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Subject: search.filters.subject.Pediatrics

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    The potential role of MR-guided adaptive radiotherapy in pediatric oncology: Results from a SIOPE-COG survey
    (ELSEVIER IRELAND LTD, 2021-01-01) Seravalli, Enrica; Kroon, Petra S.; Buatti, John M.; Hall, Matthew D.; Mandeville, Henry C.; Marcus, Karen J.; Onal, Cem; Ozyar, Enis; Paulino, Arnold C.; Paulsen, Frank; Saunders, Daniel; Tsang, Derek S.; Wolden, Suzanne L.; Janssens, Geert O.
    Background and purpose: Magnetic resonance guided radiotherapy (MRgRT) has been successfully implemented for several routine clinical applications in adult patients. The purpose of this study is to map the potential benefit of MRgRT on toxicity reduction and outcome in pediatric patients treated with curative intent for primary and metastatic sites. Materials and methods: Between May and August 2020, a survey was distributed among SIOPE- and COG-affiliated radiotherapy departments, treating at least 25 pediatrics patients annually and being (candidate) users of a MRgRT system. The survey consisted of a table with 45 rows (clinical scenarios for primary (n = 28) and metastatic (n = 17) tumors) and 7 columns (toxicity reduction, outcome improvement, PTV margin reduction, target volume daily adaptation, online re-planning, intrafraction motion compensation and on-board functional imaging) and the option to answer by `yes/no'. Afterwards, the Dutch national radiotherapy cohort was used to estimate the percentage of pediatric treatments that may benefit from MRgRT. Results: The survey was completed by 12/17 (71\% response rate) institutions meeting the survey inclusion criteria. Responders indicated an `expected benefit' from MRgRT for toxicity/outcome in 7\% (for thoracic lymphomas and abdominal rhabdomyosarcomas)/0\% and 18\% (for mediastinal lymph nodes, lymph nodes located in the liver/splenic hilum, and liver metastases)/0\% of the considered scenarios for the primary and metastatic tumor sites, respectively, and a `possible benefit' was estimated in 64\%/46\% and 47\%/59\% of the scenarios. When translating the survey outcome into a clinical perspective a toxicity/outcome benefit, either expected or possible, was anticipated for 55\%/24\% of primary sites and 62\%/38\% of the metastatic sites. Conclusion: Although the benefit of MRgRT in pediatric radiation oncology is estimated to be modest, the potential role for reducing toxicity and improving clinical outcomes warrants further investigation. This fits best within the context of prospective studies or registration trials.
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    Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections
    (BAISHIDENG PUBLISHING GROUP INC, 2016-01-01) McFarland, Lynne Vernice; Ozen, Metehan; Dinleyici, Ener Cagri; Goh, Shan
    Antibiotic-associated diarrhea (AAD) and Clostridum difficile infections (CDI) have been well studied for adult cases, but not as well in the pediatric population. Whether the disease process or response to treatments differs between pediatric and adult patients is an important clinical concern when following global guidelines based largely on adult patients. A systematic review of the literature using databases PubMed (June 3, 1978-2015) was conducted to compare AAD and CDI in pediatric and adult populations and determine significant differences and similarities that might impact clinical decisions. In general, pediatric AAD and CDI have a more rapid onset of symptoms, a shorter duration of disease and fewer CDI complications (required surgeries and extended hospitalizations) than in adults. Children experience more community-associated CDI and are associated with smaller outbreaks than adult cases of CDI. The ribotype NAP1/027/BI is more common in adults than children. Children and adults share some similar risk factors, but adults have more complex risk factor profiles associated with more co-morbidities, types of disruptive factors and a wider range of exposures to C. difficile in the healthcare environment. The treatment of pediatric and adult AAD is similar (discontinuing or switching the inciting antibiotic), but other treatment strategies for AAD have not been established. Pediatric CDI responds better to metronidazole, while adult CDI responds better to vancomycin. Recurrent CDI is not commonly reported for children. Prevention for both pediatric and adult AAD and CDI relies upon integrated infection control programs, antibiotic stewardship and may include the use of adjunctive probiotics. Clinical presentation of pediatric AAD and CDI are different than adult AAD and CDI symptoms. These differences should be taken into account when rating severity of disease and prescribing antibiotics.