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Aktekin EH, Kütük MÖ, Sangün Ö, Yazıcı N, Çaylaklı F, Erol İ, Sarıalioğlu F. Late effects of medulloblastoma treatment: multidisciplinary approach of survivors. Childs Nerv Syst 2024; 40:417-425. [PMID: 37698649 DOI: 10.1007/s00381-023-06146-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Medulloblastoma is one of the brain tumors with increased life expectancy due to improvements in treatment approaches. Besides the promising results, various undesirable effects can be encountered. This study's aim is to review long-term follow-up outcomes of our cases with medulloblastoma. METHODS Age at diagnosis, histological type of medulloblastoma, resection extension, chemotherapy and radiotherapy schemes, follow-up duration, and endocrinological, neuropsychiatric, cardiological, auditory, and visual examination results were evaluated in 20 patients diagnosed between 2007 and 2018 and followed 5 years and more. RESULTS Twenty of 53 patients were included to the study. Eleven (55%) were male. Mean age at diagnosis was 6.95 years; mean age at the time of the study was 14 years. Mean follow-up time was 8.95 years. In terms of surgery, 14 (70%) were gross total, 1 (5%) was near total, and 2 (10%) were subtotal resection. In histopathological examination, 14 (70%) were classical medulloblastoma, 4 (20%) were desmoplastic medulloblastoma, and 1 (5%) was anaplastic medulloblastoma. With regard to endocrinological evaluation, 15 (75%) patients had hypothyroidism, 5 (25%) had growth hormone deficiency, 7 (35%) had clinical growth hormone deficiency, and 5 (25%) had sex hormone disorders. In neuropsychiatric examination, 11 (55%) patients had neurological sequelae, 18 (90%) patients had psychiatric issues, and 14 (70%) patients had two or more neuropsychiatric problems simultaneously. One (5%) patient had mitral valve insufficiency. Twelve patients (60%) had hearing loss. According to visual examination, 6 (30%) patients had refraction problem, 4 (20%) had cataract, and 1 (5%) had dry eye. CONCLUSION Careful monitoring of long-term side effects is important for improving the quality of life of medulloblastoma patients. Besides endocrinological and other somatic sequelae of the disease and treatment, increased neuropsychiatric problems showed us that only cure is not the issue while treating childhood medulloblastoma.
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Affiliation(s)
- Elif Habibe Aktekin
- Department of Pediatrics Division of Pediatric Hematology-Oncology, Baskent University, Adana, Turkey.
| | - Meryem Özlem Kütük
- Department of Child and Adolescent Psychiatry, Baskent University, Adana, Turkey
| | - Özlem Sangün
- Department of Pediatric Division of Pediatric Endocrinology, Baskent University, Adana, Turkey
| | - Nalan Yazıcı
- Department of Pediatrics Division of Pediatric Hematology-Oncology, Baskent University, Adana, Turkey
| | - Fatma Çaylaklı
- Department of Ear-Nose and Throat, Baskent University, Adana, Turkey
| | - İlknur Erol
- Department of Pediatrics Division of Pediatric Neurology, Baskent University, Adana, Turkey
| | - Faik Sarıalioğlu
- Department of Pediatrics Division of Pediatric Hematology-Oncology, Baskent University, Adana, Turkey
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Aktekin EH, Gezer HÖ, Yazıcı N, Erol İ, Erbay A, Sarıalioğlu F. Five Years Follow-up of Opsoclonus-Myoclonus-Ataxia Syndrome-Associated Neurogenic Tumors in Children. Neuropediatrics 2024; 55:57-62. [PMID: 37019145 DOI: 10.1055/s-0043-1768143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
AIM Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare autoimmune disorder. Approximately half of the cases are associated with neuroblastoma in children. This study's aim is to review management of our cases with OMAS-associated neuroblastoma for treatment approach as well as long-term follow-up. METHODS Age at onset of symptoms and tumor diagnosis, tumor location, histopathology, stage, chemotherapy, OMAS protocol, surgery, and follow-up period were evaluated retrospectively in six patients between 2007 and 2022. RESULTS Mean age of onset of OMAS findings was 13.5 months and mean age at tumor diagnosis was 15.1 months. Tumor was located at thorax in three patients and surrenal in others. Four patients underwent primary surgery. Histopathological diagnosis was ganglioneuroblastoma in three, neuroblastoma in two, and undifferentiated neuroblastoma in one. One patient was considered as stage 1 and rest of them as stage 2. Chemotherapy was provided in five cases. The OMAS protocol was applied to five patients. Our protocol is intravenous immunoglobulin (IVIG) 1 g/kg/d for 2 consecutive days once a month and dexamethasone for 5 days (20 mg/m2/d for 1-2 days, 10 mg/m2/d for 3-4 days, and 5 mg/m2/d for the fifth day) once a month, alternatively by 2-week intervals. Patients were followed up for a mean of 8.1 years. Neuropsychiatric sequelae were detected in two patients. CONCLUSION In tumor-related cases, alternating use of corticosteroid and IVIG for suppression of autoimmunity as the OMAS protocol, total excision of the tumor as soon as possible, and chemotherapeutics in selected patients seem to be related to resolution of acute problems, long-term sequelae, and severity.
