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Slatnick LR, Cost C, Garrington T, Donaldson N, Macy ME. Central Nervous System Metastases in Pediatric Patients With Ewing Sarcoma. J Pediatr Hematol Oncol 2024; 46:e180-e183. [PMID: 38316140 DOI: 10.1097/mph.0000000000002825] [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] [Received: 09/13/2023] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
Metastatic central nervous system (CNS) involvement is rare in pediatric primary extracranial Ewing sarcoma (ES). We describe the incidence and course of 6 patients with extracranial ES who developed metastatic CNS lesions treated at a single institution. The median time to CNS disease detection was 16.3 months (10.0-28.3 months). Event-free and overall survival after CNS disease detection were 1.9 months (0.4 to 10.3 months) and 4.6 months (1.1 to 50.9 months), respectively. One patient was alive at the time of analysis. Clinical status and ability to obtain disease control should be considered when making decisions regarding aggressive interventions in these patients with poor prognosis.
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Affiliation(s)
- Leonora R Slatnick
- Department of Pediatrics, University of Utah, Division of Hematology/Oncology, Primary Children's Hospital, Salt Lake City, UT
| | - Carrye Cost
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Center for Cancer and Blood Disorders, Children's Hospital Colorado
| | - Timothy Garrington
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Center for Cancer and Blood Disorders, Children's Hospital Colorado
| | - Nathan Donaldson
- Department of Orthopedic Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Margaret E Macy
- Department of Pediatrics, University of Colorado Anschutz Medical Campus and Center for Cancer and Blood Disorders, Children's Hospital Colorado
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2
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Moreira DC, Metzger ML, Antillón-Klussmann F, González-Ramella O, Gao Y, Bazzeh F, Middlekauff J, Fox Irwin L, Gonzalez ML, Chantada G, Barr RD, Garrington T, Hastings C, Kutluk T, Saab R, Khan MS, Saha V, Rodríguez-Galindo C, Friedrich P. Development of EPAT: An assessment tool for pediatric hematology/oncology training programs. Cancer 2023; 129:3448-3456. [PMID: 37417913 DOI: 10.1002/cncr.34946] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/18/2023] [Accepted: 05/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE In the absence of a standardized tool to assess the quality of pediatric hematology/oncology training programs, the Education Program Assessment Tool (EPAT) was conceptualized as a user-friendly and adaptable tool to evaluate and identify areas of opportunity, pinpoint needed modifications, and monitor progress for training programs around the world. METHODS The development of EPAT consisted of three main phases: operationalization, consensus, and piloting. After each phase, the tool was iteratively modified based on feedback to improve its relevance, usability, and clarity. RESULTS The operationalization process led to the development of 10 domains with associated assessment questions. The two-step consensus phase included an internal consensus phase to validate the domains and a subsequent external consensus phase to refine the domains and overall function of the tool. EPAT domains for programmatic evaluation are hospital infrastructure, patient care, education infrastructure, program basics, clinical exposure, theory, research, evaluation, educational culture, and graduate impact. EPAT was piloted in five training programs in five countries, representing diverse medical training and patient care contexts for proper validation of the tool. Face validity was confirmed by a correlation between the perceived and calculated scores for each domain (r = 0.78, p < .0001). CONCLUSIONS EPAT was developed following a systematic approach, ultimately leading to a relevant tool to evaluate the different core elements of pediatric hematology/oncology training programs across the world. With EPAT, programs will have a tool to quantitatively evaluate their training, allowing for benchmarking with centers at the local, regional, and international level.
