Peds Flashcards by Aria Kieft

Differential for suprasellar CNS tumor

Craniopharyngioma
Optic glioma
Pituitary adenoma
Germ cell tumor
Ependymoma
Meningioma

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Differential for posterior fossa CNS tumor

Medulloblastoma
Ependymoma
Glioma
Pilocytic astrocytoma
Pineocytoma
ATRT (atypical teratoid rhabdoid tumor)

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Chemo for most peds tumors?

Vincristine carboplatin

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Optic pathway glioma dose

50.4 Gy-54Gy: GTV + 5mm +/- optic tract

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Pilocytic astrocytoma treatment

Surgery => observation
Progression => vincristine/carbo
RT if unresectable: 50.4-54 Gy to GTV + 5-10mm

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Peds HGG dose

GTR: 54Gy / 30fx
STR: 59.4Gy / 33fx
GTV1: cavity, enhancement, residual tumor
+1-1.5 cm anatomically constrained = CTV
Concurrent and adjuvant TMZ

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DIPG dose

54Gy / 30 fx
CTV= GTV + 1cm
No chemo

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Rhabdomyosarcoma stage

I: Favorable site
II: Unfavorable site ≤ 5cm and N0
III: Unfavorable site > 5cm or N1
IV: M1

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Rhabdomyosarcoma risk groups

Low risk: (embryonal)
Favorable site, group I-III (non-metastatic)
Unfavorable site group I-II

Intermediate risk: Any alveolar
Unfavorable site group III

High risk: Any metastatic

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Rhabdomyosarcoma group

Group I: R0 resection
Group IIA: R1
Group IIB: N1
Group IIC: R1 and N1
Group III: R2 or biopsy only
Group IV: M1

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Chemo for rhabdomyosarcoma

Vincristine (concurrent with RT)
Actinomycin D
Cyclophosphamide

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Rhabdomyosarcoma dosing
Group I:
Group II:
Group III:

Group I: 0 for embryonal
36Gy for alveolar

Group II: 36 Gy for R1
41.4 to positive nodal chain

Group III: 45-50.4 Gy for orbital
50.4 <5 cm
59.4 Gy > 5cm

CTV = pre-tx GTV + 1 cm
for orbital, include whole orbit

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Ewing sarcoma most common site

Pelvis
Proximal extremities
Diaphysis

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Rhabdomyosarcoma treatment paradigm

Biopsy or non-morbid resection => chemo => local therapy (second look surgery or RT) => more chemo

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Ewing sarcoma treatment paradigm

Induction chemo => local therapy => consolidation chemo

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Chemo for Ewing sarcoma

VDC-IE
Vincristine, Adriamycin, Cyclophosphamide, Ifosfamide, Etoposide

Ewing sarcoma definitive dose and volumes

CTV_45: Pre-chemo GTV + 1cm
CTV_55.8: Post-chemo soft tissue tumor + pre-chemo bone +1 cm

Ewing sarcoma post-op RT indication, dose, and volumes

Indications: <5 mm margins, spill, <90-95% necrosis
R1 PORT: 50.4 Gy to pre-chemo PTV
R2 PORT: 45 Gy to pre-chemo PTV and 55.8 Gy to post-chemo PTV

Wilms tumor staging

Stage I: GTR confined to kidney
Stage II: GTR extracapsular or vascular invasion
Stage III: everything else
Stage IV: Distant metastasis
Stage V: Bilateral renal involvement (attempt to stage separately)

Wilms tumor risk factors

Age >2
Tumor size
LOH 1p 16q
Lung met response (rapid or not rapid)

Wilms tumor indications for flank RT

Stage I-III unfavorable histology (+anaplasia)
Stage III favorable histology
Positive lymph nodes

Wilms tumor indication for whole abdomen irradiation

(Basically spillage or rupture)
Spillage not confined to retroperitoneum
Peritoneal seeding
Positive cytology
Abdominal biopsy
Rupture

Wilms tumor flank RT dosing

10.8 Gy / 6 fx
Additional 9 Gy if Diffuse anaplasia
Boost residual disease additional 10.8 Gy

Wilms tumor WAI dose and volumes

10.5 Gy/ 7fx
Boost gross disease to 21 Gy / 14 fx
1 cm above diaphragm to bottom of obturators, flash laterally, block femoral heads

Risk factors for neuroblastoma

MYCN amplification (worst) Diploid Older age (>11 or >17 months?) LOH 1p or 11q Grade

Wilms tumor treatment paradigm

Upfront resection +/- RT then +/- chemo

Neuroblastoma treatment paradigm

Low risk: Surgery alone Intermediate risk: Surgery => chemo, or chemo => surgery High risk: Induction chemo => surgery => chemo => tandem BMT => RT => cis-retinoic acid and anti-GD2

Neuroblastoma staging

L1: localized L2: localized with image-defined risk factors M: Mets

Neuroblastoma RT dosing and volumes

CTV: pre-surgical GTV + 1cm 21.6 Gy / 12 fx

Retinoblastoma RT dose and volumes

(Surgery and chemo first line) 36-45 Gy to globe

Craniopharyngioma treatment paradigm

GTR => observation STR (often done to reduce morbidity) => post-op RT 54Gy CTV = GTV + 5-10mm

Ependymoma grading

Grade 1: sub ependymoma Grade 2: classic/myxopapillary Grade 3: anaplastic

Ependymoma treatment paradigm and RT indications

Maximum safe resection STR: PORT with vincristine GTR: PORT if grade 2-3 with vincristine 54 Gy if < 3, 59.4 Gy > 3 age GTV + 0.5 cm = CTV then cis/etop

Ependymoma RT dosing and volumes

54 Gy / 30 fx CTV = GTV + 5-10 mm

ATRT treatment paradigm

Maximum safe resection => chemo and RT (sequence variable)

ATRT RT dose and volumes

54 Gy if >3 years 50.4 Gy if <3 years

Medulloblastoma high risk classification

M+ STR > 1.5 cm2 residual <3 years old Diffuse anaplasia

Medulloblastoma treatment paradigm

Maximum safe resection => chemoRT => maintenance chemo

Medulloblastoma RT dosing and volumes

Standard risk: CSI 23.4 Gy + IF boost to 54 Gy CTV = Pre-op tumor + bed + 1.0 cm High risk: CSI 36 Gy + PF boost to 55.8 Gy Boost mets to 45-55.8 Gy depending on location