Peds Flashcards
What are favorable sites
orbit, non-para h&n, non-bladder/prostate GU, billiary (bong)
What are non-parameningeal sites
larynx, soft tissues, salivary glands,
Group I rhabdo
completely resected
Group IIA rhabdo
microscopic positive margin
Group IIB rhabdo,
grossly resected LN disease
Group IIC rhabdo
IIA + IIB, positive margin and LN
Group III rhabdo
Gross residual disease
Group IV rhabdo
DM
Stage I rhabdo
favorable site
Stage II rhabdo
unfav site <=5 cm and LN-
Stage III rhabdo
unfav site >5 cm or LN+
Stage IV rhabdo
DM
Low risk rhabdo
fox-1 negative and Group I-III fav site or Group I-II unfav site
Intermediate risk rhabdo
Every Alveolar and Group III of unfav site, and Group IV age<10 embryonal
high risk rhabdo
All Group IV except for Age<10 embryonal
Path needed for rhabdo
primary site biopsy, BM biopsy, CSF if parameningeal, SLNB if extremity
Management of low risk rhabdo
VACx24 w with RT at week 12
Management of intermediate risk rhabdo
VAC/VIx42w, RT at week 12
Management of high risk rhabdo
VAC/IE x54w, Primary RT at week 20, DM RT after CHT
Dose for primary site RT for rhabdo Group 1
Embryonal: 0 Gy, Alveolar: 36 Gy
Dose for primary site RT for rhabdo Group II
IIA: 36 Gy, IIB: 41.4 Gy (draining lymphatic chain receives 36 Gy)
Rhabdo Orbit PR dose
50.4 Gy
Rhabdo Orbit CR dose
45 Gy
Dose for primary site RT for rhabdo Group III
<5 cm: 5040, >5 cm: 5940 cGY
GTV1 and GTV2 for rhabdo
GTV1: pre-CHT GTV, GTV2: Post-CHT GTV
SIB for Rhabdo
GTV1 to 36 Gy then cone down to the other dose
Rhabdo DM dose
CR: 40/2, PR: 50/2
Rhabdo whole lung dose
15/1.5 (12/1.5 if < age 6)
Whole liver RRT rhabdo
23.4/1.8
Whole abdomen Rhabdo dose
24/1.5
Management of Ewing’s Sarcoma
Induction with VAC-IE q2w x 6, then consolidation with VAC-IE q2wx11, Local therapy at Week 13
What is local therapy for ewings
Surgery or RT (surgery if reasonably resectable)
GTV1 and GTV2 for Ewings
Prechemo GTV, Postchemo GTV except Prechemo in bone
Primary site dose for Ewings
45 to PTV1, 55.8 to PTV2
Whole lung dose for Ewings
15/1.5 (12/1.5 for age<6)
Whole abdomen for Ewing’s
24/1.5
Favorable histologies for Wilms
Epithelial, stromal, blastemal
Unfav hist for wilms
CCSK, Rhabdoid, anaplasia (focal or diffuse)
Imaging findings for wilms
no calcs, pseduocapsule, claw sign, not cross midline
lab work for wilms
cbc/cmp, ua, urine vma/hva
imaging for wilms
abdom US, MRI abd, CT CAP, MRI brain if CCSK or RTK, bone scan if CCSK
how to get path for wilms
radical nephrectomy and ipsi LND NEVER BIOPSY
Stage I wilms
I: completely reseted tumor limited to the kidney
Stage II wilms
Complete resected extending into renal sinus or blood vessels
Stage III wilms
SLURPPP: spillage positive LN, unresectable, residual disease, prior biopsy, peritoneal implants/positive cytology, positive margin
Stage IV Wilms
Beyond abdomen DM
Stage V wilms
bilateral
Management of wilms
Radical neph and LND, adj CHT, Flank RT
How soon after surgery do you do flank RT for wilms
10-14 days
Standard RT dose for flank RT for wilms
10.8/1.8
Who should get dose escalated RT Flank in wilms
DA stage III, RTK, Gross residual
Indications for Whole badomen with Wilms
Rupture, spillage, peritoneal implants, positive cytology
Dosing for escalated flank RT
19.8/1.8
Dose for whole abd RT for wilms
10.5/1.5
Dose if gross residual disease whole abd RT for Wilms
21/1.5
Whole lung RT dose for wilms
12/1.5 (10.5/1.5 if Age<1)
Flank RT volume
preop extent of tumor + kidney + 1cm to CTV + 0.5 cm, lateral flash, medial VB+1cm.
Borders of PA LN if radiating during wilms flank RT
T11/T12 to L5/S1
Borders of whole abdomen field
1 cm above diaphragm, inferior: bottom of OF, Lateral: body wall, block femoral head and heart.
Lab work for Neuroblastoma
cbc/cmp, ua, urine vma/hva
Imaging for neuroblastoma
abd US, MRI abd, CT chest, MIBG scan
what makes neuroblastoma high risk
MYC amplification in L2/M/MS, Age>1.5 with stage M, Age>1.5 who progresses to M
INRT staging for neuroblastoma
L1: localized not involving vital structure, L2: locoregional tumor invading adj structures, M: DM, MS: Age <1.5 with limited DM involving skin/liver/bone or BM<10%
Management of high risk Neuroblastoma
induction chemo x 5 cycles then surgery, ASCT x2, then radiation 4-6 weeks later
RT dose for neuroblastoma
21.6/1.8, cone down to 36 to residual tumor + 1cm
What volume gets RT in neuroblastoma
post-chemo, presurgery + 2 cm
cord compression dose for neuroblastoma
9 Gy/1.8, 21.6 Gy/1.8 if Age>3
Germinomatous GCT management
24 Gy WVRT then 45 Gy IFRT
NGGCT management
carb/etop + I/E then surgery then CSI 36 Gy then IFRT 54
Management of Myxo ependymoma
GTR then observe, lRT only for STR
management of calssic/anaplastic ependymoma
GTR then 50.4 Gy IFRT.
When do you give CSI for ependymoma
if CSF+
Which wilms do not need flank rt
Stage I and II favorable histology