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Affiliation(s)
| | | | - Federico Antillón-Klussmann
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
- Universidad Francisco Marroquin, Guatemala City, Guatemala
| | | | - Yijin Gao
- Shanghai Children's Medical Center, Shanghai, China
| | | | | | | | | | - Guillermo Chantada
- Fundacion Pérez Scremini-Hospital Pereira Rossell, Montevideo, Uruguay
- Hospital Sant Joan de Déu, Barcelona, Spain
| | - Ronald D Barr
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | | | - Tezer Kutluk
- Hacettepe University Faculty of Medicine & Cancer Institute, Ankara, Turkey
| | - Raya Saab
- Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Muhammad Saghir Khan
- King Faisal Specialist Hospital and Research Center, Al Madinah Al Munawarrah, Saudi Arabia
| | | | | | - Paola Friedrich
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Harding E, Cho S, Garrington T, Mandell E. A Neonate Presenting with Cholestasis and Thrombocytopenia. Neoreviews 2023; 24:e583-e586. [PMID: 37653080 DOI: 10.1542/neo.24-9-e583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Emma Harding
- Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Soohee Cho
- Division of Pediatric Allergy, Immunology, and Bone Marrow Transplantation, Department of Pediatrics, University of California - San Francisco, San Francisco, CA
| | - Timothy Garrington
- Section of Hematology, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Erica Mandell
- Pediatric Heart Lung Center and Section of Neonatology, Department of Pediatrics, University of Colorado Anschutz School of Medicine and Children's Hospital Colorado, Aurora, CO
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Moody KM, Andersen C, Bradley J, Draper L, Garrington T, Gill J, Harrison D, Hayashi M, Heaton A, Holladay C, Lion A, Rajan A, Rozo B, Runco D, Salvador L, Ferguson V, Arnold R. In-person and virtual adaptation of an interprofessional palliative care communications skills training course for pediatric oncology clinicians. Res Sq 2023:rs.3.rs-3228580. [PMID: 37609163 PMCID: PMC10441465 DOI: 10.21203/rs.3.rs-3228580/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Purpose Effective, empathic communication is crucial for pediatric oncology clinicians when discussing palliative and end-of-life (PC/EOL) care with parents of children with cancer. Unfortunately, many parents report inadequate communication at these distressing times. This study evaluates the communication skills training (CST) clinicians received to deliver a PC/EOL communication intervention as part of a multi-site randomized-controlled trial (RCT). Methods Clinicians from eight sites formed dyads (one physician and one nurse [RN] or advanced practice provider [APP]) and were trained over 3 days (in-person or virtually). Training was adapted from VitalTalk™ and included didactic instruction, videos, visual aids, and dedicated time to practice with simulated patients. Study participants completed a confidential, post-training online evaluation survey. A self-reported quality assurance checklist was used to measure fidelity to the communication protocol when delivered to parents during the RCT. Results Thirty clinicians completed training; 26 completed post-training surveys including twelve (46.1%) physicians, 8 (30.8%) RNs and 6 (23.1%) APPs. Most were female (65.4%); white (80.8%), not Latinx (88.5%); 40-50 years old (53.9%); and in practice over 10 years (65.4%). Nine (34.6%) trained in-person; the rest trained virtually. Ninety-two percent reported the course was valuable or very valuable for developing their PC/EOL communication skills and 96% reported learning something new. Dyads trained virtually had similar fidelity to those trained in-person (95% and 90% respectively) when delivering the PC/EOL communication intervention to parents. Conclusion This PC/EOL CST was valuable for improving pediatric oncology clinicians' communication skills, successfully implemented in-person and virtually, and translated effectively into practice.
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Risendal B, Westfall JM, Zittleman L, Hodgson C, Garrington T, Sutter C, Jarrell L, LeBlanc W, Overholser L. Impact of Cancer Survivorship Care Training on Rural Primary Care Practice Teams: a Mixed Methods Approach. J Cancer Educ 2022; 37:71-80. [PMID: 32974812 DOI: 10.1007/s13187-020-01788-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With the increasing numbers of individuals surviving a diagnosis of cancer, an aging population, and more individuals experiencing multi-morbidity, primary care providers (PCPs) are seeing more patients with a history of cancer. Effective strategies are needed to adequately prepare the primary care workforce for the phase of cancer care now widely recognized as survivorship. A survivorship education program for rural primary care practices was developed using a community engagement process and delivered at the practice level by community health liaisons. A mixed method approach was used to evaluate the program impact which included a questionnaire and interviews. Descriptive analyses and generalized linear regression were used to evaluate quantitative outcomes from the questionnaires. Immersion crystallization was used to define themes from the qualitative components. Thirty-two (32) practices participated, averaging 10.3 team members/practice. The percent of correct responses to the knowledge questionnaire increased significantly, almost doubling between baseline and post-test (25% vs 46%, p < .001). Four major themes emerged from the interviews which included positive impact of the training, putting the training into practice, intention to change care delivery, contextual influences in survivorship care. Evidence from the cancer survivorship education program evaluation supports its value to key stakeholders and the potential wider dissemination of the iSurvive Program. These data also suggest the need for additional investigation into other ways beyond education that primary care practices can be supported to ensure the needs of the growing cancer survivor population in the US are met.
