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Abstract
Soft tissue sarcomas of childhood are a heterogenous group of tumors with a wide spectrum of presentations and outcomes. Most patients require multimodal therapy with chemotherapy, surgery and/or radiation. Improved outcomes in recent decades have been achieved through improvements in the comprehensive care of these children through large cooperative group studies, even as little progress has been made in the standard chemotherapy backbone. A thorough understanding of the nuances of surgical therapy for these children is required to minimize both the risk of local failure and the possibility of loss of vital form or function.
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Affiliation(s)
- Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, 225 E Chicago Ave, Box 63, Chicago, IL 60611, United States.
| | - Andrea Hayes-Jordan
- Division of Pediatric Surgery, University of North Carolina, 170 Manning Drive, G196 Physician's Office Building, Ground Floor, CB# 7223, Chapel Hill, NC 27599-7223, United States.
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2
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Papyan R, Tamamyan G, Danielyan S, Tananyan A, Muradyan A, Saab R. Identifying barriers to treatment of childhood rhabdomyosarcoma in resource-limited settings: A literature review. Pediatr Blood Cancer 2019; 66:e27708. [PMID: 30907501 DOI: 10.1002/pbc.27708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 11/11/2022]
Abstract
We performed a literature review to examine barriers for rhabdomyosarcoma treatment in low-resource settings, and identified 29 articles from 14 middle-income countries, with none from low-income countries. Notable findings included inconsistent use of local control modalities, lack of diagnostics in some settings, and high rate of abandonment specifically in low middle-income countries. Reported limitations included lack of surgical expertise and/or radiation therapy, advanced stage of disease, and absence of health insurance. Although very poor outcomes were prevalent in several settings, good outcomes were achievable in others when multidisciplinary therapy and financial coverage of medical care were made available.
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Affiliation(s)
- Ruzanna Papyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia.,Muratsan Hospital Complex, Clinic of Chemotherapy, Yerevan State Medical University, Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia
| | - Gevorg Tamamyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia.,Muratsan Hospital Complex, Clinic of Chemotherapy, Yerevan State Medical University, Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia.,Master in Advanced Oncology Program, University of Ulm, Ulm, Germany
| | - Samvel Danielyan
- Armenian Pediatric Hematology and Oncology Group, Yerevan, Armenia.,Hematology Center, Yerevan, Armenia
| | - Armen Tananyan
- Department of Oncology, Yerevan State Medical University, Yerevan, Armenia.,Muratsan Hospital Complex, Clinic of Chemotherapy, Yerevan State Medical University, Yerevan, Armenia.,National Oncology Center, Yerevan, Armenia
| | - Armen Muradyan
- Department of Urology, Yerevan State Medical University, Yerevan, Armenia
| | - Raya Saab
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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3
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Khalatbari H, Parisi MT, Kwatra N, Harrison DJ, Shulkin BL. Pediatric Musculoskeletal Imaging: The Indications for and Applications of PET/Computed Tomography. PET Clin 2018; 14:145-174. [PMID: 30420216 DOI: 10.1016/j.cpet.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of PET/computed tomography (CT) for the evaluation and management of children, adolescents, and young adults continues to expand. The principal tracer used is 18F-fluorodeoxyglucose and the principal indication is oncology, particularly musculoskeletal neoplasms. The purpose of this article is to review the common applications of PET/CT for imaging of musculoskeletal issues in pediatrics and to introduce the use of PET/CT for nononcologic issues, such as infectious/inflammatory disorders, and review the use of 18F-sodium fluoride in trauma and sports-related injuries.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas J Harrison
- Department of Pediatrics, MD Anderson Cancer Center, 7600 Beechnut Street, Houston, TX 77074, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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4
