Preirradiation ifosfamide, carboplatin, and etoposide for the treatment of anaplastic astrocytomas and glioblastoma multiforme: a phase II study.

BACKGROUND: Central nervous system (CNS) tumors are the second most common pediatric tumors. Astrocytomas represent 35% of all CNS tumors in children. Traditional treatment of anaplastic astrocytoma (AA) and glioblastoma multiforme (GM) consisting of surgery-radiotherapy-chemotherapy with nitrosoureas has resulted in a survival rate of 26% at 1 year. Neoadjuvant chemotherapy has proven good results in the treatment of other solid tumors. Chemotherapy with ifosfamide, carboplatin, and etoposide (ICE) permits synergism among the different drugs and sensitizes the tumor to radiotherapy. Our objective was to evaluate the efficacy, security, and survival rate of postoperative chemotherapy with ICE in pediatric patients with AA or GM. METHODS: Phase II study. We evaluated 11 children with AA or GM who had received no prior treatment. A magnetic resonance image (MRI) study of the tumor was made after surgery to evaluate residual tumor and routine laboratory analysis. Chemotherapy with carboplatin, ifosfamide and etoposide was given every 3 weeks for four courses. MRI studies were repeated after the second and last courses and laboratory analyses were carried out before each course to evaluate toxicity. Each patient then received hyperfractionated radiotherapy and a final MRI was done at the end of the treatment. RESULTS: Sixty percent of the patients had partial response, 30% complete response after two courses, and 60% of CR after four courses. Supratentorial and infratentorial tumors had a good response to chemotherapy. Brainstem tumors had an initial response after two courses and then increased in size. AA was the tumor with the greatest reduction of residual tumor after treatment. Overall and free survival at 53 months was 70%. To date, three patients have died secondary to tumoral progression. There have been no relapses in the seven patients with a CR. CONCLUSIONS: Postoperative chemotherapy with ICE reduces the tumor size and increases the survival rate of pediatric patients with malignant astrocytomas with minimal toxicity. Brainstem responded poorly to treatment.

Lipoid pneumonia in children: clinical and imagenological manifestations.

BACKGROUND: Oil-aspiration pneumonia is still a health problem in countries where infants are forced to receive vegetable or animal oil due to traditional habits. The aim of this paper is to present clinical and imagenological characteristics of lipoid pneumonia (LP) in children and a review of the literature. Distinguishing features of and differences between other series are presented. METHODS: Series of cases. We retrospectively analyzed all records of children with lipoid pneumonia between 1991 and 1996. RESULTS: We found 16 patients aged 1-19 months old with positive oil ingestion in 75% and history of recurrent or persistent pneumonia in 81.2%. In almost 70% of patients, there were underlying conditions known as risk factors of aspiration. Plain films and computed tomography (CT) showed that the right lung was always involved. Fat density was found in only two cases. Bronchoscopy with bronchial lavage was performed in 15 patients, with lipophages positive in each patient. CONCLUSIONS: Lipoid pneumonia must be ruled out in the differential diagnosis in infants with persistent or recurrent pneumonia with or without fever, especially in patients with aspiration risk factors. Bronchoscopy with bronchial lavage and positive lipid-laden alveolar macrophages proved a useful method for diagnosis of this condition. More studies are needed to ascertain the clinical and imagenological evolution of this condition.

[The use of thoracic radiography in a third-level-care pediatric hospital]. / Utilización de la radiografía de tórax en un hospital pediátrico de tercer nivel de atención.

OBJECTIVES: 1. To describe the frequency in which the thorax radiography is requested in a third-level pediatric hospital, 2. To identify the frequency of detected abnormalities in such a study by the radiology service, 3. To describe the frequency and the characteristics form the information considered as useful in a clinical way, not only in the radiography application but in the radiologic report and the clinical file as well, 4. To identify the frequency in which the thorax radiography result is associated with diagnosis changes and/or therapeutic ones. DESIGN OF THE INVESTIGATION: Descriptive survey. STUDY UNITS: 371 thorax X-rays completed during December 1990 and January 1991. PRIMARY RESULTS: The thorax radiographies were 32% of the entire radiological study during the survey; 335 of the latter ones (90%) were requested for inpatients. The hospital services which had the highest request for such a study were the Intensive Care Unit (n = 149, 40%) and Medical Pediatrics (n = 116, 31%). The most frequent diagnosis leading to the application was pneumonia (n = 55, 15%) and solid neoplasia (n = 51, 14%). Three-hundred forty eight of the applications had diagnostic impression given by the physician in charge(94%); whereas only 127 (34%) mentioned clinical data. The radiology report was attached to the file in 162 (44%) of the cases. It was found that form the patients who had a radiology report and the thorax radiography as an initial study (n = 95), 48 (50%) suffered from abnormalities. The results of the study were transcribed in the file in 58 cases (16%); the physician's interpretation was written down in 229 cases (62%) and in 84 studies (23%) there was no reference to the results of the study (P < 0.0001). Changes in the therapeutic plan of 93 cases (50%) were identified from the studies with official report by the radiologist, other radiology studies were requested in 65 of the patients (35%), after the interpretation of such study. CONCLUSIONS: Abnormalities in 50% were identified from the total thorax radiographies requested as the patient entered. The study application mentioned as a whole (94%) the diagnostic impression which led to the application, but only in 127 cases (34%) were supporting clinical data written down. The radiology report was attached to the file in less than half the cases (44%). In 63% of the cases the supporting reason of the study was written down whereas in 23% there was no reference to the result at all.