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Affiliation(s)
- Betsy Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, 13001 E 17th Place, Building 500, Room 3350, Aurora, CO, 80045, USA.
| | - John M Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Carol Hodgson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Timothy Garrington
- Department of Pediatric Hematology and Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christin Sutter
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lori Jarrell
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - William LeBlanc
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Linda Overholser
- Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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6
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Rodriguez KD, Schneider KW, Suttman A, Garrington T, Jellins T, Tholen K, Francom CR, Herrmann BW. Pediatric Head and Neck Tumors Associated with Li-Fraumeni Syndrome. Ann Otol Rhinol Laryngol 2021:34894211014786. [PMID: 33971750 DOI: 10.1177/00034894211014786] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Cancer predisposition syndromes are germline pathogenic variants in genes that greatly raise the risk of developing neoplastic diseases. One of the most well-known is Li-Fraumeni syndrome (LFS), which is due to pathogenic variants in the TP53 gene. Children with LFS have higher risks for multiple malignancies before adulthood, often with rare and aggressive subtypes. OBJECTIVE To examine head and neck manifestations of LFS in children treated at a tertiary children's hospital over a 20-year period. METHODS A retrospective review of LFS children with neoplastic disease presenting in traditional Otolaryngologic head and neck subsites from 2000 to 2019, with patient charts reviewed for relevant clinical, imaging, and operative data. RESULTS Of the 40 LFS patients initially identified, 27 neoplastic tumors were identified in 20 children within this cohort (20 primary, 7 second primary). Head and neck subsites aside from the brain or orbit were involved in 22% (6/27) of these tumors, representing 20% (4/20) of primary tumors and 29% (2/7) of second primary tumors. Both second primaries within the head and neck were within the radiation fields of the first primary tumor. The mean ages at primary and second primary diagnosis were 4.6 years (SD 3.5) and 12 years (SD 1.4), respectively. The male/female ratio was 1:6 among all patients with head and neck tumors. All 6 head and neck tumors were sarcomas. Rhabdomyosarcoma (N = 3, 50%) was the most common pathology, and the other 3 demonstrated rare tumor pathological subtypes (synovial cell sarcoma, pleomorphic myxoid liposarcoma, mandibular osteosarcoma). The neck was the most common subsite (75%) within this group for primary tumor presentation. CONCLUSION This study identifies a high potential for head and neck involvement in children with LFS, which has not been previously described in the literature. Otolaryngological care should be included in a multidisciplinary care team surveilling these patients.
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Affiliation(s)
- Kenny D Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Kami Wolfe Schneider
- Department of Hematology, Oncology, Bone Marrow Transplantation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Alexandra Suttman
- Department of Hematology, Oncology, Bone Marrow Transplantation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Timothy Garrington
- Department of Hematology, Oncology, Bone Marrow Transplantation, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | | | - Kaitlyn Tholen
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Christian R Francom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Brian W Herrmann
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
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Han DS, Chalmers DJ, Greffe B, Garrington T, Partrick D, Lovell M, Schneider KW, Cost NG. A Cystic Renal Mass in the Setting of a Pneumothorax: More Than Meets the Eye? Urology 2021; 154:275-277. [PMID: 33571543 DOI: 10.1016/j.urology.2021.01.049] [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] [Received: 01/19/2021] [Accepted: 01/31/2021] [Indexed: 11/15/2022]
Abstract
DICER1 syndrome is a rare hereditary cancer predisposition syndrome that has relevance to pediatric urology providers due to its association with many various pediatric genitourinary malignancies. We describe the case of a pediatric patient who was eventually diagnosed with a pathogenic DICER1 germline variant after undergoing resection of a cystic nephroma and pleuropulmonary blastoma.
