible.
          

  • Rosito P, Mancini AF, Rondelli R, et al (Univ of Bologna, Italy; Rizzoli Hosp, Bologna)
    Italian Cooperative Study for the Treatment of Children and Young Adults With Localized Ewing Sarcoma of Bone: A Preliminary Report of 6 Years of Experience
    Cancer 86: 421-428, 1999
          
    This multi-institutional Italian study of 165 patients, less than 30 years of age and localized Ewing’s sarcoma received high dose chemotherapy, vincristine, actinomycin-D, doxorubicin and cyclophosphamide plus ifosfamide and etoposide combined with hyperfractionated and accelerated radiation therapy.
           
    The 3-year survival rate was 83.6% and 3-year EFS was 77.78%. These satisfying results did not reveal any patients with secondary leukemia or myelodysplastic syndrome (MDS) as compared to the cooperative Ewing sarcoma study where out of 49 patients 2 developed MDS and 2 had acute leukemia.
              

  • Matsumoto M, Shinohara O, Ishiguro H, et al (Tokai Univ, Isehara-shi, Japan)
    Ovarian Function After Bone Marrow Transplantation Performed Before Menarche 
    Arch Dis Child 80: 452-454, 1999
        
    Seven gonadal impairment following bone marrow transplantation (BMT) is well known.
         
    This retrospective study of 18 girls following BMT before menarche and were long term survivors (disease free for over 6 years) were analyzed for menarche and basal follicle-stimulating hormone (FSH) concentration. BMT was with total body radiation (8-12 Gy) and chemotherapy.
          
    Menarche was possible in group of patients who underwent BMT at mean age of 7.2 years compared to 11.1 years who did not achieve menarche. Declining levels of FSH indicated a menarche. 
          

  • Moppett J, for the United Kingdom Children’s Cancer Study Group (Royal Hosp for Sick Children, Bristol, England) 
    Neonatal Neuroblastoma 
    Arch Dis Child Fetal Neonatal Ed 81: F134-F137, 1999
        
    The commonest neonatal tumor is neuroblastoma. This study of 33 patients with neonatal neuroblastoma revealed stage 4S as the commonest. The treatment was depending on tumor stage with various chemotherapy regimens.
         
    The survival rate was about 90%. Infants with stage 4S had good prognosis, but intraspinal tumor extension may have long term neurologic complications.
            

  • Shu XO, Linet MS, Steinbuch M, et al (Univ of Minnesota, Minneapolis; Natl Cancer Inst, Bethesda, Md; Univ of Southern California, Los Angeles; et al)
    Breast-Feeding and Risk of Childhood Acute Leukemia 
    J Natl Cancer Inst 91: 1765-1772, 1999
        
    This study was carried out by telephonic interviews with mothers of 1744 children with ALL and 1879 control subjects as well as 456 children with AML and 539 control subjects. 
         
    The interviews gathered information as regards breast-feeding history. The results determined that there was a decrease in 21% in risk of childhood acute leukemia and in individual group of AML and ALL in children who were breast fed. The association with reduced risk was stronger with increasing duration of breast-feeding. 
         
    The authors of this study do state additional epidemiologic studies are required to confirm these findings. 
         
    This association if confirmed then further work should focus on anti-infective, immune-stimulatory or immune-modulating effects of breast milk.
       

  • Pratico G, Caltabiano L, Ragusa R, et al (Univ of Catania, Italy)
    Bone Metabolism in Childhood Acute Lymphoblastic Leukemia (ALL) Off-Therapy 
    Int J Pediatr Hematol Oncol 5: 437-442, 1998
          
    Reduced bone mass is common in patients with ALL due to leukemia itself, and chemotherapeutic (steroids) agents.
         
    This study of 21 children diagnosed of acute lymphoblastic leukemia in first complete remission and off chemotherapy for at least 6 months were evaluated for total calcium, inorganic phosphate, magnesium, carboxy-terminal fragment of parathyroid hormone (PTH), calcitonin, 25 hydroxyvitamin D3 (25OHD), 1-25 dihydroxyvitamin D3 (1,25(OH)2D), osteocalcin (BGP) and other bone markers.
         
