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Hayashi K, Mori M, Sanmoto Y, Oiki H, Ishimaru T, Arakawa Y, Koh K, Kawashima H. Relationship between the timing of chemotherapy and surgical complications following surgical biopsy in children with malignant solid tumors. Pediatr Blood Cancer 2023; 70:e30030. [PMID: 36184783 DOI: 10.1002/pbc.30030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/07/2022] [Accepted: 09/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biopsies for diagnosis before chemotherapy is common in children with malignant solid tumors. Wound healing is delayed by chemotherapy; however, the ideal interval between biopsy and chemotherapy remains unknown. We aimed to summarize the relationship between chemotherapy timing and postoperative surgical complications. PROCEDURE We retrospectively reviewed patients with malignant solid tumors who underwent chemotherapy after surgical biopsy at our institution between January 2014 and August 2020. The primary outcomes were postoperative surgical complications (within 30 days) and the timing of chemotherapy. RESULTS Forty-three patients were analyzed. The types of tumors were neuroblastoma (n = 20), hepatoblastoma (n = 10), Ewing sarcoma (n = 5), germ cell tumor (n = 3), angiosarcoma (n = 1), clear cell sarcoma (n = 1), ganglioneuroblastoma (n = 1), rhabdoid tumor (n = 1), and rhabdomyosarcoma (n = 1). The operative procedures were thoracoscopy (n = 5), laparotomy (n = 17), laparoscopy (n = 14), and superficial (n = 7). The median time [range] to chemotherapy after biopsy was 4 [0-21] days. No surgical complications occurred before chemotherapy, and two (4.7%) patients experienced complications after chemotherapy. These included postoperative hemorrhage (grade 3) and surgical site infection (grade 1). Chemotherapy was initiated 1 and 6 days after biopsy, respectively, in these cases. Complications occurred 10 and 23 days after biopsy, respectively. CONCLUSION The rate of postoperative surgical complications related to biopsy seems acceptable, even when chemotherapy was initiated in the early postoperative period. Early initiation of chemotherapy after biopsy may be a suitable option, particularly in children with bulky or symptomatic malignant solid tumors.
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Affiliation(s)
- Kentaro Hayashi
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama City, Saitama, Japan.,Department of Pediatric Surgery, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Makiko Mori
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama City, Saitama, Japan
| | - Youhei Sanmoto
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama City, Saitama, Japan
| | - Hironobu Oiki
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama City, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama City, Saitama, Japan
| | - Yuki Arakawa
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama City, Saitama, Japan
| | - Katsuyoshi Koh
- Department of Hematology/Oncology, Saitama Children's Medical Center, Saitama City, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama City, Saitama, Japan
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Sorrentino S, Ash S, Haupt R, Plantaz D, Schiff I, Hero B, Simon T, Kachanov D, Shamanskaya T, Kraal K, Littooij A, Wieczoreck A, Balwierz W, Laureys G, Trager C, Sertorio F, Erminio G, Fragola M, Beck Popovic M, De Bernardi B, Trahair T. Presenting features of neuroblastoma with spinal canal invasion. A prospective study of the International Society of Pediatric Oncology Europe - Neuroblastoma (SIOPEN). Front Pediatr 2022; 10:1023498. [PMID: 36299690 PMCID: PMC9589152 DOI: 10.3389/fped.2022.1023498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Between 5 and 15% of children with neuroblastoma (NB) present with or develop spinal canal invasion (SCI). The majority of these children have symptoms of epidural compression of spinal cord and/or spinal nerves. Treatment of NB-SCI is considered an emergency but its modalities are not yet well-established. Independently of treatment, NB-SCI may result in significant long-term disabilities. We report on the first prospective study of NB-SCI focused on presenting characteristics of both symptomatic and asymptomatic patients and correlation between SCI-related symptoms and imaging features. MATERIALS AND METHODS This SIOPEN prospective NB-SCI study opened in June 2014. Patient data including SCI symptoms evaluated by standardized measures and spinal cord imaging studies were collected for each patient. For the purpose of this study data entry was locked on July 2021. RESULTS Of the 208 NB-SCI patients registered, 196 were evaluable for this analysis of whom 67% were symptomatic and 33% asymptomatic. Median age was 11 months. The thorax was the commonest primary tumor site. The median intervals between initial symptoms and diagnosis and between first medical visit and diagnosis were 14 and 3 days, respectively. The was no statistical difference in frequency of presenting characteristics between symptomatic and asymptomatic patients. Presenting features of NB-SCI patients differed from other NBs for older median age, prevalence of thoracic vs. abdominal primary site, prevalence of localized vs. metastatic disease and lower incidence of MYCN gene amplification. The most common SCI features were motor deficit in the younger and pain in the older patients that correlated on imaging with both transverse and longitudinal extent but not with the level of intraspinal tumor. Spinal cord T2-hyperintensity was more frequently detected in symptomatic patients (not significant). CONCLUSION This prospective study confirms that children with NB-SCI differ from NBs without SCI. Compared to previous studies, it provides more detailed information regarding presenting symptoms, time intervals between SCI symptoms, medical visit and diagnosis, and correlations between symptoms and imaging features.
