scholarly journals Vertebroplasty as a palliative treatment option for intractable pain in pediatric patients with spinal tumors

2021 ◽  
Author(s):  
Leandro Cardarelli‐Leite ◽  
Shahrad Rod Rassekh ◽  
Robert D'Ortenzio ◽  
Manraj Kanwal Singh Heran
Keyword(s):  
Treatment Option ◽  
Palliative Treatment ◽  
Pediatric Patients ◽  
Spinal Tumors ◽  
Intractable Pain

scholarly journals Vertebroplasty as a palliative treatment option for intractable pain in pediatric patients with spinal tumors

2021 ◽  
Author(s):  
Leandro Cardarelli Leite ◽  
Shahrad Rassekh ◽  
Robert D'Ortenzio ◽  
Manraj Heran
Keyword(s):  
Palliative Treatment ◽  
Wilms Tumor ◽  
Malignant Tumors ◽  
Pediatric Population ◽  
Treatment Options ◽  
Growth Potential ◽  
Spinal Tumors ◽  
High Morbidity ◽  
Intractable Pain

Background: Primary and secondary malignant tumors of the spine are relatively uncommon in the pediatric population but are associated with high morbidity and significantly decreased quality of life due to pain. Local management of these tumors is often challenging due to the importance of maintaining vertebral mechanical integrity as well as the spinal growth potential. Typically, surgery and/or radiation therapy have been used in the primary management of these tumors. However, treatment options become more limited when there is relapse or refractory disease, with re-resection or additional radiotherapy often not being viable therapies. The purpose of this study was to assess the feasibility of percutaneous vertebroplasty as a palliative treatment for intractable pain secondary to malignant tumors affecting the spine. Procedure: A retrospective review of all cases of vertebroplasty performed at a single institution between 2003 and 2020. Results: A total of 11 vertebral levels were treated in 3 children with relapsed cancers (two with alveolar rhabdomyosarcoma, and one with Wilms tumor). All three had clinical benefit with sustained significant improvement in their pain. Conclusions: Vertebroplasty is a currently underutilized modality that might provide excellent pain palliation in cases of relapsed cancer in the spine. Future prospective studies of its use in pediatric oncology are needed.

scholarly journals Tolvaptan Use to Treat SIADH in a Child

2018 ◽  
Vol 23 (6) ◽  
pp. 494-498
Author(s):  
Adem Yasin Koksoy ◽  
Meltem Kurtul ◽  
Aslı Kantar Ozsahin ◽  
Fatma Semsa Cayci ◽  
Meltem Tayfun ◽  
...  
Keyword(s):  
Hypertonic Saline ◽  
Treatment Option ◽  
Pediatric Patients ◽  
Hormone Secretion ◽  
Saline Infusion ◽  
Fluid Restriction ◽  
Effective Treatment Option ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Electrolyte Abnormalities ◽  
Hypertonic Saline Infusion

Hyponatremia is one of the most common electrolyte abnormalities encountered in the clinical setting in hospitalized patients. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the leading cause of hyponatremia in most of these cases. While fluid restriction, hypertonic saline infusion, diuretics, and the treatment of underlying conditions constitute the first line of treatment of SIADH, in refractory cases, and especially for pediatric patients, there seems not to be any other choice for treatment. Tolvaptan, although its use in pediatric patients is still very limited, might be an attractive treatment option for correction of hyponatremia due to SIADH. Here we present a pediatric case of SIADH that was resistant to treatment with fluid restriction and hypertonic saline infusion and was treated successfully with tolvaptan. Tolvaptan could be a good, safe, and effective treatment option in pediatric SIADH cases that are resistant to treatment. However, the dosage should be titrated carefully.

