[Show abstract][Hide abstract] ABSTRACT: Introduction Great strides in pediatric cancer treatment are allowing hundreds of thousands of children to survive into adulthood. However, these treatments can be responsible for long-term medical and dental complications. The treatments may alter the patients' dental health and require modifications to standard orthodontic care. The aim of this study was to examine knowledge and clinical experience regarding orthodontic management of childhood cancer survivors. Methods A 12-question online survey consisting of 3 sections was sent to 2500 randomly selected members of the American Association of Orthodontists and all 2300 members of the Southern Association of Orthodontists. The first section consisted of questions about the respondents' practice characteristics, the second questioned how many survivor patients the respondent had treated, and the third included questions about specific (anonymous) patient experiences and treatment modifications. Results and Conclusions There were 381 responses. The data from this study suggest a tendency for more experienced practitioners to have treated survivors of childhood cancer. Orthodontic education regarding the treatment of these patients is limited. Although most orthodontists reported having treated such patients, few had treated more than 10. There is a need for more information regarding dental complications of pediatric cancer treatment and for guidelines for the orthodontic treatment of these patients.
No preview · Article · Nov 2015 · American Journal of Orthodontics and Dentofacial Orthopedics
[Show abstract][Hide abstract] ABSTRACT: Effective cancer therapies have resulted in significant improvement in survival. However, treatment-related acute and subacute complications are a cause of significant morbidity and mortality. Effects of cancer therapy in children can be seen early in the survival period or later in life in almost all organ systems of the body. Many of these conditions are evaluated by imaging and some are diagnosed based on characteristic imaging features. This article aims to discuss acute and subacute toxicities of cancer therapy in children involving multiple organ systems, pulmonary, gastrointestinal, hepatobiliary, genitourinary and musculoskeletal systems with emphasis on those in which imaging plays a role in diagnosis or management. We also discuss the role of imaging and choice of imaging modalities in these conditions.
No preview · Article · Oct 2015 · Pediatric Radiology
[Show abstract][Hide abstract] ABSTRACT: Objective
To examine whether panoramic radiograph-determined mandibular cortical thickness correlated with quantitative computed tomography-derived bone mineral density (BMD) in survivors of childhood acute lymphoblastic leukemia (ALL).Methods
We identified patients treated for ALL at St. Jude Children's Research Hospital, seen in the After Completion of Therapy (ACT) Clinic between January of 2006 and January of 2014 who had QCT-derived BMD and panoramic radiographs obtained within 1 month of each other. Panoramic radiographs were independently scored by a pediatric radiologist, two pediatric dentists, and a general dentist using the Klemetti technique. We used the Spearman's rank correlation test and the multivariate regression model to investigate the effect of evaluator experience on results.ResultsThe study cohort comprised 181 patients with 320 paired studies: 112 (62%) male, 112 (71%) were white. Median age at ALL diagnosis was 6.4 (range, 0–18.8) years. Median age at study was 11.9 (range, 3.3 to 29.4) years. The median average BMD was 154.6 (range, 0.73–256) mg/cc; median QCT Z-score (age and gender adjusted) was −0.875 (range, −5.04 to 3.2). We found very weak association between panoramic radiograph score and both QCT-BMD average (P = 0.53) and QCT Z-score (P = 0.39). Results were not influenced by level of reader experience.Conclusions
The Klemetti technique of estimating BMD does not predict BMD deficits in children and young adult survivors of ALL, regardless of reviewer expertise. Alternative methods are needed whereby dental healthcare providers can identify and refer patients at risk for BMD deficits for detailed assessment and intervention.
