Radiotherapy for craniopharyngioma in children: a national audit.

A survey of current radiotherapy practices in the United Kingdom for treatment of craniopharyngioma in children was undertaken in view of the need to optimize control and minimize side effects in a patient group who can expect to survive for prolonged periods after treatment. Useable replies were received from 16 practitioners. A high level of conformity was reported in some areas but practice varied considerably in others. Thus whereas 15 employed magnetic resonance imaging (MRI) alone or with computed tomography (CT) to establish the gross tumour volume (GTV), six exclusively used pre-operative and seven exclusively used post-operative studies. Twelve added a margin of 1 cm to establish the planning target volume (PTV). Nine used CT planning. Fourteen gave radiation doses of between 50 and 55 Gy, but eight different dose/fractionation combinations were used. The most favoured regime (used by six) was 50 Gy in 30 fractions. Two centres provided written information on possible side effects of treatment. We suggest that it might prove helpful if a national treatment protocol was developed.

Lateralized cognitive deficits in children following cerebellar lesions.

The aim of this preliminary study was to examine the developing cognitive profiles of children with cerebellar tumours in a consecutive series of clinical patients. MRI and longitudinal intellectual profiles were obtained on seven children (two females, five males; mean age 3 years at diagnosis; mean age 7 years at first assessment). Tumours in three of the children were astrocytomas; of the remaining tumours, two were medulloblastomas, one low-grade glioma, and one ependymoma. In right-handed children, we observed an association between greater damage to right cerebellar structures and a plateauing in verbal and/or literacy skills. In contrast, greater damage to left cerebellar structures was associated with delayed or impaired non-verbal/spatial skills. Long-term cognitive development of the children studied tentatively supports a role for the cerebellum in learning/development. These findings suggest that lateralized cerebellar damage may selectively impair the development of cognitive functions subserved by the contralateral cerebral hemisphere and, in addition, that all children with cerebellar lesions in early childhood should routinely undergo long-term monitoring of their intellectual development.

Acute abdomen during adjuvant chemotherapy: superior mesenteric artery thrombosis associated with CMF chemotherapy.

We report a case of superior mesenteric artery thrombosis in a 57-year-old woman undergoing chemotherapy for T1N1M0, breast cancer. Although cancer itself is associated with an increased risk of thrombotic events, treatment with chemotherapy and/or tamoxifen in breast cancer patients increases this risk. Most cases reported are of venous thromboembolism; arterial events are rare.

Shoulder movement after the treatment of early stage breast cancer.

At 18 months after surgery and post-operative radiotherapy, the function of the ipsilateral shoulder joint was assessed both subjectively and objectively in 141 patients with early stage breast cancer. Half of the patients said that function was reduced compared with before (any) treatment. Overall, 48% had measured limitation of at least one shoulder movement. Mastectomy patients had more problems than those who had a wide local excision (79% versus 35%) as did those (node positive patients) who had axillary irradiation (73%) compared with those who did not (35%). Patients with dysfunction of shoulder movement before radiotherapy had a 60% chance of persistent movement problems at 18 months, compared with 24% of those with normal postoperative function. Informal exercise did not appear to have had any impact on the development of movement limitation.

Reduction in the diameter of human hairs following irradiation.

A measurable reduction in hair diameter was observed in human hairs following single exposures to gamma-rays, 250 KeV X-rays, 8 MV photons and 10 MV electrons in the range 2.9-14.0 Gy. The data from the different types of radiation were pooled and fitted by linear regression with a slope of 2.34 +/- 0.42% Gy-1. There was approximately 2.4% reduction in hair diameter per Gy exposure. It would appear that the measurement of damage to the matrix cells of growing human hairs exhibits potential for use in biological dosimetry, especially in cases of non-uniform overexposure.