Proton Beam Therapy Versus Conformal Photon Radiation Therapy for Childhood Craniopharyngioma: Multi-institutional Analysis of Outcomes, Cyst Dynamics, and Toxicity

PurposeWe compared proton beam therapy (PBT) with intensity modulated radiation therapy (IMRT) for pediatric craniopharyngioma in terms of disease control, cyst dynamics, and toxicity.Methods and MaterialsWe reviewed records from 52 children treated with PBT (n=21) or IMRT (n=31) at 2 institutions from 1996-2012. Endpoints were overall survival (OS), disease control, cyst dynamics, and toxicity.ResultsAt 59.6 months' median follow-up (PBT 33 mo vs IMRT 106 mo; P<.001), the 3-year outcomes were 96% for OS, 95% for nodular failure-free survival and 76% for cystic failure-free survival. Neither OS nor disease control differed between treatment groups (OS P=.742; nodular failure-free survival P=.546; cystic failure-free survival P=.994). During therapy, 40% of patients had cyst growth (20% requiring intervention); immediately after therapy, 17 patients (33%) had cyst growth (transient in 14), more commonly in the IMRT group (42% vs 19% PBT; P=.082); and 27% experienced late cyst growth (32% IMRT, 19% PBT; P=.353), with intervention required in 40%. Toxicity did not differ between groups. On multivariate analysis, cyst growth was related to visual and hypothalamic toxicity (P=.009 and .04, respectively). Patients given radiation as salvage therapy (for recurrence) rather than adjuvant therapy had higher rates of visual and endocrine (P=.017 and .024, respectively) dysfunction.ConclusionsSurvival and disease-control outcomes were equivalent for PBT and IMRT. Cyst growth is common, unpredictable, and should be followed during and after therapy, because it contributes to late toxicity. Delaying radiation therapy until recurrence may result in worse visual and endocrine function

Late Effects of Therapy in Childhood Acute Lymphoblastic Leukemia Survivors

Over the last 50 years, the survival rates in children with acute lymphoblastic leukemia (ALL) have increased remarkably. The optimal use of antileukemic agents in cooperative group protocols, central nervous system-directed treatment, improvements in supportive care, and recognition of biological, clinical, and treatment response characteristics that predict patients with a higher or a lower risk of treatment failure have improved 5-year event-free survival rates, reaching more than 85%, and 5-year overall survival rates, reaching more than 90%. Consequently, it has become increasingly important to characterize the occurrence of long-term late effects. ALL treatments have been associated with increased risks for adverse outcomes such as late mortality, secondary malignancies, and neurological, cardiac, endocrine, and social/psychological disorders. In recent decades, cooperative groups in Europe and in the United States have provided essential information about the long-term effects of ALL therapy, giving recommendations for screening as well as facilitating new approaches for reducing late-term morbidity and mortality. Current frontline protocols continue to examine ways to lower the intensity and amount of therapy to reduce late effects, whereas survivorship studies attempt to predict such adverse effects precisely and develop targeted prevention and treatment strategies

Late Effects of Therapy in Childhood Acute Lymphoblastic Leukemia Survivors

Over the last 50 years, the survival rates in children with acute lymphoblastic leukemia (ALL) have increased remarkably. The optimal use of antileukemic agents in cooperative group protocols, central nervous system-directed treatment, improvements in supportive care, and recognition of biological, clinical, and treatment response characteristics that predict patients with a higher or a lower risk of treatment failure have improved 5-year event-free survival rates, reaching more than 85%, and 5-year overall survival rates, reaching more than 90%. Consequently, it has become increasingly important to characterize the occurrence of long-term late effects. ALL treatments have been associated with increased risks for adverse outcomes such as late mortality, secondary malignancies, and neurological, cardiac, endocrine, and social/psychological disorders. In recent decades, cooperative groups in Europe and in the United States have provided essential information about the long-term effects of ALL therapy, giving recommendations for screening as well as facilitating new approaches for reducing late-term morbidity and mortality. Current frontline protocols continue to examine ways to lower the intensity and amount of therapy to reduce late effects, whereas survivorship studies attempt to predict such adverse effects precisely and develop targeted prevention and treatment strategies

The Relationship Between Hepatic Activity Index and Serum Tumor Necrosis Factor Alpha Levels in Patients with Chronic Active Hepatitis-B and Chronic Active Hepatitis-C

In the present study, we investigated the relationship between serum TNF-&#945; levels and hepatic activity in liver biopsies of chronic hepatitis B and C patients.The study was performed on 30 chronic hepatitis B patients, 25 chronic hepatitis C patients and 25 healthy controls. Serum samples of patients who underwent biopsy and healthy controls were collected. Control group was seronegative for hepatitis and had normal liver function tests. TNF- &#945; levels measured by ELISA. Knodells hepatic activity index was used in evaluation of liver biopsies. Serum TNF-&#945; levels were determined higher in chronic hepatitis B and C patients than control group. HAI and TNF- &#945; compared in chronic hepatitis B and C patients. Although we detected a relationship between HAI and TNF-&#945; levels in chronic hepatitis B patients, no true correlation was shown in chronic hepatitis C patients. Cytokines have an important role in progression of chronic hepatitis B and C infections. There is a relationship between hepatic activity index and TNF-&#945; level in chronic hepatitis B infection.But There is not relationship between hepatic activity index and chronic hepatitis C infection.only in two patients and both of them where in the middle of their reproductive age while as symptomatic ovarian cysts was a more common finding in unmarried females in 21-28 years of age group. This study concluded that laparoscopy has a diagnostic as well as a therapeutic implication in management of NSAP. [Med-Science 2015; 4(4.000): 2772-81

Dermatofibrosarcoma protuberans case report: Aggressive tumor in a preadolescent child

Dermatofibrosarcoma Protuberans is an aggressive form of skin cancer in children. It has a slow growth rate and low chance of metastasizing but is notorious for its aggressive invasive and recurrent nature. In pediatric patients, the resections can be quite aggressive but with appropriate surgical planning and approach, can have quite low morbidity and mortality. We report a unique case of a pediatric patient with dermatofibrosarcoma protuberans that was managed with repeated surgical resections, discuss operative management strategies for this aggressive diagnosis, and provide a review of the literature