Radiation therapy in the neonate.

Radiation therapy (RT) is frequently used in the management of children with cancer, but neonatal neoplasms are rare. Newborns represent 1.5% of the children with malignant diseases in the Tumor Registry at the Children's Hospital of Philadelphia over the last 30 years. Thus, occasionally the pediatrics radiation therapist must consider treating the very young infant. The specific radiation effects on growth and development must be weighed in reaching a therapeutic decision. All children are vulnerable to the late effects of radiation therapy, but the neonates may be more susceptible because of the immaturity of important organs such as the brain, lung, liver, kidney, and bone. In general, radiation therapy, should be avoided during the first several weeks of life because of the potential increased sensitivity of the liver and kidneys during that period. If radiation therapy is used at all during infancy, the benefits must be weighed against the possibility of significant late effects. Increasing knowledge of pediatric neoplasms has shown that some tumors (such as mesoblastic nephroma) require no treatment except for surgical excision; and other tumors, such as Stage IV-S neuroblastoma, may require very little treatment. In those tumors that require radiation therapy, the use of chemotherapy may allow reduction of the radiation dose. Furthermore, alterations of time-dose-fractionation schemes and careful attention to tumor volume with the use of special techniques, such as "shrinking fields," may decrease the late adverse effects of treatment.

Perinatal subglottic and hepatic hemangiomas as potential emergencies: effect of radiotherapy.

The authors analyze 5 cases of perinatal hemangiomas in internal localizations respresenting relative or immediate emergencies. Three cases were subglottic proliferating hemangiomas with threatening suffocation, the other two were large hemangiomas of the liver causing conspicuous hepatomegaly. In 3 children there were also hemangiomas of the skin and/or in the oral cavity seen as important signs in the diagnostic reflections on the nature of the urgent clinical pictures. Moreover one child with subglottic hemangioma suffered from hematological disorders characterizing the syndrome Kasabach--Merritt. In all the children transcutaneous radiotherapy was performed (ranging from 12 Gy in two weeks up to an exceptional dose of 25 Gy over 3 months). This was followed by recession of subjective complaints and, eventually, by complete regression of the irradiated angiomatous lesions, both subglottic and hepatic. The disorders of hemocoagulation disappeared also quickly and completely. At present, i. e. after 3 to 21 years, there are no undersirable post-irradiation changes in any of the patients. Nevertheless, in view of possible post-irradiation effects, particularly on the thyroid gland, the patients continue to be regularly followed up at the respective clinical departments.

Skeletal effects of megavoltage irradiation in survivors of Wilms' tumor.

The skeletal effects of megavoltage irradiation (60Co) in 25 long term survivors of Wilms' tumor are described. In general, the changes seen with megavoltage irradiation are as frequent but not as severe as those previously reported after orthovoltage irradiation. Vertebral body changes generally occur within 5 years after irradiation. Scoliosis and/or kyphosis do not usually develop until after five years postirradiation. Kyphotic curves tend to progress after the adolescent growth spurt while scoliotic curves do not. Other bony and nonosseous changes are detailed.

Carcinoma of the male breast following thymic irradiation.

A white male teenager with carcinoma of the breast had received radiation therapy for an asymptomatic enlarged thymus on the second, fourth and seventh days of life. The dose delivered to the infant breasts, the latent period, and the unusually young age of the patient suggest that the malignancy was related to the course of radiotherapy.