Stage 4 neuroblastoma: sequential hemi-body irradiation or high-dose chemotherapy plus autologous haemopoietic stem cell transplantation to consolidate primary treatment

The aim of the present study was to evaluate the effectiveness of two consecutive nonrandomised treatment programs applied between 1989 and 1999 at the Istituto Nazionale Tumori of Milan in an unselected cohort of 59 children over the age of one with stage 4 neuroblastoma. Both treatment programs consisted of two phases, the induction of the remission phase and the consolidation phase. The induction of the remission phase consisted of intensive chemotherapy, and remained the same throughout the study period. The consolidation phase consisted of sequential hemi-body irradiation (HBI) (10 Gy per session, 6 weeks apart) in the first period (1988–June 1994) and sequential high-dose cyclophosphamide, etoposide, mitoxantrone+L-PAM and autologous haemopoietic stem cell transplantation in the second (July 1994–1999). Intention-to-treat analysis revealed a significantly better outcome for patients treated with the second program, the 5-year event-free survival probability being 0.12 for program 1 and 0.31 for program 2 (P=0.03). This finding led us to conclude that sequential HBI is useless as consolidation treatment. The high-dose chemotherapy adopted in the second program enabled a proportion of patients to obtain long-term survival but, since the clinical results remain unsatisfactory, new treatment strategies are warranted

The role and involvement of the family

Brain tumors are a group of malignancies that are heterogeneous for site and histotype and are the most frequent type of tumor in childhood. New advances in treatment options improved survival rates and the quality of life of patients. However, brain tumors are still characterized by a high mortality rate and by poor intellectual, emotional and social outcomes in many cases. For this reason, in recent years many clinical studies and clinical practice interventions have focused on the quality of life of children with tumors. In this article we discuss the issue of psychological support to families of children with tumors against our own clinical experience and a review of the literature

Antidepressants in pediatric oncology

The aim of this letter is to suggest that, for this particular area of pediatric medicine, it is worth reconsidering the clinical use of all antidepressants, which are already amply used for supportive treatment and palliative care in adult patients, albeit without neglecting the contribution that can be provided by dynamic or cognitive-behavioral psychological treatments

Teoria e tecnica della consultazione psicologica clinica in ospedale con i genitori di bambini affetti da malattie organiche gravi : revisione della letteratura ed esperienze cliniche

In the last few years, psychological interventions on children affected by chronic illness and their parents gradually spread out in pediatric hospitals; these have been performed by members of hospital staff with different training, backgrounds and theoretical models. Orientation towards evidence based interventions and the need of using defined protocols, took us to revise models, theories and techniques of the above-mentioned interventions. Up to now psychological interventions in pediatric hospitals are different both in forms and cultural traditions. The literature review on psychological consultation in children affected by chronic illness and their parents has been developed in this study using databases. The aim was to identify the efficacy of these interventions starting from the analysis of common factors reported in different theoretical models, techniques and traditions and taking into consideration the clinical experience too