Pediatric Solid Tumors

Published on 04/03/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 04/03/2015

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Chapter 95

Pediatric Solid Tumors

Summary of Key Points

Osteosarcoma

Ewing Sarcoma Family Tumors

Neuroblastoma

Primary Therapy

• Specific treatment depends on stage of disease, age of the patient, and biological features of the tumor.

• With few exceptions (completely resected primary tumor, localized tumor with/without complete excision and favorable tumor biological features, infants with stable stage 4S disease), multiple-agent chemotherapy is the backbone of multimodality treatment.

• Survival depends on stage and biological features of the tumor (e.g., histopathological subtype, MYCN gene amplification).

• The overall survival rate for asymptomatic patients with favorable biology stage 1, 2a, or 2b tumors is greater than 90%.

• Overall survival among patients with advanced-stage 3 or 4 with MYCN gene amplification disease is poor. Less than one-third of children with high risk disease are long-term survivors.

Wilms Tumor

Primary Therapy

• Surgery: Surgical resection of the primary tumor usually precedes chemotherapy in the approach taken by the Children’s Oncology Group (COG). Presurgical chemotherapy is used in the approach taken by the International Society of Pediatric Oncology (SIOP).

• Chemotherapy: Agents used depend on disease stage and favorable versus anaplastic histology: stages I and II, favorable histology—vincristine, actinomycin D; stages III and IV, favorable histology, and stage I, anaplastic histology—vincristine, doxorubicin, actinomycin D; stages II through IV, anaplastic histology—vincristine, cyclophosphamide, doxorubicin, carboplatin, etoposide.

• Radiation therapy: Radiation therapy is included in management for stages III and IV, favorable histology, and stages II through IV, anaplastic histology.

• Recurrent disease is effectively managed with radiation therapy and chemotherapy with agents not used for initial treatment.

• Patients who initially received aggressive treatment may respond to cyclophosphamide or ifosfamide-, carboplatin-, and etoposide-based regimens.

Renal Cell Carcinoma

Rhabdomyosarcoma

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