Peds Flashcards
For Rhabdomyosarcoma, what is indicated RT dosing for groups I,IIA,IIB/C, and group III orbit based on ARST 0331 IRS-VI? when is RT administered?
RT indications<div>Group I: no RT</div><div>Group IIA: 36 Gy</div><div>Group IIB/C: 41.4 Gy</div><div>Group III orbit: 45 Gy</div><div><br></br></div><div>RT week 13 for all patients<br></br></div>
what is current favored chemo for rhabdomyosarcoma?
on ARST 1431: VAC/VI = vincristine, actinomycinD, cyclophosphamide / vincristine, irinotecan
rhabdomyosarcoma over 5cm should be boosted to what dose?
59.4 Gy (due to higher recurrence rate on D9803)
what is benefit of delayed primary excision for rhabdomyosarcoma?
allows for lower RT dose (more tumor shrinkage), thus potentially less adverse effects in future<div><br></br></div><div>no local control benefit (tested on D9803)</div>
what are Oberlin risk factors for rhabdomyosarcoma, investigated in ARST 0431 IRS-VI?
Oberlin risk factors:<div>-Age >10 years or <1 year</div><div>-unfavorable primary site of disease</div><div>-≥3 metastatic sites</div><div>-bone or bone marrow involvement<br></br></div>
consider RT with vincristine <b>+irinotecan</b> for what patients with metastatic rhabdomyosarcoma?
consider for 0-1 Oberlin risk factors present, not if 2+ Oberlin risk factors<div><br></br></div><div>improved EFS compared to historical cohort on ARST 0431 IRS-VI, but unsure if due to RT with additional radiosensitizer or interval compression of chemo</div>
is there a benefit to hyperfractionated RT in rhabdomyosarcoma?
no - tested on IRS-IV
what was pt population on ADOD0031?
1712 pediatric pts w Hodgkin’s lymphoma, intermediate risk<div><br></br></div><div>[=anything other than Stage IA-IIA nonbulky which is low risk, and Stage IIIB, IVB which is high risk]</div><div><br></br></div><div>Stage IA-IIA with bulky disease or stage IB, IAE, IIB, IIAE, IIIA, IVA with or without bulky disease.</div><div><br></br></div><div>Bulky: ≥6cm nodal aggregate or >1/3 ratio mediastinal width</div>
what was tested regimen in AHOD0031?
“ABVE-PC x2 (doxorubicin, bleomycin, vincristine, etoposide, cyclophosphamide, prednisone) →<div><br></br></div><div>CT at cycle 2 to assess for rapid early response (RER) of CR or PR, or slow early response (SER).</div><div><br></br></div><div> <span>•RERs:</span> ABVE-PC +2 then CT or PET eval</div><div><span><br></br></span></div><div><span>•CR</span>:</div><div>→21 Gy/ 15 fx IFRT</div><div>vs.</div><div> <span>→obs</span></div><div><span><br></br></span></div><div><span>•less than CR</span>:</div><div>IFRT in all</div><div><br></br></div><div> <span>•SERs:</span></div><div><span></span>→DECAx2 + ABVE-PCx2 + 24 Gy IFRT </div><div>vs.</div><div>→ABVE-PCx2 + 21 Gy IFRT</div>”
where is first relapse in pediatric Hodgkin’s lymphoma amongst patients with any response to first line chemo?
First relapse is usually at initial nodal sites, bulky or nonbulky, and rarely out of field<br></br><div>(from AHOD0031)</div>
Based on AHOD0031, RT can be eliminated for what pediatric Hodgkin’s lymphoma pts?
“<span>•RERs with CR</span><span>:</span><div><span>No benefit in EFS with IFRT</span></div><div><span>4-yr EFS 88% IFRT vs. 84%, p=.11</span></div><div>-For PET defined CRs, EFS 87% both arms</div><div>-OS 99% in both arms (primary endpoint is EFS)</div>”
what patients - even with RER - still should have IFRT according to AHOD0031?
“<span>Those with both anemia and bulky Stage I/II disease benefited from RT</span><div>4-yr EFS 89% vs. 78%</div>”
what was IFRT dosing in AHOD0031?
21 Gy / 1.5 fx, AP/PA
how was rapid early response assessed in AHOD0031?
RER was sum of perpendicular diameters of <60% of all volumes after cycle 2
how was complete response defined in AHOD0031?
≥80% improvement in sum of perpendicular diamteters, or a return to normal size, plus no residual MS mass >2.0 cm, and negative gallium or PET.
what stages are low risk pediatric Hodgkin’s lymphoma?
