Impact of tumor location and pathological discordance on survival of children with midline high-grade gliomas treated on Children's Cancer Group high-grade glioma study CCG-945.

Children with high-grade glioma (HGG) have a poor prognosis compared to those with low-grade glioma (LGG). Adjuvant chemotherapy may be beneficial, but its optimal use remains undetermined. Histology and extent of resection are important prognostic factors. We tested the hypothesis that patients with midline HGG treated on Children's Cancer Group Study (CCG) CCG-945 have a worse prognosis compared to the entire group. Of 172 children eligible for analysis, 60 had midline tumors primarily localized to the thalamus, hypothalamus and basal ganglia. Time-to-progression and death were determined from the date of initial diagnosis, and survival curves were calculated. Univariate analyses were undertaken for extent of resection, chemotherapy regimen, anatomic location, histology, proliferation index, MGMT status and p53 over-expression. For the entire midline tumor group, 5-year PFS and OS were 18.3 ± 4.8 and 25 ± 5.4 %, respectively. Many patients only had a biopsy (43.3 %). The sub-groups with near/total resection and hypothalamic location appeared to have better PFS and OS. However, the effect of tumor histology on OS was significant for children with discordant diagnoses on central pathology review of LGG compared to HGG. Proliferative index (MIB-1 > 36 %), MGMT and p53 over-expression correlated with poor outcomes. Children treated on CCG-945 with midline HGG have a worse prognosis when compared to the entire group. The midline location may directly influence the extent of resection. Central pathology review and entry of patients on clinical trials continue to be priorities to improve outcomes for children with HGG.

Fluorine-18 NaF PET imaging of child abuse.

We describe the use of 18F-NaF positron emission tomography (PET) whole-body imaging for the evaluation of skeletal trauma in a case of suspected child abuse. To our knowledge, 18F NaF PET has not been used in the past for the evaluation of child abuse. In our patient, this technique detected all sites of trauma shown by initial and follow-up skeletal surveys, including bilateral metaphyseal fractures of the proximal humeri. Fluorine-18 NaF PET has potential advantage over Tc-99m-labeled methylene diphosphonate (MDP) based upon superior image contrast and spatial resolution.

Neuroimaging-detected late transient treatment-induced lesions in pediatric patients with brain tumors.

OBJECT: After the resection of brain tumors in pediatric patients, it can be difficult to differentiate recurrent tumor from treatment effects. Although late-delayed reactions are thought to be permanent, in this study the authors sought to characterize transient brain lesions (TBLs) in the late-delayed period that completely resolved without imaging or neurological sequelae. METHODS: In a retrospective review of an institutional neuroimaging brain tumor database, 11 patients were identified who met the imaging criteria (transient T2-weighted hyperintense enhancing lesions outside of the tumor bed, which occurred after radiation and/or chemotherapy) and had undergone three-dimensional dosimetry; their radiographic, clinical, and radiation-dosimetry results were analyzed. In the 11 patients who had been treated with multiple protocols 17 loci of abnormality, including 43 discrete, asymptomatic TBLs, were detected. The median TBL diameter was 1 cm or smaller, without mass effect or necrosis, and occurred 10 months after radiation therapy, 11 months after chemotherapy, resolved by 3 months, and occurred within the high-dose radiation treatment volume (median 55.8 Gy). The findings from extended follow up revealed the development of additional permanent complications of radiation therapy within the radiation port in five of the 11 patients. CONCLUSIONS: A benign form of treatment-induced brain injury in children, TBLs should be treated using short-interval follow up. When these lesions are identified as a result of their characteristic imaging features, location, and temporal course, TBLs may be clearly distinguished from recurrent tumor or radiation necrosis and do not require biopsy. Further studies are needed to determine whether patients with TBLs are at an increased risk of developing more severe treatment-related brain injury.

Update on childhood sexual abuse.

PURPOSE OF REVIEW: Childhood sexual abuse (CSA) is a problem of epidemic proportion affecting children and communities worldwide. This review will examine the most recent published CSA literature emphasizing not only new findings in diagnosis, management, and prevention, but also practice implications for the medical and community-based provider. Sexual assault and rape, though forms of sexual abuse, are broader than the scope of this article and not discussed in detail at this time. RECENT FINDINGS: Prevalence rates for CSA are difficult to obtain. To identify populations at greatest risk and tailor treatment and prevention initiatives, consistent methods for defining and reporting cases of CSA are needed. Appreciating the quality and quantity of adverse health outcomes associated with CSA has helped clinicians and community providers expand and develop treatment programs. The physical and psychological late effects of abuse can be permanent and life threatening and the primary care provider should assess for mental health problems as well as physical maladies in all routine examinations. Children do not often disclose experiences of abuse for months to years and caregivers must be cognizant of the medical and behavioral indicators that signal early abuse. Child advocacy centers are community-based programs that incorporate medical, psychological, and legal support services for children and their families. This therapeutic model is based on a multidisciplinary team assessment aimed at decreasing stress, providing adequate protection and services for the child, and optimizing chances for a successful legal outcome. SUMMARY: While prevention remains the ultimate goal, improved awareness and education for communities and professionals alike is required to ensure appropriate and quality care for all children who are sexually abused.