No preview · Article · Sep 2015 · International Journal of Paediatric Dentistry
[Show abstract][Hide abstract] ABSTRACT: Background. Mesenchymal chondrosarcoma is an aggressive, uncommon histologic entity arising in bone and soft tissues. We reviewed our institutional experience with this rare diagnosis. Methods. We conducted a retrospective chart review on patients with mesenchymal chondrosarcoma over a 24-year period. Clinicopathologic and radiographic features were reviewed. Results. Twelve patients were identified. Nine were females; median age was 14.5 years (1.2-19.7 years). The most common site was the head/neck (7/12). Disease was localized in 11/12 patients (one with lung nodules). Six with available tissue demonstrated NCOA2 rearrangement by FISH. Six underwent upfront surgical resection, and six received neoadjuvant therapy (2 chemotherapy alone and 4 chemotherapy and radiation). All patients received adjuvant chemotherapy (most commonly ifosfamide/doxorubicin) and/or radiation (median dose 59.4 Gy). At a median follow-up of 4.8 years, 5-year disease-free survival and overall survival were 68.2% (95% CI 39.8%, 96.6%) and 88.9% (95% CI 66.9%, 100%). Two patients had distant recurrences at 15 and 42 months, respectively. Conclusion. Aggressive surgical resection of mesenchymal chondrosarcoma with chemoradiotherapy yields excellent local control and may reduce likelihood of late recurrence. Characterization of downstream targets of the HEY1-NCOA2 fusion protein, xenograft models, and drug screening are needed to identify novel therapeutic strategies.
[Show abstract][Hide abstract] ABSTRACT: Malignancies arising in connective tissue comprise a clinically important and histologically diverse category of pediatric cancers. These have traditionally been classified by presumed cell of origin or type of differentiation, with the caveat that some diagnoses originate from undefined cell types. Newer genetic data indicates that molecular perturbations, particularly translocations and their derivative chimeric fusions, correlate with histological types and better predict clinical behavior and outcome. Many diagnostic imaging techniques can be profitably applied to these tumors for the purposes of diagnosis, staging, and disease monitoring. These range from ultrasonography to newer positron emission tomography (PET) scans. Rhabdomyosarcomas constitute a large proportion of sarcomas in children, but in older children and adolescents, non-rhabdomyosarcomatous soft tissue sarcomas (NRSTS) predominate as a group. This review will cover classification, grading, morphological and genetic diagnosis, and diagnostic imaging features of these diverse lesions, Rarely adult types of sarcomas occur in children, but they will be included in this relatively brief chapter.
[Show abstract][Hide abstract] ABSTRACT: Survivors of childhood cancer are at risk for treatment-related musculoskeletal late effects. Early detection and orthopedic intervention can help ameliorate musculoskeletal late effects and prevent subsequent complications. This systematic review summarizes the literature describing associations between cancer, its treatment, and musculoskeletal late effects. We searched PubMed and Web of Science for English language articles published between January 1970 and December 2012. The search was limited to investigations with at least 15 participants and conducted at least 2 years after completion of therapy for childhood, adolescent, or young adult cancer. Some late skeletal effects, including low bone mineral density, osteonecrosis, slipped capital femoral epiphyses, oncogenic rickets, and hormone-related growth disturbances have been previously reviewed and were excluded, as were outcomes following amputation and limb-salvage procedures. Of 2347 references identified, 30 met inclusion criteria and were retained. An additional 54 studies that met inclusion criteria were found in reference lists of retained studies. Of 84 studies, 60 focused on associations between radiotherapy, six between chemotherapy, and 18 between surgery and musculoskeletal late effects. We found that younger age, higher radiation dosage, and asymmetric or partial bone radiation volume influences the effects of radiation on the musculoskeletal system. Methotrexate and vincristine are associated with long-term muscular strength and flexibility deficits. Laminectomy and chest wall resection are associated with spinal malalignment, and enucleation is associated with orbital deformities among survivors. Radiotherapy, chemotherapy, and surgery are associated with musculoskeletal late effects independently and additively. Associations are additionally influenced by host and treatment characteristics - See more at: http://eurekaselect.com/126128#sthash.oR3WGlrK.dpuf
Full-text · Article · Nov 2014 · Current Pediatric Reviews