[Improved results in children with acute lymphoblastic leukemia treated with the ALL-BFM 90 protocol in the Czech Republic]. / Zlepsení výsledku lécby detí s akutní lymfoblastickou leukémií podle protokolu ALL-BFM 90 v Ceské republice.

BACKGROUND: Prognosis of children with acute lymphoblastic leukaemia (ALL)--the most common cancer in childhood, has improved remarkably over the last 40 years. The authors report the treatment outcome in children with ALL cured according to ALL-BFM 90 Study protocol in the Czech Republic during the first half of nineties. METHODS AND RESULTS: Children aged 0-18 years were included into the study in 10 centers between 1990 to 1996. Patients were classified into standard-risk (SR), medium-risk (MR) and high-risk (HR) group according to initial leukaemic burden, early treatment response, and genotype of leukaemia. Duration of the chemotherapy was two years. Treatment results were evaluated in 352 children. With a median follow-up of 7.3 years, event-free-survival (EFS) was 71.3% and overall survival 76.4%. EFS was 80.3%, 74% and 28.2% in SR, MR and HR group, respectively. Relapse was diagnosed in 17.8% of the patients. CONCLUSIONS: The treatment outcome of children with ALL improved significantly (p = 0.0045) compared to the previous study ALL-BFM 83 (EFS 62%). These results are comparable to those achieved by leading leukaemia study groups in the world.

The technique of craniospinal irradiation in the management of intracranial ependymomas.

PURPOSE: To present a new technique of craniospinal irradiation as a postoperative prophylactic treatment in patients with intracranial ependymomas being at risk for relapse. PATIENTS AND METHODS: In the last 3 years, 9 pediatric patients under 15 years of age with grade 2-4 ependymomas located infratentorially received postoperative craniospinal axis radiotherapy by a new technique developed in our department. This technique was based on a proper usage of the asymmetric jaws of the linear accelerator. In whole brain and cervical spine irradiation (with the caudal border at C3-C4 level), two opposite lateral fields were chosen with shielding blocks of the eye bulbs and the face part of the scull. The spinal cord was irradiated from C3 to S2-4 with two direct radiation fields using asymmetric jaws as well. Doses of 35 Gy to the whole craniospinal axis and 54 Gy to the tumor bed were delivered. In cases of residual tumor doses were increased up to 58-60 Gy. RESULTS: Radiotherapy was well tolerated and dose reduction was not needed in any case. Skin reactions were mild in all patients. The gastrointestinal and hematological toxicity were also mild to moderate (World Health Organization - WHO grade 1-2). Four patients also received postirradiation chemotherapy because of large tumor size and unfavorable histology. Six patients entered clinical and imaging complete remission (CR) for a median of 22 months (range 14-30 months). The evaluation of the effectiveness of the method was limited by the short follow-up interval. CONCLUSION: The proposed new technique of craniospinal irradiation in the postoperative management of highrisk ependymomas is advantageous in terms of side effects and could be recommended for wide usage.

[Use of central venous catheters in children with hematologic neoplasms from the viewpoint of the pediatric surgeon]. / Pohled detského chirurga na pouzití centrálního zilního katétru u hematologicko-onkologicky nemocných detí.

Venous access by cannulation of the central vein is a necessary prerequisite of the oncological treatment. Within the period 1998-2001 there 395 CVCs (Central Venous Catheters) were introduced using a subcutaneous tunnel in 335 hospitalised patients at the Clinic of the Child Surgery, Orthopaedics and Traumatology FN Brno. In 310 patients Hickman CVC was used and in 25 Groshong CVC. Using the vena subclavia 1. dx., 131 CVCs were introduced, via the vena subclavia 1. sin. 264 CVCs. The average period of CVCs introduction was 3 months. In 78 introduced CVCs infectious complication developed. A local infection was noticed only 8 times, general infection at 70 cases. In 13 patients CVCs had to be removed. The authors present their experience with the introduction of tunneled CVCs in oncological patients and the options for solving the infectious complications when using CVCs.