ABSTRACT
OBJECTIVE@#To study the efficacy and safety of intensity-modulated radiotherapy (IMRT) in children with high-risk neuroblastoma (NB).@*METHODS@#A retrospective analysis was performed on the medical data of 24 children with high-risk NB who were diagnosed and treated with IMRT in the Department of Hematology and Oncology, Hunan Provincial People's Hospital, from April 2018 to December 2020. The medical data included age, radiotherapy dose, times of radiotherapy, laboratory examination results, adverse reactions, and survival.@*RESULTS@#All 24 children (14 boys and 10 girls) received IMRT, with a mean age of (65±23) months and a median age of 59 months. The primary tumor was located in the abdomen in 23 children and 1 child had primary tumor in the mediastinum. The median age was 41.5 months at the time of radiotherapy. The radiation dose of radiotherapy ranged from 14.4 to 36.0 Gy, with a mean dose of (22±3) Gy and a daily dose of 1.8-2.0 Gy. The radiotherapy was performed for a total number of 8-20 times, with a mean number of 11.9 times. Among these children, 6 received radiotherapy for the residual or metastatic lesion. Of all the 23 children, 3 experienced cough, 2 experienced diarrhea, and 1 experienced vomiting during radiotherapy. At 2 weeks after radiotherapy, serum creatinine ranged from 2.3 to 70.1 μmol/L and alanine aminotransferase ranged from 9.1 to 65.3 μ/L. Ten children experienced grade Ⅲ bone marrow suppression and 2 experienced grade Ⅳ bone marrow suppression 1 to 2 weeks after radiotherapy. Four children experienced grade Ⅲ bone marrow suppression and 1 experienced grade Ⅳ bone marrow suppression 3 to 4 weeks after radiotherapy. During a median follow-up time of 13.5 months, 23 children (96%) achieved stable disease and 1 died. Up to the follow-up date, second malignant tumor or abnormal organ function was not observed.@*CONCLUSIONS@#IMRT can improve the local control rate of NB. IMRT appears to be safe in the treatment of children with NB.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Neuroblastoma/radiotherapy , Radiotherapy Dosage , Radiotherapy, Intensity-Modulated/adverse effects , Retrospective StudiesABSTRACT
Resumen: Introducción: El tratamiento del neuroblastoma en estadios avanzados incluye quimioterapia, cirugía y terapia con I131-Metayodo benzilguanidina (I131-MIBG). La disfunción tiroidea se reporta entre 12 y 85% a pesar de la protección tiroidea. Objetivo: Identificar la frecuencia de disfunción tiroidea en casos de neu roblastoma tratados con I131-MIBG. Pacientes y Método: Estudio transversal. Se incluyeron todos los casos con diagnóstico de neuroblastoma que recibieron I131-MIBG en el periodo de 2002-2015, a los cuales se les realizó antropometría completa, perfil de tiroides: hormona estimulante de tiroides (TSH), Triyodotironina total y libre (T3t y T3l), tiroxina total y libre (T4t, T4l), y anticuerpos antitiroglobulina y antiperoxidasa. Resultados: Se identificaron un total de 27 pacientes; once fallecieron (40%). De los 16 casos sobrevivientes, 9 (56%) presentaron disfunción tiroidea: 2 (13%) casos con hipotiroidismo subclínico y 7 (44%) casos con hipotiroidismo clínico (3 casos por retraso en el desa rrollo psicomotor y 4 por desaceleración del crecimiento). Los pacientes presentaron manifestaciones clínicas a los 16,1 meses (1,2-66,3 meses) de recibir el radiofármaco a una dosis acumulada de 142 mCi (96-391.5 mCi). No se logró evidenciar diferencias en la edad al diagnóstico, la edad al inicio del tratamiento con el I131-MIBG, la dosis acumulada del I131-MIBG y el tiempo trascurrido entre la dosis y el perfil tiroideo entre los casos con o sin disfunción tiroidea. Conclusiones: El 56% de los pacientes con neuroblastoma presentaron disfunción tiroidea. La mayoría de los casos con hipotiroidismo fue ron referidos cuando los datos de disfunción tiroidea eran clínicamente evidentes. Se propone en esta poblacion realizar perfil tiroideo semestral y valoración anual por un endocrinólogo pediatra durante los primeros 5 años posteriores al diagnóstico oncológico.
