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Year : 2019  |  Volume : 15  |  Issue : 9  |  Page : 261-262

Paediatrics


Date of Web Publication28-Nov-2019

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How to cite this article:
. Paediatrics. J Can Res Ther 2019;15, Suppl S2:261-2

How to cite this URL:
. Paediatrics. J Can Res Ther [serial online] 2019 [cited 2019 Dec 14];15:261-2. Available from: http://www.cancerjournal.net/text.asp?2019/15/9/261/271712




 > Abstract: 222: Pediatric brachytherapy: A useful tool to treat flowering buds Top


Patricia Sebastian, Rajesh Balakrishnan, Selvamani Backianathan

Christian Medical College, Vellore, Tamil Nadu, India, E-mail: drpat@cmcvellore.ac.in

Background: More than three fourth of pediatric cancer patients are long term survivors. Many pediatrictumors are radiosensitive and radiation therapy is one of the modalities used in treatment of cancers in children. Prevention of growth retardation, preservation of organs and its function, reducing chances of second primary due to RT are equally important along with curing the disease in them. Brachytherapy is an apt tool to deliver radiation in them. Purpose and Objective(s): To present case series of 3 patients of pediatric brachytherapy from our institution with details about the nature of the disease, technique and procedure with the dosimetric advantages in them. Materials and Methods: The first patient was a 2-year old girl child with recurrent vaginal yolk sac tumor treated using customized mould brachytherapy (36 Gy in 12 fractions over 6 days) preserving pelvic bones, bladder and rectum from radiation who remained disease free at 3-year followup with no side effects of brachytherapy. The second patient was a 1-year old boy child with left gluteal region Ewing's sarcoma. After chemotherapy and wide local excision, he was treated with interstitial brachytherapy (32Gy in 8 fractions over 4 days). His proximal femur – growth plate and pelvis bones were spared and he remained disease free at 8 months' followup without any side effects. The third patient was a 2-year old boy child with nonmetastatic prostatic Rhabdomyosarcoma post chemotherapy who underwent debulking of the prostatic tumor. The brachy catheters were placed intraoperatively through perineum onto the surface of prostate and posterior surface of bladder. This technique has been described by Haie-Meder et al from Institute of Gustave Roussy, France. The dose delivered was 36 Gy in 12 fractions over 6 days. The child had regression of disease on MRI at 4-month followup. The pelvic bones and pelvic structures were preserved from radiation. Results: All 3 patients showed disease response to brachytherapy and did not have any side effects in the followupperiod . The mean doses to the organs of risk were as follows: the child with vaginal yolk sac tumor had 16.6% of the dose to rectum, 9.3% to bladder and maximum dose o f 22.4% to the pelvic bones. The child with Ewings sarcoma had maximum dose of 11.1% to the pelvic bones and negligible dose to the pelvic structures. The child with prostatic rhabdomyosarcoma had 60.9% to rectum, 34.8% of the dose to bladder and maximum point dose of 25.9% to the pelvic bones. These minimum doses to OARs achieved by brachytherapy are not possible by the best of external beam techniques. It may be possible to obtain by proton therapy but the availability and cost constrains its use. Conclusion: Brachytherapy is a better, conservative, cost effective tool compared to external radiotherapy techniques. Functional organ preservation, prevention of growth abnormalities, reduction in development of second primary tumors are the potential benefits with pediatric brachytherapy.


 > Abstract: 246: An audit of clinical profile and radiation protocol deviation of pediatric patients in India Top


Rashi Agrawal, Ramandeep Arora

Max Superspeciality Hospital, Saket, New Delhi, India, E-mail: drrashi.ag@gmail.com

Introduction: Radiation therapy is a critical part of multimodality treatment for several pediatric cancers. Ensuring quality requires timeliness to start and completion of delivery of treatment. This is an under-researched area in developing countries where most of the childhood cancer cases occur. In this retrospective study we describe the profile of children undergoing radiation and analyse deviation from timeliness of radiation. Materials and Methods: Data on all children with cancer who completed radiation treatment at our institute from Jan 2009 to Dec 2018 was retrieved. Demographic and clinical parameters were studied. We looked at two specific metrics: (1) Time taken to complete radiation vs time it should have taken assuming that radiation was delivered 5 days a week. A significant deviation means: time taken> 10% expected time. (2) Time interval from surgery to start of radiation (in CNS tumors only). Results: Total 62 patients were evaluated, 59.6% patients were male. Median age was 12 years (range 2-20 years). CNS tumors (37%), Leukemias (23%) and sarcomas (16%) were the most common cancer groups. 87% patients received radiotherapy with curative doses. Most of our patients received adjuvant radiotherapy, only one patient received neoadjuvant radiotherapy. 10 (16%) of patients had significant deviation in the timeliness of their treatment. Reasons for deviation included clinical condition and side effects (60%), patient compliance (20%), radiation planning issues (10%) and unknown (10%). In CNS tumors, median time period from surgery to start of radiation was 35 days. In 38% patients, radiation commenced more than 6 weeks after surgery. Reasons included (patient compliance 25%, international patient 12.5%, radiation planning issues 12.5%). Conclusion: A minority of childhood cancer patients at our centre had significant deviation in the start and completion of scheduled radiation treatment. Causes are diverse and steps need to be taken to address this.