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Affiliation(s)
| | - Shifra Ash
- Joan and Sanford Weill Paediatric Haematology Oncology and Bone Marrow Transplantation Division, Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Riccardo Haupt
- DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Dominique Plantaz
- Department de Paediatrics, Hôpital Couple Enfants, CHU Grenoble, Grenoble, France
| | - Isabelle Schiff
- Department de Paediatrics, Hôpital Couple Enfants, CHU Grenoble, Grenoble, France
| | - Barbara Hero
- Department of Paediatric Haematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Thorsten Simon
- Department of Paediatric Haematology and Oncology, Children's Hospital, University of Cologne, Cologne, Germany
| | - Denis Kachanov
- Department of Clinical Oncology, Dmitry Rogachev National Medical Research Center of Paediatric Haematology, Oncology and Immunology, Moscow, Russia
| | - Tatyana Shamanskaya
- Department of Clinical Oncology, Dmitry Rogachev National Medical Research Center of Paediatric Haematology, Oncology and Immunology, Moscow, Russia
| | - Katheljine Kraal
- Princess Màxima Centre for Paediatric Oncology, Utrecht, Netherlands
| | | | - Alexsandra Wieczoreck
- Paediatric Oncology and Haematology Department, Institute of Paediatrics, Jagiellonian University, Krakow, Poland
| | - Walentyna Balwierz
- Paediatric Oncology and Haematology Department, Institute of Paediatrics, Jagiellonian University, Krakow, Poland
| | - Geneviève Laureys
- Department of Paediatric Haematology-Oncology, Prinses Elisabeth Kinderziekenhuis, University Hospital, Gent, Belgium
| | - Catherine Trager
- Women's and Childrens Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Giovanni Erminio
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Martina Fragola
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maja Beck Popovic
- Centre Hospitalier Universitaire Vaudois, Unité d'Hémato-Oncologie Pédiatrique, Lausanne, Switzerland
| | - Bruno De Bernardi
- Paediatric Oncology Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Toby Trahair
- Kids Cancer Center, Sydney Children's Hospital, Randwick, NSW, Australia.,Children's Cancer Institute, Lowy Cancer Research Centre, University of New South Wales, Kensington, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia
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Körber F, Schäfer JF. [Radiological imaging of neuroblastoma]. Radiologe 2021; 61:639-648. [PMID: 34156482 DOI: 10.1007/s00117-021-00875-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neuroblastomas are tumors of the sympathetic nervous system that arise from the sympathetic trunk and adrenal glands. Tissue compositions, molecular genetics, and overall prognosis are heterogeneous. With an incidence of 1:6000, neuroblastomas account for 5.5% of childhood tumors. They usually occur in children up to preschool age with the mean age of 14 months. Adults are very rarely affected. Imaging, especially magnetic resonance imaging (MRI), plays an essential role in diagnosis, risk stratification, and therapy control. MATERIALS AND METHODS Based on a selective literature search in the PubMed database, the national and international societies' guidelines and study protocols, the imaging standards and the latest developments are presented. CONCLUSION Imaging plays a key role in neuroblastomas due to the heterogeneous prognosis and the resulting very different therapy. A high degree of standardization in implementation and interpretation is important in every phase of the disease process. Sonography, MRI with diffusion weighting, and 123I‑mIBG-SPECT are essential modalities. The extent of the diffusion restriction for assessing the degree of maturity and assessing the therapeutic response is becoming increasingly important in clinical routine. Up to now, PET imaging has mostly been complementary. Newly developed PET tracers promise comprehensive diagnostics and may also play a major role in theranostics.
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Affiliation(s)
- Friederike Körber
- Institut für Diagnostische und Interventionelle Radiologie, Schwerpunkt Kinder- und Jugendradiologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Jürgen Frank Schäfer
- Bereich pädiatrische Radiologie, Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
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Gaunt T, D'Arco F, Smets AM, McHugh K, Shelmerdine SC. Emergency imaging in paediatric oncology: a pictorial review. Insights Imaging 2019; 10:120. [PMID: 31853747 PMCID: PMC6920284 DOI: 10.1186/s13244-019-0796-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/25/2019] [Indexed: 11/12/2022] Open
Abstract
Despite the decline in mortality rates over the last 20 years, cancer remains one of the leading causes of death in children worldwide. Early recognition and treatment for acute oncological emergencies are vital in preventing mortality and poor outcomes, such as irreversible end-organ damage and a compromised quality of life.Imaging plays a pivotal and adjunctive role to clinical examination, and a high level of interpretative acumen by the radiologist can make the difference between life and death. In contrast to adults, the most accessible cross-sectional imaging tool in children typically involves ultrasound. The excellent soft tissue differentiation allows for careful delineation of malignant masses and along with colour Doppler imaging, thromboses and large haematomas can be easily identified. Neurological imaging, particularly in older children is an exception. Here, computed tomography (CT) is required for acute intracranial pathologies, with magnetic resonance imaging (MRI) providing more definitive results later.This review is divided into a 'body systems' format covering a range of pathologies including neurological complications (brainstem herniation, hydrocephalus, spinal cord compression), thoracic complications (airway obstruction, superior vena cava syndrome, cardiac tamponade), intra-abdominal complications (bowel obstruction and perforation, hydronephrosis, abdominal compartment syndrome) and haematological-related emergencies (thrombosis, infection, massive haemorrhage). Within each subsection, we highlight pertinent clinical and imaging considerations.The overall objective of this pictorial review is to illustrate how primary childhood malignancies may present with life-threatening complications, and emphasise the need for imminent patient management.