Abstract: Introduction: The treatment of advanced neuroblastoma includes chemotherapy, surgery, and radiotherapy with 131-I-Metaiodobenzylguanidine (131-I-MIBG). Despite strategies to protect thyroid function, its dysfunction is reported between 12 and 85%. Objective: To identify the frequency of thyroid dys function in cases of neuroblastoma treated with 131-I-MIBG. Patients and Method: Cross-sectional study. We included all the cases with neuroblastoma treated with 131-I-MIBG between 2002 and 2015, with complete somatometry, and complete thyroid profile (TSH, free and total T3 and T4, and anti-thyroglobulin and antiperoxidase antibodies). Results: 27 patients were identified out of which eleven died (40%). Out of the 16 surviving cases, 9 (56%) presented thyroid dysfunction: 2 (13%) cases with subclinical hypothyroidism and 7 (44%) cases with clinical hypothyroidism (3 cases due to psychomotor developmental delay and 4 due to growth deceleration). The patients presented cli nical manifestations at 16.1 months (1.2-66.3 months) after receiving the radiopharmaceutical at acumulative dose of 142 mCi (96-391.5 mCi). No differences were found in the age at diagnosis, age at the start of treatment with 131-I-MIBG, the cumulative dose of 131-I-MIBG, and the time elapsed between the dose and the thyroid profile among the cases with or without thyroid dysfunction. Con clusions: 56% of patients with neuroblastoma had thyroid dysfunction. Most of the cases with hypothyroidism were referred when thyroid dysfunction was clinically evident. A thyroid profile should be performed every 6 months, along with an annual endocrinological evaluation during the next 5 years in these patients.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Radiopharmaceuticals/adverse effects , 3-Iodobenzylguanidine/adverse effects , Hypothyroidism/etiology , Iodine Radioisotopes/adverse effects , Neuroblastoma/radiotherapy , Thyroid Diseases , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Radiopharmaceuticals/therapeutic use , 3-Iodobenzylguanidine/therapeutic use , Hypothyroidism/diagnosis , Hypothyroidism/epidemiology , Iodine Radioisotopes/therapeutic useABSTRACT
Neuroblastoma is predominantly a tumor of early childhood, most cases occur in children under 5 years old. It originates in the adrenal gland and paravertebral ganglion cells (neural crest-derived), being the most common an extracranial solid tumor in children. It is characteristic a spontaneous regression, However in some cases it shows progression and dissemination to other organs. Objetive: To show a neuroblastoma in adolescence, with poor response to chemotherapy and radiotherapy, requiring surgery treatment. Clinical case: A 16 y.o. Female patient, previously asymptomatic, who after a body temperature rise up to 39 ° C, was found to have a tumor in the right hemithorax. Biopsy was compatible with neuroblastoma. Surgical removal of a large 20 x 19 cm tumor was achieved, the only complication presented 10 days postop was recurrent pneumothorax. Conclusion: Despite little or no response to standard treatment, surgical resection of this large tumor achieved complete remission for this patient.
El neuroblastoma es predominantemente un tumor de la infancia temprana que en la mayoría de los casos se presenta en menores de 5 años. Se origina en la glándula suprarrenal y células ganglionares paravertebrales (derivadas de la cresta neural), siendo el tumor sólido extracraneal más común en pediatría, presenta regresión espontánea en algunos casos y en otros progresión y diseminación a otros órganos. Objetivo: Analizar el caso de una adolescente portadora de un neuroblastoma resistente a quimioterapia y radioterapia, que requiere tratamiento quirúrgico. Caso clínico: Paciente asintomática, edad 16 años, que a raíz de alza febril se le detecta un tumor en hemitórax derecho. La biopsia fue compatible con un neuroblastoma. Se realizo la extirpación quirúrgica de un gran tumor con diámetro de 20 cm x 19 cm. A los 10 días se complica con neumotórax recidivante. Conclusión: A pesar de la poca o nula respuesta a las armas terapéuticas habituales: quimioterapia y radioterapia, la cirugía logró la resección del tumor torácico con remisión completa.