 > Abstract: 285: The case for limited volume radiotherapy treatment in central nervous system germ cell tumour: A single centre experience Top


Namrata Das, Chinna Babu Dracham, Renu Madan, Narendra Kumar, Rakesh Kapoor

PGIMER, Chandigarh, India, E-mail: namrata747@gmail.com

Background: Primary Central Nervous System (CNS) Germ Cell Tumours (GCTs) comprise of a rare and heterogenous group of tumours primarily affecting the paediatric age group. Historically, radiation alone has constituted the primary modality of treatment. However, long term sequelae in children particularly with craniospinal irradiation led to exploration of various treatment strategies: progressively limited volumes and doses for pure germinomatous tumours (GT) and a combined modality approach for the worse faring non-germinomatous germ cell tumours (NGGCT). The rarity of this disease and dearth of randomized trials has not established the standard of care for all tumour types. We report our institutional experience of treating CNS GCT with limited volume radiotherapy with or without chemotherapy using a risk-based approach. Aim: To evaluate the radiotherapy treatment practice with time for the treatment of intracranial germ cell tumours (GCT) in a tertiary care institute and to assess the patterns of relapse and survival. Methods: Twenty-three patients of surgically confirmed or suspected intracranial germ cell tumours who received radiation with or without chemotherapy from 2007 to 2019 were included in the study. More than two-thirds of patients were germinomatous tumours (GT) (78.26%) and the rest were classified as the mixed germ cell subtype of non-germinomatous germ cell tumours (NGGCT). A review of the histopathology, tumour markers, surgical intervention, clinical course and recurrence patterns was done. The mean follow-up period was 35 months (range: 4–91 months). Results: The median age of patients was 19 years (range: 7-45 years) years with a male preponderance (60.9%). 60% of tumours were in the pineal region followed by 26% suprasellar tumours. Conformal radiotherapy techniques were used in all patients. For germinomas, localized radiotherapy to the lesion with chemotherapy (BEP – Bleomycin, Etoposide, Cisplatin) (38.9 %) was the standard of care with a shift towards whole ventricular radiotherapy (38.9%) in the last three years. The five-year survival rates were 78.6% for germinomas and 73% for mixed germ cell tumours. Localized radiation with BEP based chemotherapy (78.26%) has been the institutional practice and the three recurrences were all out of field. Conclusion: As expected, non-germinomatous histology was significantly associated with a worse survival outcome (p<0.05). Localized radiotherapy with or without chemotherapy has provided survival outcomes comparable to those found in other studies. No deaths were encountered in the patients receiving whole ventricular radiotherapy for GTs but a longer follow up is required to consolidate these results and assess neurocognitive benefits.


 > Abstract: 441: A retrospective analysis of retinoblastoma patients treated with external beam orbital radiotherapy Top


Aastha Shah, Ali Azher, Ankita Parikh, U. Suryanarayan

Gujarat Cancer Research Institute, Ahmedabad, Gujarat, India, E-mail: shahaastha2781994@gmail.com

Objectives: To evaluate the treatment outcomes of children with retinoblastoma treated with external beam orbital radiotherapy in Gujarat Cancer & Research Institute, Ahmedabad, Gujarat from 2014 to 2017. Materials and Methods: A retrospective analysis of 50children treated with radiotherapy from 2014 to 2017 was carried out to evaluate the outcomes. Group A patients were offered curative RT after enucleation and group B were treated for advanced disease with palliative intent. The mean follow up was 24 months. The dosage for palliative intent was 30Gy in 15 fractions with 200CGy per fraction and curative dose was 40Gy in 20 fractions with 180CGy per fraction. Results: Although RT retained useful vision and considerable tumor reduction in RB patients, the treatment outcomes still remain poor. The common side effects like dry eyes, cataracts and retinopathy were observed and the median follow up was insufficient to assess the second malignancy and growth deformities. The better results were observed with patients with negative CSF cytology and normal brain imaging. Conclusion: EBORT is highly effective in preserving eyes with useful vision.






 

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