Paeds Flashcards
How is treating paediatric patient different from an adult
Tumour types different to adults
More at risk of late side effects
Neurocognitive effects
Muscle development
Bone or growth development
Tissue tolerance differences
Risk of new cancers forming later in life
Compliance
Family involvement
Medulloblastoma
Starts in posterior fossa
Most common malignant brain tumour
Can occur in adults but most common in children under 16
More common in males
Symptoms of medullablastoma
Headaches
Nausea
Motor skills
Tiredness
Tilting head to one side
Back pain
Walking difficulty or balance problems
Inability to control bladder and bowel
Diagnosis of medulloblastoma
Symptom history and neurological examination
MRI with and without contrast - can be of whole spine
Lumbar puncture
Surgery- biopsy
Pathology of report
Classification of medulloblastoma
- High risk disease: <3years old at diagnosis, tumour remaining following surgery and is more than 1.5cm2 in volume, M1-M4 staging
- Average risk disease: absence of these features
Survival rates
M0- 70-80%
If disease has spread to SC - 60%
Prognosis for children under 3 is worse
MDT
OT - play therapy
Physics
Med and Rad Onc
GA team
Paed nurses
Standard RT team
Speechies, dieticians
Considerations for family
Siblings, parents and guardians
Separated parents - consider consent
Children in foster care
Family or patient requiring to travel and stay away from home
Clinical trial for patients
SJMB12 - new diagnosis of PNET, between the ages of 3-22, no previous chemo or RT, must start treatment in 36 days following surgery
SJMB12 Treatment pathway
Diagnosis
Surgery
RT - within 36 days
Break - few months
Chemo - 6 months
Paediatric interventions
Play therapy
Environment - waiting room decorations, stickers
Distraction - music, audiobooks
Rewards - lollies, presents
What is Play therapy
Using play based procedural support to prepare children for medical experiences
- extent of therapy depends on patient
- sessions prior to CT and treatment
- usually 1-3 session can take more
Components of play therapy
- delivery of a social story by the OT
- practice making mask and vacbag on a toy or parents
- playing in the treatment room using controls
- watching parents on the monitor outside the treatment room
- practice leaving the child in the room by themselves
Benefits of play therapy
- reduced costs of GA
- daily sedation can also lead to issues such as respiratory depression, aspiration, central line infection, learning disabilities, decreased attentiveness and decreased cognitive functioning
Why do we need GA
For children under 3
Behavioural issues
Compliance issues due to health condition
Side effects of Surgery
Posterior fossa syndrome
Can occur in 8-24% of patients
Absence or reduction in speech
Axial hypotonia and ataxia - balance issues
Broad spectrum of severity, mild to completely disabling symptoms
What if GA not an option for young children
Do it while they are sleeping
Treatment options
3DCRT
IMRT
VMAT
TOMO
Should nappies be kept on
Take them off as they impact pelvic tilt
Filled nappy is also tissue equivalent and can effect dosimetry
Alternative options for tattoos
Point guards
Patient challenges
GA
Swelling from surgery and shunt location
Pain at surgery site
Changing equipment used by anaesthetists changes jaw position and head tilt
Solution mouth piece at CT for worst case scenario
CSI dose
Standard risk - CSI 23.4GY + cumulative primary site 54Gy in 30#
High risk - CSI 36-39.6GY+ Cumulative primary site 54GY IN 30#
Planning OARS
Brain stem
Eyes
Lacrimal gland
Optic nerve and chasm
Hypothalamus
Pituitary
Temporal lobe
Middle and inner ear
Cochlea
CN8
Parotids
Oral cavity
Spinal cord
Thyroid
Ovaries
Challenges of CSI
Treatment must start in 36 days following surgery
Time consuming and challenging plan
Numerous objectives on optimiser