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Affiliation(s)
- Daniel S Han
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO.
| | - David J Chalmers
- Maine Medical Center Urology, Maine Medical Center, Portland, ME
| | - Brian Greffe
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
| | - Timothy Garrington
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
| | - David Partrick
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO
| | - Mark Lovell
- Department of Pathology, Children's Hospital Colorado, Aurora, CO
| | | | - Nicholas G Cost
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO
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8
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Friend BD, Wolfe Schneider K, Garrington T, Truscott L, Martinez-Agosto JA, Venick RS, Tsai Chambers E, Weng P, Farmer DG, Chang VY, Federman N. Is polycystic kidney disease associated with malignancy in children? Mol Genet Genomic Med 2019; 7:e00725. [PMID: 31197971 PMCID: PMC6625336 DOI: 10.1002/mgg3.725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/18/2019] [Accepted: 04/08/2019] [Indexed: 01/16/2023] Open
Abstract
Background Polycystic kidney disease (PKD) is an inherited condition characterized by progressive development of end‐stage renal disease, hypertension, hepatic fibrosis, and cysts in the kidney, liver, pancreas, spleen, thyroid, and epididymis. While malignancies have been reported in association with PKD in adults, the incidence of malignancies in children with PKD is not currently known. Methods We report on five patients with a known history of PKD who developed a malignancy as children at the University of California, Los Angeles and the University of Colorado Anschutz Medical Campus. Patients were included from 2012 to 2017. Results We present five patients with a history of PKD diagnosed with a malignancy during childhood without any additional known mutations to suggest a genetic predisposition to develop cancer. This includes the first reported case of hepatocellular carcinoma in a patient with autosomal recessive polycystic kidney disease. Conclusion Our report illustrates the potential that PKD may be associated with an increased risk for developing cancer, even in children. Further research is necessary to better understand this relationship.
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Affiliation(s)
- Brian D Friend
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California
| | - Kami Wolfe Schneider
- Section of Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Timothy Garrington
- Section of Hematology, Oncology, and Bone Marrow Transplantation, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, Colorado
| | - Laurel Truscott
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Julian A Martinez-Agosto
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,Department of Human Genetics, UCLA David Geffen School of Medicine, Los Angeles, California.,UCLA Clinical Genomics Center, Los Angeles, California
| | - Robert S Venick
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Eileen Tsai Chambers
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,Division of Pediatric Nephrology, Department of Pediatrics, Duke University, Durham, North Carolina
| | - Patricia Weng
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California
| | - Douglas G Farmer
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Vivian Y Chang
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Noah Federman
- Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, California.,UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, California.,Department of Orthopaedics, UCLA David Geffen School of Medicine, Los Angeles, California
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9
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Deeney S, Stewart C, Treece AL, Black JO, Lovell MA, Garrington T, Karrer F, Bruny J. Diagnostic utility of core needle biopsy versus open wedge biopsy for pediatric intraabdominal solid tumors: Results of a prospective clinical study. J Pediatr Surg 2017; 52:2042-2046. [PMID: 28943139 DOI: 10.1016/j.jpedsurg.2017.08.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/28/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE The best method for diagnosing pediatric nonnephroblastoma solid intraabdominal tumors is unknown. We hypothesized that core needle biopsy (CNB) is noninferior to open wedge biopsy (OWB) for pathologic diagnosis. METHODS We prospectively enrolled children aged 1day to 17years with radiographic evidence of nonnephroblastoma solid intraabdominal tumors scheduled for OWB from 5/2013 to 12/2015 at a single institution. Four 16-gauge CNBs were obtained, followed by OWB. Two pathologists independently reviewed all specimens to determine adequacy for diagnosis. RESULTS Fourteen patients enrolled, 57% male, with an average age of 4years (range 7days to 16years). Both pathologists agreed OWB was completely sufficient for diagnosis in 13 patients (93%), compared to 4 patients for CNB (29%: Burkitt lymphoma, adrenocortical tumor, inflammatory myofibroblastic tumor, p=0.001, δ=-0.64±0.27, 95% CI). In 6 patients (43%), CNB was incompletely diagnostic according to at least one pathologist (neuroblastoma, hepatoblastoma). In 4 patients (29%), both pathologists determined that CNB was nondiagnostic (ganglioneuroblastoma, teratoma, hepatoblastoma, and recurrent neuroblastoma). CONCLUSIONS In a prospective clinical study, CNB is inferior to OWB for the pathologic diagnosis of pediatric nonnephroblastoma solid intraabdominal tumors. These data suggest that OWB should generally be performed in these patients. LEVEL OF EVIDENCE Study of Diagnostic Test, Level I.
