Renal cell carcinoma in children: A clinicopathologic study

Purpose: To identify the prognostic factors, treatment, and outcome of children affected by renal cell carcinoma (RCC). Patients and Methods: The series included 41 patients (18 males and 23 females) with a median age of 124 months observed at the 11 Italian Association for Pediatric Hematology and Oncology centers from January 1973 to January 2001. Clinical data, surgical notes, pathologic findings, and summaries of therapy were taken from the charts. Results: Seven (17%) of the 41 patients had a papillary histology, and 34 (82.4%) had nonpapillary histology. Eighteen patients (43.9%) had stage I, one patient (2.4%) had stage II, two patients (4.8%) had stage IIIA, 10 patients (24.3%) had stage IIIB, and nine patients (21.9%) had stage IV disease. One patient had a bilateral involvement at diagnosis. Seven patients experienced disease recurrence. Lung and liver were the most common distant lesions and usually were fatal. In this study, the major factor influencing the prognosis was the stage. Event-free survival at 20 years was 53.5% for all patients. Overall survival at 20 years was 54.9% for all patients. Conclusion: RCC is a rare disease in children and adolescents. This neoplasm has a different clinical presentation in children compared with adults but the same outcome. In our experience, patients with localized disease could be cured by nephrectomy alone. Prospective studies in a larger number of patients are needed to confirm radiation therapy and biologic response modifiers as effective adjunct therapy in RCC stage III. The alternative therapy seems warranted in patients with advanced disease. © 2003 by American Society of Clinical Oncology

Pictor A (PKS 0518-45) - From Nucleus to Lobes

We present radio and optical imaging and kinematic data for the radio galaxy Pictor A, including HST continuum and [OIII], emission-line images (at a resolution of 25 - 100 mas) and ground-based imaging and spectroscopy (at a resolution of ~ 1.5". The radio data include 3 cm Australia Telescope images of the core, at a resolution comparable to that of the optical, ground-based images, and a VLBI image of a jet in the compact core (at a resolution of 2 - 25 mas), which seems to align with a continuum ``jet'' found in the HST images. The core radio jet, the HST optical continuum ``jet'', and the NW H-alpha filaments all appear to point toward the optical-synchrotron hot-spot in the NW lobe of this object and are associated with a disrupted velocity field in the extended ionized gas. The ground-based spectra which cover this trajectory also yield line ratios for the ionized gas which have anomalously low [NII] (6564), suggesting either a complex, clumpy structure in the gas with a higher cloud-covering factor at larger radii and with denser clouds than is found in the nuclear regions of most NLRG and Seyfert 2 galaxies, or some other, unmodeled, mechanism for the emergent spectrum from this region. The H-alpha emission-line filaments to the N appear to be associated with a 3 cm radio continuum knot which lies in a gap in the filaments ~ 4" from the nucleus. Altogether, the data in this paper provide good circumstantial evidence for non-disruptive redirection of a radio jet by interstellar gas clouds in the host galaxy.Comment: 19 pages, 6 ps.gz fig pages, to appear in the Ap.J. Supp

Short topotecan-based induction regimen in newly diagnosed high-risk neuroblastoma

Purpose: Topotecan is an active drug in relapsed neuroblastoma. We investigated the efficacy and toxicity of a topotecan-based induction regimen in newly diagnosed neuroblastoma. Methods: Patients older than 1 year with either metastatic or localised stage 2-3 MYCN-amplified neuroblastoma received 2 courses of high-dose topotecan (HD-TPT) 6 mg/m2 and high-dose cyclophosphamide (HD-CPM) 140 mg/kg, followed by 2 courses of ifosfamide, carboplatin and etoposide (ICE) every 28 days. After surgery on primary tumour, a fifth course with vincristine, doxorubicin and CPM was given, followed by high-dose chemotherapy with stem cell support. Response was assessed in accordance with the International Neuroblastoma Response Criteria. Results: Of 35 consecutive patients, 33 had metastatic disease. The median length of induction phase was 133 days (range 91-207) and time to high-dose chemotherapy was 208 days (range 156-285). The median tumour volume reduction was 55% after two HD-TPT/HD-CPM courses and 80% after four courses. Radical surgery was performed in 16/27 patients after chemotherapy. After the fifth course, 29/34 patients (85%) had achieved a partial remission (12) or a CR/very good partial remission (17). CR of metastases was achieved in 13/32 (41%) and bone marrow was in complete remission in 16/24 patients (67%). Grade 4 neutropenia and/or thrombocytopenia occurred in 100% of HD-TPT/HD-CPM and in 95% of ICE courses, while non-haematological toxicities were manageable. Conclusions: These data indicate that our induction regimen is feasible and well tolerated. A major response rate of 85% with 41% complete metastatic response confirms this regimen as effective induction in high-risk neuroblastoma. © 2011 Published by Elsevier Ltd

LOTIS Search for Early Time Optical Afterglows: GRB 971227

We report on the very early time search for an optical afterglow from GRB 971227 with the Livermore Optical Transient Imaging System (LOTIS). LOTIS began imaging the `Original' BATSE error box of GRB 971227 approximately 14 s after the onset of gamma-ray emission. Continuous monitoring of the position throughout the evening yielded a total of 499 images (10 s integration). Analysis of these images revealed no steady optical afterglow brighter than R=12.3 +- 0.2 in any single image. Coaddition of different combinations of the LOTIS images also failed to uncover transient optical emission. In particular, assuming a constant early time flux, no optical afterglow brighter than R=14.2 +- 0.2 was present within the first 1200 s and no optical afterglow brighter than R=15.0 +- 0.2 was present in the first 6.0 h. Follow up observations by other groups revealed a likely X-ray afterglow and a possible optical afterglow. Although subsequent deeper observations could not confirm a fading source, we show that these transients are not inconsistent with our present knowledge of the characteristics of GRB afterglows. We also demonstrate that with the upgraded thermoelectrically cooled CCDs, LOTIS is capable of either detecting very early time optical afterglow or placing stringent constraints on the relationship between the gamma-ray emission and the longer wavelength afterglow in relativistic blast wave models.Comment: 17 pages, 3 eps figures, revisions based on reviewers comment

Local control in metastatic neuroblastoma in children over 1 year of age

Background: Local control is always considered in metastatic neuroblastoma (NBL). The aim of this study is to evaluate the impact of radical surgery on survival in children over 1 year of age. Methods: Fifty-eight patients older than 1 year of age with metastatic NBL were treated with conventional plus high-dose chemotherapy with or without addition of local radiotherapy (RT, 21Gy). Surgery was classified as radical surgery (complete resection and gross total resection) or non-radical surgery. The Kaplan-Meier method and the Cox proportional hazard model were used to calculate the probability of progression free and overall survival (PFS and OS) and for multivariate analysis. Results: The 5-year PFS and OS for patients with radical surgery were 26% (95% CI 14-40%) and 38% (95% CI 23-53%) respectively, while the PFS and OS for patients without radical surgery were 33% (95% CI 10-59%) and 31% (95% CI 10-55%) (respectively, P 0.85 and P 0.42). The 5-year PFS and OS for patients who received RT were 36% (95% CI 19-53%) and 46% (95% CI 26-64%) respectively, while the 5-year PFS and OS for patients who did not receive RT were 22% (95% CI 9-38%) and 27% (95% CI 13-42%) respectively (P 0.02 for PFS). Multivariate analysis confirmed the role of well-known prognostic factors, such as the presence of MYCN amplification, age and response before high-dose chemotherapy. Conclusions: Our data suggest that the degree of resection does not influence survival in metastatic NBL patients treated with high-dose chemotherapy; local RT contributes to local disease control