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Affiliation(s)
- Elif Habibe Aktekin
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baskent University, Adana, Turkey
| | | | - Nalan Yazıcı
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baskent University, Adana, Turkey
| | - İlknur Erol
- Division of Pediatric Neurology, Department of Pediatrics, Baskent University, Adana, Turkey
| | - Ayşe Erbay
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baskent University, Adana, Turkey
| | - Faik Sarıalioğlu
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baskent University, Adana, Turkey
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Affiliation(s)
- F Burcu Belen-Apak
- Department of Paediatric Haemotology and Oncology, Faculty of Medicine, Baskent University, Sehit Temel Kuguluoglu Str. No:24, Bahcelievler, Ankara, Turkey.
| | - F Sarıalioğlu
- Department of Paediatric Haemotology and Oncology, Faculty of Medicine, Baskent University, Sehit Temel Kuguluoglu Str. No:24, Bahcelievler, Ankara, Turkey
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Barış Z, Özçay F, Yılmaz Özbek Ö, Haberal N, Sarıalioğlu F, Haberal M. A single-center experience of post-transplant lymphoproliferative disorder (PTLD) cases after pediatric liver transplantation: Incidence, outcomes, and association with food allergy. Turk J Gastroenterol 2018; 29:354-360. [PMID: 29755021 DOI: 10.5152/tjg.2018.17731] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS We evaluated our 16-year single-center experience of pediatric post-transplant lymphoproliferative disorder (PTLD) cases who underwent liver transplantation between 2001 and 2017. MATERIALS AND METHODS Of the 236 pediatric patients who underwent liver transplantation between 2001 and 2017, the clinical and laboratory data of eight patients diagnosed with PTLD were reviewed. The pre-transplant Epstein-Barr virus (EBV) status of 172 patients was also recorded. RESULTS The total incidence of PTLD was 3.4%. The incidence of PTLD was 10% in pre-transplant EBV immunoglobulin G (IgG)-seronegative patients and 0.8% in pre-transplant EBV IgG-seropositive patients. The mean age of the patients at liver transplantation was 2.71±3.21 years, and four patients were aged below 1 year at the time of transplantation. PTLD was diagnosed at 21.81±18.1 months after transplantation. The primary site of involvement was variable among patients: peripheral and mediastinal lymph nodes, stomach and intestine, transplanted graft, bone marrow, and nasopharynx. The eosinophil count varied greatly among patients, with a mean value of 524.62±679/mm3. Three patients had a food allergy and were administered an elimination diet at the time of PTLD diagnosis. Six patients had PTLD of B-cell origin. One patient died due to neutropenic sepsis during chemotherapy, whereas seven patients were followed up in full remission for 7.75±4 years. CONCLUSION PTLD is a life-threatening complication of solid-organ transplantation with a heterogeneous clinical spectrum. Food allergy had a close association with PTLD. A close follow-up of patients with risk factors and an early diagnosis with appropriate treatment may lead to a better outcome.
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Affiliation(s)
- Zeren Barış
- Department of Pediatric Gastroenterology, Başkent University Hospital, Ankara, Turkey
| | - Figen Özçay
- Department of Pediatric Gastroenterology, Başkent University Hospital, Ankara, Turkey
| | - Özlem Yılmaz Özbek
- Department of Pediatric Allergy, Başkent University Hospital, Ankara, Turkey
| | - Nihan Haberal
- Department of Pathology, Başkent University Hospital, Ankara, Turkey
| | - Faik Sarıalioğlu
- Department of Pediatric Oncology, Başkent University Hospital, Ankara, Turkey
| | - Mehmet Haberal
- Department of General Surgery and Transplant Surgery, Başkent University Hospital, Ankara, Turkey
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Sarıalioğlu F, Yazıcı N, Erbay A, Boyvat F, Demir Ş, Özçay F, Uslu N. A New Perspective for Infantile Hepatic Hemangioma in the Age of Propranolol: Experience at Baskent University. EXP CLIN TRANSPLANT 2017; 15:74-78. [PMID: 28302004 DOI: 10.6002/ect.tond16.l19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Propranolol was first used in 2008 to treat hemangioma; its efficacy and safety have since changed the classical treatment indications. Infantile hepatic hemangioma presents as a spectrum of clinical conditions varying from simple asymptomatic lesions to lethal complications. Tufted hemangioma and Kaposiform hemangioendothelioma are congenital vascular tumors that lead to Kasabach-Merritt syndrome. Hemangiomas, like pure arteriovenous malformations, can cause hyperdynamic heart failure, and diffuse nodular-type hemangiomas can present with hypothyroidism. Respiratory problems and hepatic failure can be associated with diffuse nodular-type liver hemangiomas. There is a spectrum of approaches to management, varying from "watchful waiting" to liver transplant. In the age of propranolol, there has been a prominent change in the infantile hepatic hemangioma treatment algorithm. Our suggestion is early treatment with 3 mg/kg/day propranolol plus 1.0 to1.5 mg/kg/day prednisolone in all patients. This protocol is the most effective strategy for type 3 infantile hepatic hemangioma. Approximately one-third of patients with abdominal compartment syndrome in the era before propranolol treatment required liver transplant; this new treatment obviates transplant for many of these patients.
