Background and hypothesis Bone and lung are the common sites of metastasis in pediatric round cell tumors and its presence indicates poor outcomes. Staging workup for these malignancies thus includes bone marrow biopsy (BMB) along with evaluation of thorax, and tissue analysis for N MYCN status in neuroblastoma. BMB is an invasive procedure requiring general anesthesia with known disadvantages.With an aim of avoiding an invasive BMB a study was taken up to evaluate efficacy of FDG PET CT in detecting marrow involvement in neuroblastoma and rhabdomyosarcoma at staging.
Materials and methodProspective observational study evaluated 83 newly diagnosed treatment naïve patients of neuroblastoma (n = 43) and rhabdomyosarcoma (n = 42) who underwent conventional imaging of PETCT with CECT of local region along with a CT thorax and BMB (both iliac crest) done within 1 week. Findings of FDG PETCT were compared with bone marrow histology and accuracy parameters were calculated.
ResultThe overall sensitivity, specificity, accuracy, positive-predictive value (PPV), negative-predictive value (NPV) of FDG PETCT for detection of marrow disease was 100%, 86.1%, 89.4%. 68.9% and 100%, respectively. Subset analysis showed sensitivity, specificity, PPV and NPV of 100%, 66%, 71.4% and 100%, respectively, for neuroblastoma, with rhabdomyosarcoma patients having few events NPV of 100% accuracy of 97.6%.Conclusion FDG PETCT with sensitivity and NPV of 100% can be considered as a first stop imaging and biopsy can be avoided in patients with a negative scan.
1 Background and Objective Coronavirus disease-2019 (COVID-19) or its
complications in children with cancer were not increased as compared to
normal children in earlier reports. However, continuing intensive
treatment during ongoing COVID-19 infection has not been studied
systematically. We report a single tertiary center experience on
COVID-19 in children with cancer and continuation of cancer-directed
therapy in them. 2 Methods Children ≤15years on active cancer treatment
detected with COVID-19 until September 15th, 2020 were prospectively
followed-up. Patients were managed in accordance to well-laid
guidelines. Treatment was continued for children with COVID-19 infection
who were clinically stable and on intensive treatment for various
childhood cancers as far as practicable. 3 Results One hundred
twenty-two children (median age 8years; range 1-15years, male: female
1.7:1) with cancer were diagnosed with COVID-19. All-cause mortality
rate was 7.4%(n=9) and COVID-19 related mortality rate was 4.9%(n=6).
Of 118 children, 99 (83.9%), 60 (50.8%), 43 (36.4%), 26 (22.0%) and
6 (5.1%) had RT-PCR positivity at 14, 21, 28, 35 and 60 days from
diagnosis of COVID-19 respectively. Scheduled risk-directed intravenous
chemotherapy was delivered in 70 (90.9%) of 77 children on active
systemic treatment with a median delay of 14days (range, 0-48days) and
no increased toxicities. 4 Conclusions COVID-19 was not a major
deterrent for the continuation of active cancer treatment despite
persistent RT-PCR positivity. The long-term assessment of treatment
adaptations requires further prospective follow up and real time
addressal.
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