[Pain in adolescents with cancer.]. / Les douleurs de l'adolescent atteint d'un cancer.

Adolescence is a transitional period between childhood and adulthood that can be difficult to cross. The disease is often lived as supplementary suffering, as the word cancer is often linked to a long, painful and lethal disease. The teenager presenting cancer has several obstacles to overcome: his adolescence, his cancer disease and his pain. Pain can be present throughout the cancerous disease: at diagnosis, in case of relapse, or in the event of terminal tumor progression. Pain can be difficult to assess in adolescents who are opposed to treatments or to healthcare. Pain management must be discussed with a multidisciplinary team and has to have a holistic approach including drug therapy and complementary approaches.

Urate-oxidase in the prevention and treatment of metabolic complications in patients with B-cell lymphoma and leukemia, treated in the Société Française d'Oncologie Pédiatrique LMB89 protocol.

PURPOSE: To evaluate the frequency of metabolic complications and dialysis due to tumor lysis syndrome in patients with B-cell advanced-stage non-Hodgkin's lymphoma (NHL) and L3 leukemia at initiation of chemotherapy including the use of urate-oxidase. PATIENTS AND METHODS: Retrospective review of the clinical records of 410 patients with stage III and IV B-cell NHL and L3 leukemia treated in France and prospectively registered in the LMB89 protocol. RESULTS: During the first week of chemotherapy, only 34 of 410 patients recorded metabolic problems that included hypocalcemia (< 70 mg/dl) in 24 patients, hyperphosphatemia (> 6.5 mg/dl) in 28 and elevation of creatinine > or = 2 SD in 16. Six patients underwent dialysis for life-threatening problems and a seventh as a preventive measure. In the other 27 cases, metabolic problems were successfully resolved using urate-oxidase in combination with alkaline hyperhydration. Among the 410 patients, one case of hemolysis was reported and there was no severe allergic reaction to urate-oxidase. CONCLUSIONS: Only 1.7% of patients in our study receiving urate-oxidase during their induction chemotherapy needed renal dialysis. Urate-oxidase was well tolerated, and used as prophylaxis and/or treatment of hyperuricemia and tumor lysis syndrome consistently gave a lower rate of renal and metabolic complications than in other series of similar patients.

[Pediatric aspects of anthracycline cardiotoxicity and practical implications for prevention]. / Aspects pédiatriques de la toxicité cardiaque des anthracyclines et implications pratiques pour sa prévention.

Discovered during the sixties, anthracycline antibiotics are today widely used anti-cancer drugs. Their potentially fatal cardiac toxicity, which is related in part to the total cumulative dose, has been described since 1967. The aim of this paper is to describe their biological and clinical toxic effects on the heart, especially of children, and to propose prevention guidelines. The mechanisms of cardiac toxicity, with their destructive consequences on functional myocytes reserve, are shortly recalled. Acute, sub-acute and chronic clinical aspects of anthracycline's cardiomyopathy are the subject of a literature review. In Pediatric Oncology, the prolonged survival usually observed allows delayed congestive heart failure to occur by myocardial reserve insufficiency, as hemodynamic needs are quickly increasing, especially at the end of the somatic growth. Furthermore, the frequency of cardiac abnormalities is increasing with time after therapy, reaching about half of the explored patients after 15 years. The main known methods to prevent such a toxicity are reviewed. The parcimonious use of anthracyclines is already seen in children. Every method to decrease the maximal plasma concentration of the drug (weekly schedule or prolonged infusion) has to be considered. The active cardioprotectant agent such as ICRF-187, is in clinical development. Detection, prevention, and therapy of cardiac abnormalities, which are likely to precede delayed heart failure, still remains a difficult problem in these more and more numerous children to be cured of cancer.

[Research on bone marrow involvement in the diagnosis of solid tumors in children. Methods, results and interpretation]. / Recherche d'un envahissement de la moelle osseuse lors du diagnostic de tumeur solide chez l'enfant. Méthodes, résultats et interprétation.

The assessment of bone marrow involvement by tumor cells remains an essential problem at diagnosis in pediatric solid tumors. Besides the conventional cytological and histological methods, some modern cell density separation techniques have been described in order to improve the detection of minimal or scattered bone marrow involvement. Immunological or genetical (molecular biology) tools can be used for the recognition of separated cells. In terms of investigations, MRI and MIBG radionucleide scan, although giving no definite proof, have the ability to macroscopically study the scattering of bone marrow invasion in the particular case of neuroblastoma. In some pediatric tumors, especially neuroblastomas and non Hodgkin lymphomas, an extensive bone marrow investigation is mandatory at diagnosis. Such an investigation is only necessary in case of particular criteria at diagnosis of Hodgkin's disease, Ewing' sarcomas, rhabdomyosarcomas and retinoblastomas. All other pediatric solid tumors do not need to be investigated in terms of bone marrow involvement at diagnosis, with the exceptions of advanced disseminated disease or if an autologous bone marrow transplantation is planned.