Survival and functional outcome of childhood spinal cord low-grade gliomas

2009 ◽  
Vol 4 (3) ◽  
pp. 254-261 ◽  
Author(s):  
Katrin Scheinemann ◽  
Ute Bartels ◽  
Annie Huang ◽  
Cynthia Hawkins ◽  
Abhaya V. Kulkarni ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Pediatric Patients ◽  
Progression Free Survival ◽  
Spinal Tumors ◽  
High Morbidity ◽  
Low Grade ◽  
Aggressive Approach ◽  
Intramedullary Spinal Cord ◽  
Free Survival ◽  
Low Grade Gliomas

Object Intramedullary spinal cord low-grade gliomas (LGGs) are rare CNS neoplasms in pediatric patients, and there is little information on therapy for and outcome of these tumors in this population. Furthermore, most patient series combine adult and pediatric patients or high- and low-grade tumors, resulting in controversial data regarding optimal treatment of these children. To clarify these issues, the authors performed a regional population-based study of spinal cord LGGs in pediatric patients. Methods All pediatric patients with LGGs treated during the MR imaging era (1985–2007) were identified in the comprehensive database of the Hospital for Sick Children in Toronto. Data on demographics, pathology, treatment details, and outcomes were collected. Results Spinal cord LGGs in pediatric patients constituted 29 (4.6%) of 635 LGGs. Epidemiological and clinical data in this cohort were different than in patients with other spinal tumors and strikingly similar to data from pediatric patients with intracranial LGGs. The authors observed an age peak at 2 years and a male predominance in patients with these tumors. Histological testing revealed a Grade I astrocytoma in 86% of tumors. Although 5-year progression-free survival for the entire group was 48 ± 9%, all patients were alive at a median follow-up of 8.2 years. Five-year progression-free survival was 88 ± 13% for patients undergoing gross-total resection and 34 ± 11% for those undergoing all other therapies, respectively (p = 0.02). Chemotherapy and radiation therapy showed similar efficacy, achieving sustained tumor control in most patients. However, this excellent survival rate was associated with an 83% rate of significant neurological and orthopedic sequelae. Conclusions This study provides basic data on the incidence, clinical course, and outcome of spinal cord LGGs in pediatric patients. The similarities between spinal and intracranial LGGs in pediatric patients showing excellent survival but high morbidity suggest that a less aggressive approach may be the preferable treatment option for these patients.

scholarly journals RONC-09. PSEUDOPROGRESSION AFTER PROTON THERAPY OF PEDIATRIC SPINAL PILOCYTIC ASTROCYTOMA AND MYXOPAPILLARY EPENDYMOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii457-iii457
Author(s):  
Susan McGovern ◽  
Jason Johnson ◽  
Stephen Kralik ◽  
David Grosshans ◽  
Mary Frances McAleer ◽  
...  
Keyword(s):  
Proton Therapy ◽  
Pilocytic Astrocytoma ◽  
Pediatric Patients ◽  
Clinical Situation ◽  
Spinal Tumors ◽  
Myxopapillary Ependymoma ◽  
Subsequent Decrease ◽  
Post Radiation ◽  
Additional Tumor

Abstract BACKGROUND Pseudoprogression after proton therapy of CNS tumors is a challenging clinical situation. The rate of pseudoprogression after proton therapy of pediatric spinal tumors is unknown. METHODS Records of pediatric patients with spinal pilocytic astrocytoma (sPA; n = 9) or myxopapillary ependymoma (MPE; n = 6) with gross disease treated with proton therapy with at least 6 months of follow up from completion of proton therapy were retrospectively reviewed for demographics, treatment characteristics, and occurrence of pseudoprogression. Pseudoprogression was defined as a post-radiation increase in tumor size with subsequent decrease in size without additional tumor-directed therapy. RESULTS The median age at radiation for sPA patients was 10.1y (range, 7.0 – 16.2y) and 12.7y (range, 7.9 – 14.4y) for MPE patients. The median prescribed dose was 45 GyRBE (range, 39.6 – 50.4 GyRBE) for sPA patients and 50.4 GyRBE (range, 45 – 54 GyRBE) for MPE patients. One sPA patient received concurrent vincristine. Median follow up after proton therapy was 44 months (range, 9 – 99 months). Six of nine sPA patients (67%) had pseudoprogression occurring at a median of 81 days (range, 34 – 136 days) after proton therapy; no MPE patients developed pseudoprogression (0%; p < 0.03). Two sPA patients with pseudoprogression were symptomatic and improved with medical therapy. CONCLUSION Preliminary analysis suggests that pseudoprogression occurs frequently within 6 months after proton therapy for sPA and infrequently after proton therapy for MPE.

scholarly journals Open thoracic anterolateral cordotomy for pain relief in children: report of 2 cases