Subject(s)
Humans , Female , Adolescent , Thoracic Neoplasms/surgery , Neuroblastoma/surgery , Thoracic Neoplasms/diagnosis , Thoracic Neoplasms/drug therapy , Thoracic Neoplasms/radiotherapy , Neuroblastoma/diagnosis , Neuroblastoma/drug therapy , Neuroblastoma/radiotherapy , Treatment OutcomeABSTRACT
Neuroblastoma is the most common intra-abdominal malignancy of infancy and the most common extra cranial solid tumor of childhood. Compared to any other tumour, this, tumour has varied clinical presentation and has great differences in distribution and respond to therapy. Although there have undoubtedly been major advances in therapy over recent decades, there is still room for significant improvements in outcome to be made. To review the clinical behaviors, management options and outcome of pediatric retroperitoneal neuroblastoma, treated at Sohag university hospital and to highlight on some prognostic factors affecting the outcome. Thirteen children with abdominal neuroblastoma were diagnosed and treated between April 1997 and April 2004 at surgery department of Sohag university Hospital. The data included the age, sex, clinical presentation, duration of symptoms, primary anatomic site, size, stage of the tumour, metastatic site if present, histopathology, modalities of treatment and prognostic factors. Patients were stratified as stage 1, 2A, 2B, 3, 4, 4S according to the post surgical International Neuroblastoma Staging System [INSS]. Thirteen patients were encountered. There were seven males and six females. Their ages ranged from 9 months to 5 years. The mean age was 1.8 years. Clinical presentation included painless abdominal swelling in7patients [54%], abdominal pain in 5 [38%], vomiting in 5 [38%], fever in 4 [30%], diarrhea in 2 [15%] and loss of weight in 2 [15%]. Duration of symptoms was from 2 weeks to 8 months, the mean duration was 1 1.5 weeks. Primary sites of involvement included: general retroperitoneal space in 8 patients [62%], the pelvis in 3[23%] and adrenal in 2 patients [15%], site of metastasis was the liver in 3, bone marrow in 4, cortical bone in 2 and distant lymph nodes in 3 patients. According to [INSS], stage 2B in 3, stage 3in 3, stage 4in 3 and stage 4s in 4 patients. Pathological features showed: neuroblastoma in 9 patients [70%], gangiloneuroblastoma in 3 [23%] and Ganglloneuroma in one patient [7%]. All cases were subjected to surgery, where complete excision was done in 7, total nephrectomy in 2. partial exision in 2 and only biopsy in 2 patients. All patients were subjected to postoperative chemotherapy. 6 patients to postoperative radiotherapy. Overall survival rates at 3 years at different stages were as followed: Stage 2: 100%; Stage 3: 33.3%; Stage 4: 0%: and Stage 4S: 100%. The overall survival rate during 3years follow up was 61.5% [5 out of 13 patients] died. Mortality rate is 38.5%. The tumour growth rates of neuroblastoma in age < two years are quicker than in age > two years. Wide local excision with retroperitoneal lymphadenectomy is the treatment of choice in operable cases. Neuroblastoma in pediatrics age group patients is more sensitive to chemotherapy than in older children. Factors of favorable prognosis are infants and children less than two years, stage 1, 2, and .48, the tumour site at the pelvis or retroperitoneal, low level of N.S.E and favorable histology
Subject(s)
Humans , Male , Female , Retroperitoneal Neoplasms , Child , Neuroblastoma/surgery , Neuroblastoma/radiotherapy , Chemotherapy, Adjuvant , Prognosis , Follow-Up Studies , Survival RateABSTRACT
