effect of dose-volume parameters on central nervous system relapse in pediatric patients with acute leukemia receiving prophylactic cranial irradiation

Aim of the study: To investigate the effects of dose-volume parameters of brain parenchyma, optic nerves [ONs] and cribriform plate [CP], which were determined on central nervous system [CMS] control in pediatric leukemia patients who have undergone prophylactic cranial irradiation [PCI] at our department

Patients and Methods: In the current study, the records of 14 patients were examined retrospectively. Along with the minimum and maximum doses for brain and CP, D95% [minimal dose received by the 95% volume of a structure] and V95% [percent volume of target receiving 95% of prescribed dose] could be obtained from the dose-volume histogram. Statistical analyses were conducted using the Mann Whitney test in SPSS-15

Results: ALL/AMI ratio was 9/5. CMS relapse was observed only in 2 patients. The minimum dose was 1249 [1100-1782] cGy, 1036 [547-1651] cGy, 856 [308-1460] cGy and 1234 [922-1727] cGy for brain parenchyma, right ON, left ON and CP, respectively. The value of D95%/D was 1,01 [1-1.06] and 0.99 [0.92-1.06] for brain parenchyma and CP, respectively. V95% was 99.8% [98.6%-100%] and 98.1% [80.5%-100%] for brain parenchyma and CP, respectively. The analyses revealed that none of the target tissue dose-volume parameters for PCI affected CNS relapse [p>0.05]

Conclusion: In our study; it was found that the dose-volume parameters of the brain, CP and ONs did not have any effect on CNS relapse. Along with the other clinical factors, the scarce number of patients included in the study might have concealed the effects of parameters related to RT.

Isolated hemihyperplasia in an infant: an overlooked sign for Wilms tumor development

Children with overgrowth syndromes including isolated hemihyperplasia have an increased risk for developing embryonal tumors, particularly Wilms' tumor and hepatoblastoma. Screening with sonography has been suggested as a method of identifying these tumors while they are still at an early stage. We describe an infant diagnosed with Wilms tumor in whom isolated hemihyperplasia had been overlooked by several physicians prior to the tumor diagnosis. We recommend tumor surveillance for all patients with Beckwith-Wiedemann syndrome and isolated hemihyperplasia at least for the first six years of life since full molecular characterization of every patient is not readily available