    The only difference was significant lower values of PTH in patients with ALL than control and 12 demonstrated hypoparathyroidism. This trend suggests re-establishment of bone mineralization, when off therapy. It may be useful to administer calcium to increase mineral anabolism. 
          

  • Matthey KK, for the Children’s Cancer Group (Univ of California, San Francisco; et al)
    Treatment of High-Risk Neuroblastoma With Intensive Chemotherapy, Radiotherapy, Autologous Bone Marrow Transplantation, and 13-cis-Retinoic Acid
    N Engl J Med 341: 1165-1173, 1999
        
    This study of 539 patients of neuroblastoma of which 129 underwent transplantation and 150 received chemotherapy.
         
    The 3 year event-free survival was significantly better for patients receiving high dose chemotherapy, radiotherapy and bone marrow transplantation than for patients receiving chemotherapy alone.
         
    In addition, among patients without progressive disease, 13-cis-retinoic acid further improved the outcome. 
         

  • Cushing B, Giller R, Ablin A, et al (Children’s Hosp of Michigan, Detroit; Children’s Hosp, Denver; Univ of California, San Francisco; et al)
    Surgical Resection Alone Is Effective Treatment for Ovarian Immature Teratoma in Children and Adolescents: A Report of the Pediatric Oncology Group and the Children’s Cancer Group 
    Am J Obstet Gynecol 181: 353-358, 1999
        
    This study of 44 patients aged 1.5 years to 20 years with completely resected ovarian immature teratoma (stage I, grades 1 and 2) did not receive chemotherapy and were followed up for recurrence.
         
    At median follow up of 4.2 years, the overall 4-year event-free survival was 97.7%. One patient, with large tumor and yolk sac involvement recurred. She received chemotherapy and is alive without recurrence for 57 months.
         
    Surgery is curative for most children with ovarian immature teratoma even when a-fetoprotein levels are elevated or microscopic foci of yolk sac tumors were found and postoperative chemotherapy to be reserved for recurrence. 
         

  • Perentesis JP, Katsanis E, DeFor TE, et al (Univ of Minnesota, Minneapolis)
    Autologous Stem Cell Transplantation for High-Risk Pediatric Solid Tumors
    Bone Marrow Transplant 24: 609-615, 1999
         
    This study done on 24 children and young adults with metastatic or relapse solid tumor underwent ASCT with two protocols MT 9408 consisting of phenytoin, busulfan, melphalan, thiotepa, and MT 8911 received etopside, thiotepa and cyclophosphamide.
        
    Survivors had Ewing sarcoma, desmoplastic small cell tumor, and relapsed or metastatic anaplastic Wilms tumor. 
        
    This report indicates improved salvage rate for high-risk Ewing’s in complete remission before ASCT; fewer patients with rhabdomyosarcoma were included in the study population. 
         

  • Cortes D, Visfeldt J, Mfller H, et al (Rigshospitalet, Copenhagen; Centre for Research in Health and Social Statistics, Copenhagen)
    Testicular Neoplasia in Cryptorchid Boys at Primary Surgery: Case Series 
    BMJ 319: 888-889, 1999
        
    Boys with cryptorchidism have a four fold high risk of testicular cancer than in general population.
        
    This study evaluated 1535 consecutive specimens of testicular tissue obtained from patients with undescended testes and recorded for malignant transformation. 
         
    In patients with intra-abdominal testes, there were abnormal external genitalia and abnormal karyotype.
        
    The risk of testicular neoplasia was significantly higher in patients with bilateral cryptorchidism (14.7%) than in unilateral cryptorchidism (9.7%).
         

  • Abramson DH, Frank CM, Dunkel IJ (New York Presbyterian Hosp; Mem Sloan-Kettering Cancer Ctr, New York)
    A Phase I/II Study of Subconjunctival Carboplatin for Intraocular Retinoblastoma 
    Ophthalmology 106: 1947-1950, 1999
         
    This study of eleven patients with retinoblastoma received subconjunctival carboplatinum 1.4 to 2.0 ml of a 10-mg/mL solution at 3 weekly interval adverse events included periorbital edema and optic atrophy.
         
    Major responses were noted in 3 of 5 eyes with vitreous disease. 2 out of 5 eyes with retinal tumors responded. This modality appears safe and effective for intraocular retinoblastoma however longer follow-up is required.
         