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Affiliation(s)
- Trevor Gaunt
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Felice D'Arco
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Anne M Smets
- Academic Medical Center, PO Box 22700, Amsterdam, 1100 DE, The Netherlands
| | - Kieran McHugh
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
- UCL Great Ormond Street Institute of Child Health, London, UK.
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Pio L, Blanc T, de Saint Denis T, Irtan S, Valteau-Couanet D, Michon J, Brisse H, Galmiche-Rolland L, Joyeux L, Odent T, Harte C, Glorion C, Zerah M, Sarnacki S. Multidisciplinary surgical strategy for dumbbell neuroblastoma: A single-center experience of 32 cases. Pediatr Blood Cancer 2019; 66 Suppl 3:e27670. [PMID: 30828979 DOI: 10.1002/pbc.27670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prognosis of dumbbell neuroblastoma (NBL) is mainly determined by the sequelae induced by the tumor itself and the neurosurgical approach. However, after primary chemotherapy, surgical management of the residual tumor, especially the spinal canal component, remains controversial. METHODS We conducted a single-center retrospective cohort study over the last 15 years (2002-2017) including patients treated for NBL with spinal canal extension focusing on timing and type of surgery, complications, and functional and oncological follow-up. RESULTS Thirty-two children (14 M, 18 F) were managed for NBL, with the majority (26) presenting with NBL stroma poor while four had ganglioneuroblastoma intermixed, one nodular, and one ganglioneuroma. All but two patients received neoadjuvant chemotherapy. Upfront laminotomy for spinal cord decompression was performed in two patients; nine patients had extraspinal surgery with a follow-up neurosurgical procedure in seven cases; eight patients had initial neurosurgery followed by an extraspinal procedure, while six patients underwent a combined multidisciplinary approach. With a median follow up of 3.6 years (0.1-14.9), 29 patients (90.6) are alive and two out of three (19, 65.5%) have functional sequelae. CONCLUSION Patients with NBL with persistent spinal canal extension of the tumor after neoadjuvant chemotherapy treated at our center had outcomes that compare favorably with the literature. This is likely due to the multidisciplinary approach to optimal surgical strategy and continuous evaluation of the respective risks of tumor progression. Neurological disability results from initial spinal cord compression or the radicular sacrifice required for tumor resection.
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Affiliation(s)
- Luca Pio
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Timothé de Saint Denis
- Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabine Irtan
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | | | - Jean Michon
- Department of Pediatric Oncology, Oncology Center SIREDO (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer, Institut Curie, Paris, France
| | - Hervé Brisse
- Imaging Department, Institut Curie, Paris, France.,Paris Sciences et Lettres Research University, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Luc Joyeux
- Department of Pediatric Surgery, Queen fabiola Children's Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Odent
- Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,Department of Pediatric Orthopedics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Glorion
- Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,Department of Pediatric Orthopedics, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michel Zerah
- Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
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Petit A, Rubio A, Durand C, Piolat C, Perret C, Pagnier A, Plantaz D, Sartelet H. A Wilms' Tumor with Spinal Cord Compression: An Extrarenal Origin? Case Rep Pediatr 2018; 2018:1709271. [PMID: 30254782 DOI: 10.1155/2018/1709271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/05/2018] [Indexed: 11/17/2022] Open
Abstract
Spinal cord compression in Wilms' tumor (WT) is an extremely rare event that can have a very poor prognosis if not taken care of rapidly. Most cases reported in the literature involve widely metastatic patient with bone or paraspinal metastases or occasionally intradural metastasis. Here, we present the case of a 3-year-old girl of WT confirmed by biopsy, with spinal cord compression due to the direct contiguous spread of a tumor through 2 vertebral foramina. Abdominal ultrasonography and magnetic resonance imaging performed for an abdominal mass revealed a large heterogeneous tumor near the upper pole of the left kidney. A nodular infiltration extended through the T11-L1 and L1-L2 neural foramina, forming an intraspinal mass that compressed the spinal cord. Major paresthesia subsequently occurred, requiring urgent treatment with corticosteroids and chemotherapy. The evolution was rapidly satisfying. After six courses of chemotherapy, a left nephrectomy was performed. Macroscopic examination identified a large tumor attached to the kidney without renal infiltration. Microscopical examination concluded to a nephroblastoma with regressive changes, of intermediate risk. Evolution at 6 months is satisfactory, with no neurological deficit. The histological aspect of the tumor and the clinical outcome suggest that she had an extrarenal WT that spread through the vertebral foramina and was secondarily attached to the kidney.
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