2017 ◽  
Vol 20 (3) ◽  
pp. 278-283 ◽  
Author(s):  
Dora Steel ◽  
Matthew A. Kirkman ◽  
Dominic N. P. Thompson ◽  
Kristian Aquilina
Keyword(s):  
Pain Relief ◽  
Adverse Effects ◽  
Effective Treatment ◽  
Treatment Option ◽  
Terminal Phase ◽  
Neoplastic Disease ◽  
Intractable Pain ◽  
Effective Treatment Option ◽  
Effective Analgesia

Open anterolateral cordotomy is an effective treatment option for adults with intractable pain, but it has seldom been attempted in children. In the 2 previously reported cases in children, the procedure was used within 10 days of death from neoplastic disease. In this paper the authors describe 2 cases in which open cordotomy was used successfully in children outside the immediate terminal phase of disease. Both patients experienced effective analgesia with minimal adverse effects. The authors propose that consideration of cordotomy as an option for the management of intractable pain in children does not need to be delayed until death is imminent.

Metastatic spinal tumors

2001 ◽  
Vol 11 (6) ◽  
pp. 1-9 ◽  
Author(s):  
Robert F. Heary ◽  
Christopher M. Bono
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
External Beam Radiotherapy ◽  
Cord Compression ◽  
Spinal Tumors ◽  
Surgical Approaches ◽  
Vascular Tumors ◽  
Preoperative Embolization ◽  
Intractable Pain ◽  
Primary Malignancy

Metastatic spinal tumors are the most common type of malignant lesions of the spine. Prompt diagnosis and identification of the primary malignancy is crucial to overall treatment. Numerous factors affect outcome including the nature of the primary cancer, the number of lesions, the presence of distant nonskeletal metastases, and the presence and/or severity of spinal cord compression. Initial management consists of chemotherapy, external beam radiotherapy, and external orthoses. Surgical intervention must be carefully considered in each case. Patients expected to live longer than 12 weeks should be considered as candidates for surgery. Indications for surgery include intractable pain, spinal cord compression, and the need for stabilization of impending pathological fractures. Whereas various surgical approaches have been advocated, anterior-approach surgery is the most accepted procedure for spinal cord decompression. Posterior approaches have also been used with success, but they require longer-length fusion. To obtain a stable fixation, the placement of instrumentation, in conjunction with judicious use of polymethylmethacrylate augmentation, is crucial. Preoperative embolization should be considered in patients with extremely vascular tumors such as renal cell carcinoma. Vertebroplasty, a newly described procedure in which the metastatic spinal lesions are treated via a percutaneous approach, may be indicated in selected cases of intractable pain caused by non- or minimally fractured vertebrae.

scholarly journals Testis Sparing Surgery in Pediatric Testicular Tumors

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2867
Author(s):  
Cezanne D. Kooij ◽  
Caroline C.C. Hulsker ◽  
Mariëtte E.G. Kranendonk ◽  
József Zsiros ◽  
Annemieke S. Littooij ◽  
...  
Keyword(s):  
Treatment Option ◽  
Pediatric Patients ◽  
Single Case ◽  
Case Reports ◽  
Germ Cell Tumors ◽  
Testicular Atrophy ◽  
Low Grade ◽  
Testicular Tumors ◽  
Safe Treatment ◽  
Safe Treatment Option

Objective: The purpose of this review is to evaluate the outcomes of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered a safe treatment option in pediatric patients with testicular tumors. Methods: A database search was performed in Cochrane, Pubmed, and Embase for studies that focused on TSS as treatment for testicular tumors in the pediatric population, excluding reviews and single case reports. Results: Twenty studies, describing the surgical treatment of 777 patients with testicular tumors, were included in the analysis. The majority of pediatric patients with benign germ cell tumors (GCTs) (mean age: 3.7 years) and sex cord-stromal tumors (SCSTs) (mean age: 6.6 years) were treated with TSS, 61.9% and 61.2%, respectively. No cases of testicular atrophy occurred. Four of the benign GCTs, i.e., three teratomas and one epidermoid cyst, recurred. No cases of recurrence were reported in patients with SCSTs. Of the 243 malignant GCTs (mean age: 4.2 years), only one patient had TSS (0.4%). Conclusion: TSS is a safe treatment option for prepubertal patients less than 12 years of age with benign GCTs and low grade SCSTs.

Sign in / Sign up

Export Citation Format

Share Document