Update in Pediatric Oncology

Resident: Adam J. Bottrill Date: 15JAN10 Region: Providence
Article title: Update in Pediatric Oncology
Author(s): Dunn, Nancy et al.
Journal: Pediatric Oncology
Page #s: pp. 10-19
Year: 1990
Major topic: Pediatric Dentistry
Minor topic(s): None
Type of Article: Topic Summary
Main Purpose: Fortunately, the outlook for children with cancer is improving. This article gives a brief overview of current
Overview of method of research: NA
Key points in the article discussion:

I. Intro:
A. Childhood cancer is still very rare and 85% are either hematological, sarcomas or embryonal tumors (85% of adult cancers are carcinomas). Despite this, it is still the leading cause of death from disease in children under 15y.o. Now, death rate is actually less than half of what it was in 1950.
B. Most children diagnosed with cancer are referred to treatment centers where they are cared for by multi-disciplinary teams. This concentration of care and knowledge has led to massive advancements in knowledge, prognosis indicators and supportive care techniques.

II. Advances in Dx and Tx modalities
A. Tumor Biology
1. Collaborative study participation has lead to numerous histological comparisons, discoveries and prognostic indicator progress.
B. Prognostic Indicators
1. Relatively new phenomena. There were none when no one survived their disease. As more and more children survived, it became apparent that some did better than others. We can now more safely group patients into prognostic risk groups based on these prognostic indicators. Also allows therapy to be more individual.
C. Supportive Care
1. New recommendations WRT to SBE prophylaxis have been developed based on observations and therapies administered to these large groups of kids.
D. Newer Therapeutic Concepts
1. Lately, the interrelationship between surgical, radiation and chemotherapy has been changing. There aren’t many cancers that can be completely removed surgically. Also, early radiation treatment has been playing a smaller role. Chemotherapy is becoming more of the mainstay of treatment in pediatric Pt’s. Bone marrow transplants have become a 4th and commonly used method of treatment.

III. Pediatric Malignancies

A. ALL: 75-80% of childhood leukemias. Most common single malignancy in children. More common in White males age 3-5. Etiology unknown, many theories. Siblings at greater risk and children of parents with chromosomal abnormalities and immunocompromised states at greater risk. Fatigue, bone pain, fever, weight loss, bleeding, pallor, pymphadenopathy or asymptomatic.
1. Dx. made by >25% lymphoblasts in bone marrow.
2. Chemotherapy has provided >95% remission. Overall chance of >5 yr, event-free survival is approx 60%.
3. Usually any bone marrow relapse withing 6 mo. of chemo is sign of poor prognosis.

B. ANLL: 15-20% of leukemias in children. Similar to ALL. But not typically presenting with lymphadenopathy. Gingival hyperplasia more common.
1. Similar treatment to ALL: aggressive chemo, supportive care and CNS prophylaxis. >5yr event-free survival 25-45%. With chemo, up to 60% with bone marrow transplant.

C. CML: Rare in childhood representing <5%>
Assessment of article: Bottom line... too much information to summarize effectively. I barely skimmed the surface and omitted TONS. Maybe someone should call shenanigans on ME.