  • Asanuma H, Nakai H, Takeda M, et al (Tokyo Metropolitan Kiyose Children’s Hosp)
    Renal Cell Carcinoma in Children: Experience at a Single Institution in Japan 
    J Urol 162: 1402-1405, 1999
        
    Renal cell carcinoma (RCC) is rare in children as compared to Wilm’s tumor.
        
    This study of 4 Japanese children with RCC had presented with hematuria and abdominal mass and CT scan revealing characteristic classification in tumor and high density areas with microcalcification. Interferon appeared beneficial in selected patients. 
         

  • Dang NC, Siegel SE, Phillips JD (Children’s Hosp, Los Angeles; Univ of Southern California, Los Angeles)
    Malignant Chest Wall Tumors in Children and Young Adults 
    J Pediatr Surg 34: 1773-1778, 1999
        
    This study of 19 patients with chest wall tumor most common being malignant small round cell tumor (MSRCT) also known as Ewing’s family of tumors followed by rhabdomyosarcoma and other tumors.
         
    Some underwent upfront complete resection and 9 had initial biopsy followed by chemotherapy and radiotherapy. Overall survival at a median of 4 years was 42%. Localized disease had the best survival. 
         
    Most patients with MSRCT did not survive and all patients with RMS and 2 of 3 patients with embryonal RMS. The best survival was with other “malignant sarcomas”. 
        

  • Day N, for the UK Childhood Cancer Study Investigators (Univ of Cambridge, England; et al)
    Exposure to Power-Frequency Magnetic Fields and the Risk of Childhood Cancer
    Lancet 354: 1925-1931, 1999
         
    The UK childhood cancer study evaluated the electromagnetic field (EMF) measures of children and its association with acute lymphoblastic leukemia, all leukemia, CNS tumors and other malignant disease.
        
    There was no evidence that exposure to magnetic field associated with electricity supply increased risk of childhood cancers and leukemias.
      

  • Stark B, Sharon R, Rechavi G, et al (Tel Aviv Univ, Israel; Bruce Rappaport Technion, Haifa, Israel; Hebrew Univ, Jerusalem, Israel)
    Effective Preventive Central Nervous System Therapy With Extended Triple Intrathecal Therapy and the Modified ALL-BFM 86 Chemotherapy Program in an Enlarged Non-High Risk Group of Children and Adolescents With Non-B-Cell Acute Lymphoblastic Leukemia: The Israel National Study Report 
    Cancer 88: 205-216, 2000
         
    Preventive cranial radiotherapy (CRT) in children with acute lymphoblastic leukemia (ALL) although effective is complicated by neurologic problems and second malignancies. In a sub group of low risk ALL substituting CRT with intensified intrathecal is promising. 
          
    This study of 225 evaluated patients of ALL (non B-cell) on modified BMF 86 chemotherapy protocol for non-high risk children and adolescents required extended intrathecal methotrexate, cytosine arabinoside and hydrocortisone 18 times along with systemic therapy.
          
    This could provide adequate CNS protection and systemic leukemic control for this subgroup of patients. The addition of etoposide was not beneficial. 
          

  • Rodriguez-Galindo C, Ramsey K, Jenkins JJ, et al (St Jude Children’s Research Hosp, Memphis, Tenn; Univ of Tennessee, Memphis)
    Hemangiopericytoma in Children and Infants 
    Cancer 88: 198-204, 2000
          
    Hemangiopericytoma (HPC), a soft tissue neoplasm and has two distinct clinical syndrome involving adults and infants. In this study of 12 children, of which 3 infants, the results in infantile HPC were gratifying in spite of positive tumor margins. 
         
    In children older than 1 year, an aggressive behavior similar to older individuals was identified and requires aggressive treatment approach.
          

  • Mora J, Filippa DA, Thaler HT, et al (Mem Sloan-Kettering Cancer Ctr, New York)
    Large Cell Non-Hodgkin Lymphoma of Childhood: Analysis of 78 Consecutive Patients Enrolled in 2 Consecutive Protocols at the Memorial Sloan-Kettering Cancer Center 
    Cancer 88: 186-197, 2000
          
    Large cell lymphomas compromise 15-30% of childhood non-Hodgkin’s lymphomas. This study of 78 patients with stage III and IV diffuse large cell lymphoma (DLCL) received 2 consecutive regimens LSA2-L2 and LSA4.
           