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Affiliation(s)
- Faik Sarıalioğlu
- Department of Pediatric Oncology-Hematology, Baskent University Faculty of Medicine, Ankara, Turkey
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Erdoğan İ, Sarıalioğlu F. Cardiac evaluation in children with hemangiomas. Turk Kardiyol Dern Ars 2016; 44:498-502. [PMID: 27665331 DOI: 10.5543/tkda.2016.65171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Hemangiomas are tumors most commonly encountered in pediatric patients, and are frequently treated with propranolol. However, there are currently no standard methods for evaluating cardiac function in patients prior to propranolol treatment. The present study was designed to aid in the evaluation of pretreatment cardiac and effects of propranolol on vital signs in pediatric hemangioma patients. METHODS A pediatric oncology specialist and a pediatric cardiology specialist examined all patients prior to initiation of propranolol treatment. All patients were examined by the same 2 physicians. Cardiac evaluation included complete echocardiogram and electrocardiography. From September 2009 to January 2014, 146 patients aged 4 days to 10 years were screened. RESULTS No patient had cardiac contraindication to propranolol. The effect of hemangioma on left ventricle size was examined, but left ventricle dilatation was found in only 3 patients. However, 68 patients had abnormal echocardiogram: 17 had patent foramen ovale, 4 had ventricular septal defect, 9 had atrial septal defect (associated with right heart enlargement), 8 had patent ductus arteriosus, 6 had physiologic pulmonary stenosis, and 1 had an aortic coarctation. No contraindications to propranolol or side effects were observed. However, cardiac anatomic defects were more common in this patient group than in the general population. CONCLUSION Hemangiomas in infants or children, even in small or premature infants, can be treated with propranolol without significant cardiac side effects. In addition, large dermal hemangiomas were not found to affect ventricular size in pediatric patients.
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Affiliation(s)
- İlkay Erdoğan
- Department of Pediatric Cardiology, Başkent University Faculty of Medicine, Ankara, Turkey.
| | - Faik Sarıalioğlu
- Department of Pediatric Oncology, Başkent University Faculty of Medicine, Ankara, Turkey
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Asilsoy S, Yazici N, Demir S, Erbay A, Koçer E, Sarıalioğlu F. A different cause for respiratory disorder in children: cases with pulmonary Langerhans cell histiocytosis. Clin Respir J 2015; 11:193-199. [PMID: 26083968 DOI: 10.1111/crj.12324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/27/2015] [Accepted: 05/14/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In children, complaints of a respiratory disorder are very frequent. Etiology of respiratory illness is a broad spectrum that varies from a simple viral infection to a malignant disorder. Pulmonary Langerhans cell histiocytosis (PLCH) is one of these entities and it is truly rare in children. The aim of this study is to evaluate our patients with PLCH. METHODS Patients who had been diagnosed with PLCH were retrospectively evaluated. Features of medical history, onset of the complaints, date of the diagnosis, chest X-Ray and computed tomography (CT) findings, histopathology and other laboratory investigations were considered. RESULTS There were four cases with PLCH. All of them were male, ages were between 5 months and 16 years. In three cases, major complaints were chronic respiratory problems whereas in one of them there was acute respiratory distress beginning with cough and leading to pneumothorax. In all of the cases, multisystemic involvement was prominent. The diagnosis was proven by histopathology in all of the cases. In two children with smaller age, skin involvement was detected. Time from complaint to diagnosis was minimum 3 months and maximum 3 years. CONCLUSION PLCH is a rare disorder in children. Pulmonary involvement is generally a component of systemic involvement but in many cases it might have been detected with early respiratory complaints. So, children with chronic respiratory problems should be carefully evaluated and should be followed up for rare entities like PLCH.
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Affiliation(s)
- Suna Asilsoy
- Pediatric Allergy, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Nalan Yazici
- Pediatric Oncology, Baskent University, Faculty of Medicine, Adana, Turkey
| | - Senay Demir
- Pediatic Radyology, Baskent University, Faculty of Medicine, Adana, Turkey
| | - Ayse Erbay
- Pediatric Oncology, Baskent University, Faculty of Medicine, Adana, Turkey
| | - Emrah Koçer
- Pathology, Baskent University, Faculty of Medicine, Adana, Turkey
| | - Faik Sarıalioğlu
- Pediatric Oncology, Baskent University Faculty of Medicine, Adana, Turkey
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Yazıcı N, Sarıalioğlu F, Varan B, Aşlamacı S, Tarhan C, Atılgan AO. Treatment of cardiac infantile fibrosarcoma. Pediatr Blood Cancer 2013; 60:953-4. [PMID: 23441070 DOI: 10.1002/pbc.24497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 01/16/2013] [Indexed: 11/12/2022]
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