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Fernandez-Pineda I, Hudson MM, Pappo AS, Bishop MW, Klosky JL, Brinkman TM, Srivastava DK, Neel MD, Rao BN, Davidoff AM, Krull KR, Mulrooney DA, Robison LL, Ness KK. Long-term functional outcomes and quality of life in adult survivors of childhood extremity sarcomas: a report from the St. Jude Lifetime Cohort Study. J Cancer Surviv 2017; 11:1-12. [PMID: 27262580 PMCID: PMC5136514 DOI: 10.1007/s11764-016-0556-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/30/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE This study compared measured physical performance, health-related quality of life (HRQOL), and social role attainment between extremity sarcoma survivors and controls, and evaluated associations between disease and treatment exposures, health conditions, and performance measures. METHODS Survivors of extremity sarcoma from the St. Jude Lifetime cohort and controls frequency matched by age-, sex-, and race completed physical performance testing and questionnaires. Survivors with Z-scores on outcome measures ≤ -2.0 SD (compared to controls) were categorized with severe impairment/limitation. RESULTS Among 206 survivors (52.4 % male median age 36 years (range 19-65)), 37 % had low relative lean mass, 9.7 % had an ejection fraction <50 %, 51.5 % had diffusion capacity for carbon monoxide <75 %, 27.7 % had sensory and 25.2 % motor neuropathy, and 78.2 % had musculoskeletal complications. Severe impairments/limitations were present among ≥25 % of survivors on fitness, balance, and physical HRQOL measures, and among ≥15 % on strength and activity of daily living measures. Lower extremity tumor location (OR 8.23, 95 % CI 2.54-26.67, P value 0.0004) and amputation (OR 8.07, 95 % CI 3.06-21.27, P value <0.0001) were associated with poor fitness. Poor fitness was associated with increased odds of scoring <40 on the SF-36 physical component summary (OR 4.83, 95 % CI 1.95-11.99, P value 0.001) and role-physical subscale (OR 3.34, 95 % CI 1.33-8.43, P value 0.01). Survivors and controls had similar rates of marriage, independent living, employment, and college attendance. CONCLUSIONS Extremity sarcoma survivors experience high rates of physical impairment and report lower than expected physical HRQOL. However, they are as likely as peers to be married, live independently, be employed, and attend college. IMPLICATIONS FOR CANCER SURVIVORS Follow-up for extremity sarcoma survivors should include assessment of need for further orthopedic care and rehabilitation to address cardiopulmonary and musculoskeletal health.
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Affiliation(s)
- Israel Fernandez-Pineda
- Department of Surgery, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
| | - M M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - A S Pappo
- Department of Oncology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - M W Bishop
- Department of Oncology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - J L Klosky
- Department of Psychology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - T M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - D K Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - M D Neel
- Department of Surgery, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - B N Rao
- Department of Surgery, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - A M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - K R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - D A Mulrooney
- Department of Oncology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - L L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
| | - K K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA
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Schaefers J, Vervloessem D, De Roover D, De Praeter M, van der Werff Ten Bosch J, van den Akker M. Soft tissue swelling in children: case report, differential diagnosis, and diagnostic delay. Clin Case Rep 2016; 4:643-6. [PMID: 27386119 PMCID: PMC4929796 DOI: 10.1002/ccr3.585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/13/2016] [Accepted: 04/30/2016] [Indexed: 12/27/2022] Open
Abstract
A general practitioner faces regularly soft tissue swelling in otherwise healthy children. Delay in diagnosis of soft tissue malignancies is often due to asymptomatic nature and the unfamiliarity with the age-dependent differential diagnosis. Hence, an accurate knowledge is important to prevent important delay in diagnosis of potential malignancies.