    The recurrence rate was higher with CD30+ anaplastic large cell lymphoma (ALCL). 72% disease-free survival rate was noted.
          
    The authors recommended DLCL with CD30+ ALCL receive aggressive induction therapy as for B-cell lymphomas along with prolonged period maintenance without CNS prophylaxis.
          

  • Hovi L, Saarinen-Pihkala UM, Vettenranta K, et al (Univ of Helsinki; Univ of Oulu, Finland)
    Growth in Children With Poor-Risk Neuroblastoma After Regimens With or Without Total Body Irradiation in Preparation for Autologous Bone Marrow Transplantation 
    Bone Marrow Transplant 24: 1131-1136, 1999
          
    This study of 31 patients of poor risk neuroblastoma treated with myeloablative preparative regimens and autologous BMT of which, group I were 15 patients without TBI and group II with TBI.
          
    Those who received TBI have poor growth after ABMT and those without TBI had growth close to normal. Clinicians should evaluate the need for growth hormone therapy early to maximize final height
           

  • Hasle H, Clemmensen IH, Mikkelsen M (Aarhus Univ, Denmark; Danish Cancer Society, Copenhagen; John F Kennedy Inst, Glostrup, Denmark)
    Risks of Leukaemia and Solid Tumors in Individuals With Down’s Syndrome 
    Lancet 355: 165-169, 2000
          
    The association of Down’s Syndrome (DS) with leukemia is well known. This study of 2814 individuals with DS, from Danish Cytogenetic Register and linked with the Danish Cancer Registry were evaluated.
          
    Sixty cancer cases occurred among these patients and 97% of cases of malignant diseases in children. The cumulative risk of leukemia was 2.1% by 5 years of age and 2.7% by 30 years of age.
          
    No leukemia cases occurred beyond 29 years of age. Of the great interest was the fact there was a decreased risk of solid tumors in all age groups.
           

  • Welch Dinauer CA, Tuttle RM, Robie DK, et al (Walter Reed Army Med Ctr, Washington, DC; Uniformed Services Univ of the Health Sciences, Bethesda, Md)
    Extensive Surgery Improves Recurrence-Free Survival for Children and Young Patients With Class I Papillary Thyroid Carcinoma 
    J Pediatr Surg 34: 1799-1804, 1999
          
    Papillary thyroid cancer (PTC) in children is rarely fatal but with multifocality, the risk of recurrence is high.
            
    This study of 37 patients with class I PTC who were 21 years or younger were evaluated. Those treated with lobectomy with or without isthmusectomy had higher recurrence than patients with subtotal or total thyroidectomy.
          
    The incidence of complications was comparable and hence more extensive surgery in children with class I PTC is associated with lower risk of recurrence.
          

  • Dubois J, Hershon L, Carmant L, et al (Universite de Montreal)
    Toxicity Profile of Interferon (IFN) Alfa-2b in Children: A Prospective Evaluation 
    J Pediatr 135: 782-785, 1999
          
    This study of 53 children treated with IFN alfa-2b for diseases such as hemangiomas, juvenile laryngeal papillomatosis and occasionally for chronic viral hepatitis.
         
    However, most patients had more than one event of grade I toxicity, neurologic toxicity with somnolence was most significant. In general, children tolerate IFN-alfa therapy well.
           

  • Garaventa A, Bellagamba O, Lo Piccolo MS, et al (Giannina Gaslini Children’s Hosp, Genova, Italy; Galliera Hosp, Genova, Italy) 
    131I-Metaiodobenzylguanidine (131I-MIBG) Therapy for Residual Neuroblastoma: A Mono-institutional Experience With 43 Patients 
    Br J Cancer 81: 1378-1384, 1999
           
    This study on 43 children with stage 3 or stage 4 neuroblastoma treated and had failed to respond completely after first line protocol received 131I-MIBG.
          
    This improved the cure rate of stage 3 and response in those with stage 4 neuroblastoma however, with long-term toxicity such as acute leukemia and poor thyroid reserve.
           

 

 

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