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Affiliation(s)
- Scott Deeney
- University of Colorado School of Medicine, Department of Surgery; Children's Hospital Colorado, Division of Pediatric Surgery.
| | - Camille Stewart
- University of Colorado School of Medicine, Department of Surgery; Children's Hospital Colorado, Division of Pediatric Surgery
| | | | | | - Mark A Lovell
- Children's Hospital of Colorado, Department of Pathology
| | - Timothy Garrington
- University of Colorado School of Medicine, Department of Surgery; Children's Hospital of Colorado Center for Cancer and Blood Disorders
| | - Frederick Karrer
- University of Colorado School of Medicine, Department of Surgery; Children's Hospital Colorado, Division of Pediatric Surgery
| | - Jennifer Bruny
- University of Colorado School of Medicine, Department of Surgery; Children's Hospital Colorado, Division of Pediatric Surgery
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Amini A, Waxweiler T, Maroni P, Kessler E, Cost C, Greffe B, Garrington T, Liu A, Cost N. PD34-01 SURVIVAL OUTCOMES OF ADOLESCENT PATIENTS WITH NON-SEMINOMA TESTICULAR GERM-CELL TUMORS: A POPULATION-BASED STUDY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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11
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Overholser LS, Moss KM, Kilbourn K, Risendal B, Jones AF, Greffe BS, Garrington T, Leonardi-Warren K, Yamashita TE, Kutner JS. Development of a Primary Care-Based Clinic to Support Adults With a History of Childhood Cancer: The Tactic Clinic. J Pediatr Nurs 2015; 30:724-31. [PMID: 26278341 DOI: 10.1016/j.pedn.2015.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Describe the development and evolution of a primary-care-based, multidisciplinary clinic to support the ongoing care of adult survivors of childhood cancer. METHODS A consultative clinic for adult survivors of childhood cancer has been developed that is located in an adult, academic internal medicine setting and is based on a long-term follow-up clinic model available at Children's Hospital Colorado. RESULTS The clinic opened in July 2008. One hundred thirty-five patients have been seen as of April 2014. Referrals and clinic capacity have gradually increased over time, and a template has been developed in the electronic medical record to help facilitate completion of individualized care plan letters. CONCLUSIONS A primary care-based, multidisciplinary consultative clinic for adults with a history of childhood cancer survivor is feasible and actively engages adult primary care resources to provide risk-based care for long-term pediatric cancer survivors. This model of care planning can help support adult survivors of pediatric cancer and their primary care providers in non-academic, community settings as well.
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Affiliation(s)
- Linda S Overholser
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO.
| | - Kerry M Moss
- Connecticut Children's Medical Center, Hartford, CT
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO
| | | | | | - Brian S Greffe
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
| | - Timothy Garrington
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, CO
| | | | - Traci E Yamashita
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Jean S Kutner
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO; University of Colorado Health
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12
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Waxweiler TV, Rusthoven CG, Proper MS, Cost CR, Cost NG, Donaldson N, Garrington T, Greffe BS, Heare T, Macy ME, Liu AK. Non-Rhabdomyosarcoma Soft Tissue Sarcomas in Children: A Surveillance, Epidemiology, and End Results Analysis Validating COG Risk Stratifications. Int J Radiat Oncol Biol Phys 2015; 92:339-48. [PMID: 25968827 DOI: 10.1016/j.ijrobp.2015.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/02/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE Non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) are a heterogeneous group of sarcomas that encompass over 35 histologies. With an incidence of ∼500 cases per year in the United States in those <20 years of age, NRSTS are rare and therefore difficult to study in pediatric populations. We used the large Surveillance, Epidemiology, and End Results (SEER) database to validate the prognostic ability of the Children's Oncology Group (COG) risk classification system and to define patient, tumor, and treatment characteristics. METHODS AND MATERIALS From SEER data from 1988 to 2007, we identified patients ≤18 years of age with NRSTS. Data for age, sex, year of diagnosis, race, registry, histology, grade, primary size, primary site, stage, radiation therapy, and survival outcomes were analyzed. Patients with nonmetastatic grossly resected low-grade tumors of any size or high-grade tumors ≤5 cm were considered low risk. Cases of nonmetastatic tumors that were high grade, >5 cm, or unresectable were considered intermediate risk. Patients with nodal or distant metastases were considered high risk. RESULTS A total of 941 patients met the review criteria. On univariate analysis, black race, malignant peripheral nerve sheath (MPNST) histology, tumors >5 cm, nonextremity primary, lymph node involvement, radiation therapy, and higher risk group were associated with significantly worse overall survival (OS) and cancer-specific survival (CSS). On multivariate analysis, MPNST histology, chemotherapy-resistant histology, and higher risk group were significantly poor prognostic factors for OS and CSS. Compared to low-risk patients, intermediate patients showed poorer OS (hazard ratio [HR]: 6.08, 95% confidence interval [CI]: 3.53-10.47, P<.001) and CSS (HR: 6.27; 95% CI: 3.44-11.43, P<.001), and high-risk patients had the worst OS (HR: 13.35, 95% CI: 8.18-21.76, P<.001) and CSS (HR: 14.65, 95% CI: 8.49-25.28, P<.001). CONCLUSIONS The current COG risk group stratification for children with NRSTS has been validated with a large number of children in the SEER database.