O trabalho tece consideraçoes gerais sobre o conceito e características dos neuroblastomas, estuda sua incidência, etiologia e quadro clínico do tumor primário e das metástases, analisa os critérios diagnósticos, estadiamento do tumor, fatores prognósticos e tramento
Subject(s)
Humans , Male , Infant , Neuroblastoma/surgery , Neuroblastoma/diagnosis , Neuroblastoma/etiology , Neuroblastoma/drug therapy , Neuroblastoma/radiotherapy , Neuroblastoma/epidemiology , Neoplasm Staging , Neoplasm Metastasis , PrognosisABSTRACT
A partir do relato da experiência de uma criança portadora de câncer, de sua família e dos profissionais responsáveis pelo caso säo abordadas e formas de atuaçäo da equipe de saúde na área de Oncologia pediátrica säo sugeridas
Subject(s)
Child , Adolescent , Humans , Female , Brain Neoplasms/therapy , Neuroblastoma/surgery , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Mother-Child Relations , Neuroblastoma/drug therapy , Neuroblastoma/radiotherapy , Patient Care Team , Reoperation/psychology , Sick RoleABSTRACT
Los autores muestran la desorganización del desarrollo dentario en tres niños que han recibido radiaciones y una quimioterapia antimitótica. Ellos piensan que, en esos casos, la quimioterapia induce anomalías dentarias y, en un caso, un efecto acumulativo o de potenciación de radiaciones por la quimioterapia que no puede ser excluido. Los efectos secundarios de las irradiaciones sobre el sistema dentario son frecuentemente incorporados en los estudios de larga duración en niños que sobreviven a un cáncer. Las incidencias sobre el desarrollo de la dentición son varias: agenesia(s) dentarias(s), microdoncia, interrupción en el crecimiento de las raíces, raíces cortas y en V, cierre prematuro de los ápices, hipoplasia adamantina. Por el contrario, los efectos producidos por los quimioterápicos sobre el desarrollo de la dentición son mucho menos conocidos y son objeto de pocas publicaciones. La casi totalidad de los estudios han sido hechos sobre animales. Nos ha parecido por lo tanto interesante incluir tres observaciones de niños tratados muy tempranamente con quimoterápicos (un caso) y radioterapi + quimioterapia (dos casos). Estos pacientes, de 10 años y medio, 11 años y 16 años de edad, son actualmente seguidos en consulta ortodóncica y presentan daños en su sistema dentario que puden ser atribuidos principalmente a la quimioterapia
Subject(s)
Abnormalities, Radiation-Induced , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Tooth Abnormalities/etiology , Abnormalities, Drug-Induced , Radiotherapy/adverse effects , Tooth Abnormalities/chemically induced , Histiocytic Sarcoma/drug therapy , Histiocytic Sarcoma/radiotherapy , Neuroblastoma/drug therapy , Neuroblastoma/radiotherapy , Rhabdomyosarcoma/drug therapy , Rhabdomyosarcoma/radiotherapyABSTRACT
Los tumores del sistema nervioso central representan el tumor sólido más común en la edad pediátrica, sin embargo los neuroblastomas primarios del sistema nervioso central son raros, correspondiendo al 1% de todos los tumores del cerebro. Este tumor es más común durante la primera década de vida. Este tumor es altamente celular y frecuentemente forma rosetas tipo Homer Wright. El presente artículo es la revisión de dos casos diagnosticados en el Departamento de Radioterapia de la Universidad de Puerto Rico. Luego de revisar la literatura médica podemos concluir que el tratamiento de este raro tumor debe ser excisión radical del tumor, de ser posible, seguido de radioterapia post operatoria al sistema nervioso central. De acuerdo a la literatura médica no se justifica la irradicación profiláctica a la columna vertebral ni la administración de quimioterapia