I, IIA
pt population of CCG5942 (ped hodgkin’s lymphoma)
826 pts with low risk HL - stage I or IIA
what was tested regimen in CCG5942?
COPP/ABV → if CR →<div>→21 Gy IFRT</div><div>vs.</div><div>→no IFRT</div>
if IFRT necessary for low risk pediatric hodgkin’s lymphoma with complete response after COPP/ABV?
no. IFRT improves PFS but not OS.<div><br></br></div><div>10-yr EFS 91% obs vs. 83% IFRT 21 Gy, p=.004</div><div><b>10-yr OS ~97%, not different</b></div><div><br></br></div><div>risk factors for worse EFS were bulky, B symptoms, or nodular sclerosing<br></br></div>
current standard chemo for Ewings sarcoma
VDC-IE q2weeks<div><br></br></div><div>vincristine, doxorubicin, cyclophosphamide - ifosphamide, etoposite</div>
for Ewing’s sarcoma, local control obtained with surgery vs RT is similar vs different with what sites?
5-yr LF 4% surgery<div>15% RT (p<0.01)</div><div>7% S+RT (p=0.12)</div><div><br></br></div><div>Worse LF with use of RT for pelvis and extremity, and age ≥18.</div><div>Other sites (axial non-spine, spine, extraskeletal tumors) have similar LF with S vs. RT</div><div><br></br></div><div>Tumor size did not correlate with LF</div><div><br></br></div><div>from COG meta-analysis of 956 patients</div>
if pt with lung metastases from Wilm’s with favorable histology (and no LOH) has complete response of pulmonary nodules to chemo, is Whole lung irradiation necessary?
4-yr EFS 80% [vs. 85% in historical control]<div>4-yr OS 96% Expected vs. observed events</div><div>15% vs. 20%, p=0.052</div><div><br></br></div><div>from COG AREN0553</div>
what was pt population in COG ACNS0331?
549 pts w standard risk medulloblastoma
what was tested regimen in COG ACNS0331 for medulloblastoma?
→23.4 Gy CSI plus 30.6 Gy posterior fossa boost to 54 Gy total with cis/CPM <div>vs.</div><div>→same but with 18 Gy CSI in ages 3-7 and IFRT in ages 2-21</div>
can CSI be dose de-escalated to 18 Gy from 23.4 Gy for standard risk medulloblastoma? why not?
“no, based on ACNS0331.<div><br></br></div><div><span>Low dose CSI worse than standard dose</span> For SD-CSI vs. LD-CSI, <span>5-yr EFS 82.6%</span> vs. 72.1%<br></br></div><div><br></br></div><div>Isolated DF 12.8% for LDCSI and 8.2% for SDCSI.<br></br></div>”
can IFRT replace boosting entire posterior fossa for medulloblastoma?
yes, from ACNS0331<div><br></br></div><div>For PFRT vs IFRT,</div><div>5-yr EFS 80.8% vs. 82.2%</div><div><br></br></div><div>5-yr OS 85.2% vs. 84.1%<br></br></div>
if pt with grade 2-3 ependymoma has STR, can RT be delayed by administering chemo first?
no<div>5yr EFS 37%, vs 67% for those who had near GTR and underwent immediate RT</div><div><br></br></div><div>from ACNS 0121</div>
is biopsy required to diagnose germinomas?
no, can be diagnosed by labs and imaging alone
what is standard regimen for treating NGGCT?
from ACNS0112<div><br></br></div><div>cis/etoposide alt cis/ifosphamide x6 → CSI 36 Gy plus boost to 54 Gy</div><div><br></br></div><div>45 Gy boost to mets</div>
can CSI be converted to whole ventricle RT if pt with NGGCT has complete response to chemo?
no<div>trial ACNS1123 (with no CSI if CR to chemo) closed early due to increased rate of failures, all in spine</div>
“what are 3 noninferior treatment regimens for DIPG as tested in Cairo? what is one caveat to ““noninferior”” status?”
39 Gy / 13 fx<div>45 Gy / 15 fx</div><div>54 Gy / 30 fx</div><div><br></br></div><div>39 Gy / 13 fx had worse outcomes in pts <5yo</div>
what are 2 treatment regimens for localized germinoma? is PFS/OS different?
CSI 24 Gy + boost 16 Gy<div>vs.</div><div>induction carbo/etoposide alt etoposide/ifos then 40 Gy IFRT<div><br></br></div><div>showed better 5yr PFS (97 vs 88%) with CSI</div><div><br></br></div><div>OS equivalent 90-95%</div></div>