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Affiliation(s)
- Timothy V Waxweiler
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Michelle S Proper
- Department of Radiation Oncology, Billings Clinic, Billings, Montana
| | - Carrye R Cost
- Division of Hematology and Oncology, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Nicholas G Cost
- Division of Urology, Department of Surgery, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Nathan Donaldson
- Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Timothy Garrington
- Division of Hematology and Oncology, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Brian S Greffe
- Division of Hematology and Oncology, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Travis Heare
- Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Margaret E Macy
- Division of Hematology and Oncology, Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colorado
| | - Arthur K Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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13
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Simko SJ, Tran HD, Jones J, Bilgi M, Beaupin LK, Coulter D, Garrington T, McCavit TL, Moore C, Rivera-Ortegón F, Shaffer L, Stork L, Turcotte L, Welsh EC, Hicks MJ, McClain KL, Allen CE. Clofarabine salvage therapy in refractory multifocal histiocytic disorders, including Langerhans cell histiocytosis, juvenile xanthogranuloma and Rosai-Dorfman disease. Pediatr Blood Cancer 2014; 61:479-87. [PMID: 24106153 PMCID: PMC4474604 DOI: 10.1002/pbc.24772] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/21/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Existing therapies for recurrent or refractory histiocytoses, including Langerhans cell histiocytosis (LCH), juvenile xanthogranuloma (JXG), and Rosai-Dorfman disease (RDD), have limited effectiveness. We report our experience with using clofarabine as therapy in children with recurrent or refractory histiocytic disorders, including LCH (11 patients), systemic JXG (4 patients), and RDD (3 patients). METHODS Patients treated with clofarabine for LCH, JXG, or RDD by Texas Children's Hospital physicians or collaborators between May 2011 and January 2013 were reviewed for response and toxicity. RESULTS Patients were treated with a median of three chemotherapeutic regimens prior to clofarabine. Clofarabine was typically administered at 25 mg/m(2) /day for 5 days. Cycles were administered every 28 days for a median of six cycles (range: 2-8 cycles). Seventeen of 18 patients are alive. All surviving patients showed demonstrable improvement after two to four cycles of therapy, with 11 (61%) complete responses, 4 (22%) partial responses, and 2 patients still receiving therapy. Five patients experienced disease recurrence, but three of these subsequently achieved complete remission. All patients with JXG and RDD had complete or partial response at conclusion of therapy. Side effects included neutropenia in all patients. Recurring but sporadic toxicities included prolonged neutropenia, severe vomiting, and bacterial infections. CONCLUSION Clofarabine has activity against LCH, JXG, and RDD in heavily pretreated patients, but prospective multi-center trials are warranted to determine long-term efficacy, optimal dosing, and late toxicity of clofarabine in this population.
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Affiliation(s)
- Stephen J. Simko
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
| | | | | | - Mrinalini Bilgi
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
| | | | - Don Coulter
- University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | | | - Linda Stork
- Oregon Health and Science University, Portland, OR
| | | | | | | | - Kenneth L. McClain
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
| | - Carl E. Allen
- Baylor College of Medicine, Houston, TX,Texas Children’s Cancer and Hematology Centers, Houston, TX
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14
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Abstract
Natural killer (NK) cell tumors are a rare and heterogeneous group of disorders. Immature NK cell tumors are less common, and are less recognized and defined than mature NK cell tumors. There is insufficient experience of diagnosis and treatment with immature NK cell tumors, especially in pediatric patients. Here we describe a pediatric patient with precursor NK cell leukemia and review the literature of the previously reported cases in children to further help characterize the diagnosis, treatment, and outcome.
