Misc

Question 1

How is CNS pediatric leukemia defined/categorized?

Answer 1

1. CNS 1: -cytology (no blasts)
2. CNS 2: +cytology, < 5 WBC/uL
3. CNS 3 - +cytology w/ ≥5 WBC/uL, or any CNS lesion/CN deficits

Only CNS 3 requires RT as part of the tx

Question 2

Which CNS category of pediatric leukemia always requires RT as part of the tx?

Answer 2

• CNS 3
  – Target: Brain, post 1/2 orbits, ONs, down to C2/C3 (german helmet field)
  – Standard risk dose: 18 Gy in 10 fx

Question 3

What is the CSI RT dose for CNS I and CNS 2 pediatric leukemias?

Answer 3

If intermediate or high-risk: 12 Gy

Question 4

What is the most common cancer in the 15-19 age group?

Answer 4

• Hodgkin Lymphoma
• Leukemia
• Non-Hodgkin Lymphoma
• Germ cell tumors

Question 5

What are the sx of Parinaud (dorsal-midbrain) syndrome, and which tumors is it classically a/w?

Answer 5

• a/w: pineoblastoma
• Sx:
  – Impaired upward gaze
  – Pseudo-Argyll-Robertson pupil
  
  • impaired pupil reaction to light but not accommodation)
    – Convergence-retraction vertical nystagmus

Question 6

What is the current SOC RT dose for CNS non-germinomatous germ cell tumors?

Answer 6

• Ventricles: 36 Gy
• Boost: 54 Gy

Question 7

What is the preferred conditioning regimen for children > 4 YO w/ high-risk ALL undergoing ASCT?

Answer 7

• TBI + Etoposide
  – Higher OS than chemo-conditioning alone

Question 8

What is the RT dose for DIPG in children?

Answer 8

• CFRT: 54-59.4 Gy
• Hypo: 39 Gy in 3 fx, 33 in 6 fx

Question 9

Do you bx DIPG?

Answer 9

• Not usually, because of high morbidity a/w the disease
• Dx based on imaging alone

Question 10

What is the general tx paradigm for NGGCT?

Answer 10

• CHT x 6C (Carboplatin/Etoposide a/w Etoposide/Ifosfamide)
• If complete response on MRI → RT (36 Gy CSI, boost to 54 Gy)
• Surgery should be avoided as these tumors are normally located on deep, midline structures where resection would result in severe morbidity

Question 11

What is the general tx paradigm for pure germinoma?

Answer 11

• CHT (carboplatin/etoposide/bleomycin x4C)
• → RT (24 Gy whole ventricular radiation, dx boost to 45 Gy)

Question 12

What is the RT dose to the testicle in a pt w/ + testicular disease after induction CHT for T-ALL?

Answer 12

24 Gy in 12 fx

Question 13

What is a bifocal germinoma?

Answer 13

Germinoma that involves the suprasellar and pineal regions

Question 14

What is a trilateral retinoblastoma? What is the usual tx?

Answer 14

• Involves b/l orbits and pineal gland
• RT: 36 Gy CSI, boost cranium to 45 Gy, and pineal gland to 50.4 Gy

Question 15

How do you manage LGG in children?

Answer 15

• Maximal safe resection
• GTR → no RT
• STR → 50.4-54 Gy

Question 16

What second malignant neoplasm is a/w RB tx?

Answer 16

Osteosarcoma