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Affiliation(s)
| | - Dirk Vervloessem
- Pediatric Surgery Queen Paola Children's Hospital Antwerp Belgium
| | | | | | | | - Machiel van den Akker
- Department of Pediatrics Queen Paola Children's Hospital Antwerp Belgium; Pediatric of Hematology Oncology UZ Brussel Brussels Belgium
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Bhatt N, Deady S, Gillis A, Bertuzzi A, Fabre A, Heffernan E, Gillham C, O'Toole G, Ridgway PF. Epidemiological study of soft-tissue sarcomas in Ireland. Cancer Med 2015; 5:129-35. [PMID: 26589778 PMCID: PMC4708898 DOI: 10.1002/cam4.547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/21/2015] [Accepted: 09/02/2015] [Indexed: 11/10/2022] Open
Abstract
Soft‐tissue sarcomas (STS) account for 1% of adult and 7% of pediatric malignancies. Histopathology and classification of these rare tumors requires further refinements. The aim of this paper is to describe the current incidence and survival of STS from 1994 to 2012 in Ireland and compare these with comparably coded international published reports. This is a retrospective, population study based on the data from the National Cancer Registry of Ireland (NCRI). Incidence and relative survival rates for STS in Ireland were generated. Incidence of STS based on gender, age and anatomical location was examined. Annual mean incidence rate (European Age Standardized) in Ireland between 1994 and 2012 was 4.48 ± 0.15 per 100,000 person‐years. The overall relative 5‐year survival rate of STS for the period 1994–2011 in Ireland was 56%, which was similar to that reported in the U.K. but lower than in most of Europe and U.S.A. Survival rate fluctuated over the period examined, declining slightly in females but showing an increase in males. STS incidence trends in Ireland were comparable to international reports. Survival trends of STS were significantly different between Ireland and other European countries, requiring further study to understand causation.
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Affiliation(s)
- Nikita Bhatt
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | | | - Amy Gillis
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Alexia Bertuzzi
- Department of Medical Oncology, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
| | - Aurelie Fabre
- Department of Histopathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Eric Heffernan
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Charles Gillham
- Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland
| | - Gary O'Toole
- Department of Orthopaedics, St. Vincent's University Hospital, Dublin, Ireland
| | - Paul F Ridgway
- Department of Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland
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De Niro JE, Cham EM, Silkiss RZ. Undifferentiated sarcoma of the orbit with angiomyxoid features. J Pediatr Ophthalmol Strabismus 2014; 51 Online:e4-7. [PMID: 25314104 DOI: 10.3928/01913913-20140218-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 01/06/2014] [Indexed: 11/20/2022]
Abstract
A 7-month-old female infant developed a grade 3 un-differentiated sarcoma with angiomyxoid features of the right orbit. The tumor expanded rapidly 2 months after an initial sub-total resection and extended posteriorly toward the right cavernous sinus. After treatment with ifosphamide, doxorubicin, and proton beam radiation, there was no discernible residual tumor 20 months after starting chemotherapy.
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Emergency surgical treatment of an ulcerative and hemorrhagic congenital/infantile fibrosarcoma of the lower leg: case report and literature review. J Pediatr Orthop B 2013; 22:228-32. [PMID: 22568962 DOI: 10.1097/bpb.0b013e3283536908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fibrosarcomas are rare malignant soft-tissue tumors occurring mostly in infants younger than 1 year of age. Fibrosarcomas can ulcerate and cause various complications, which could threaten a fetus in utero or a child in the early neonatal period. We report a unique case of congenital infantile fibrosarcoma of the lower leg, its treatment and pathology. The large expansive and destructive lesion was not appreciated on routine prenatal ultrasound exams at 20 and 33 weeks gestation. The newborn required immediate emergency surgical intervention after delivery to prevent death by hemorrhagic shock. Initial debulking of the tumor was performed and hemostasis was attained on the day of birth. The child was resuscitated and definitive treatment of the leg was deferred until a pathologic diagnosis was obtained. Given the extent of the fibrosarcoma, the lower leg was not salvageable and the patient received a through-the-knee amputation in the neonatal period. The patient is free of disease at 2 years of age.
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Ray A, Huh WW. Current State-of-the-Art Systemic Therapy for Pediatric Soft Tissue Sarcomas. Curr Oncol Rep 2012; 14:311-9. [DOI: 10.1007/s11912-012-0243-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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