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Affiliation(s)
- Xiayuan Liang
- Department of Pathology, University of Colorado School of Medicine, Denver, USA.
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15
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Wei X, Sun W, Fan R, Hahn J, Joetham A, Li G, Webb S, Garrington T, Dakhama A, Lucas J, Johnson GL, Gelfand EW. MEF2C regulates c-Jun but not TNF-α gene expression in stimulated mast cells. Eur J Immunol 2003; 33:2903-9. [PMID: 14515274 DOI: 10.1002/eji.200324127] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Mitogen-activated protein kinase (MAPK) cascades play essential roles in the transduction of extracellular signals to cytoplasmic and nuclear effectors. The MAPK kinase kinase MEKK2 is essential for activation of c-Jun N-terminal kinase (JNK) and extracellular signal-regulated kinase 5 (ERK5). These pathways are important for expression of specific cytokine genes in mast cells following cross-linking of the high-affinity IgE receptor (FcepsilonRI). A consequence of ERK5 activation is activation of the transcriptional factor myocyte enhancing factor-2C (MEF2C), leading to increased c-Jun expression. We have investigated the role of MEF2C activation in mast cells and demonstrated that it requires sequential activation of the signaling cascade of MEKK2-MEK5-ERK5. Following phosphorylation of MEF2C, activated MEF2C regulates transcription of c-Jun but not TNF-alpha. Inhibition of ERK5, MEK5 activation or activation of MEKK2-deficient mast cells was associated with inhibition of MEF2C phosphorylation and a decrease in c-Jun expression. Thus, these data define an activation module, MEKK2-MEK5-ERK5-MEF2C in the transcriptional activation of c-Jun in mast cells following FcepsilonRI cross-linking. These results demonstrate the novel and important, MEKK2-dependent role of MEF2C in induction of c-Jun expression in mast cells activated through FcepsilonRI, a pathway distinct from that involving MEKK2-MEK5-ERK5 in the regulation of mast cell cytokine production.
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Affiliation(s)
- Xudong Wei
- Department of Pediatrics, National Jewish Medical and Research Center, Denver, Co 80206, USA
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16
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Wei X, Wei RH, Garrington T, Johnson GL, Gelfand EW. MEKK2-MEK5-BMK1/ERK5-MEF2C activation: A new pathway regulating c-jun gene expression in stimulated mast cells. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)82133-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Garrington T, Silliman CC, Bensard D, Ingram JD. Response to successful management of a child with asparaginase- induced hemorrhagic pancreatitis. Med Pediatr Oncol 1998; 31:127. [PMID: 9714616 DOI: 10.1002/(sici)1096-911x(199808)31:2<127::aid-mpo19>3.0.co;2-k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- T Garrington
- University of Colorado School of Medicine, Denver, Colorado
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18
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Abstract
BACKGROUND Octreotide is a synthetic somatostatin analogue which has been suggested for use in the management of acute pancreatitis. While studies have looked at octreotide use in the setting of pancreatitis due to chronic alcohol use or trauma, little is known of its role in management of drug induced acute pancreatitis; particularly in the pediatric setting. PATIENTS AND METHODS We present a case of a 5 1/2-year-old white female who developed severe, necrotizing, hemorrhagic pancreatitis with pseudocyst formation secondary to L-asparaginase use as a part of her therapy for acute lymphoblastic leukemia (ALL). She was managed initially with intravenous fluids, bowel rest, nasogastric suctioning, parenteral narcotices, and broad spectrum antibiotics. In addition, within 12 hours of admission to The Children's Hospital (TCH) in Denver, Colorado, she began therapy with octreotide (5 micrograms/kg/day IV divided b.i.d.). With this management, her pseudocyst decompressed without need for surgical intervention, her pancreatitis fully resolved, and she recovered full pancreatic function without any long-term sequelae. CONCLUSION Use of octreotide may have served a role in limiting the severity of the disease process in this case. Further studies need to be done to verify its usefulness in this setting.
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Affiliation(s)
- T Garrington
- Department of Pediatrics, University of Colorado School of Medicine, Denver, USA
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