Chronic inflammatory diseases of the bowel: diagnosis and follow-up.

Approximately one fourth of cases of inflammatory bowel disease (IBD) occur during childhood and children are more prone than their adult counterparts to have severe disease at presentation. To investigate these diseases MR imaging is no longer an emerging tool. Numerous reviews and articles have been published on this topic underlying the advances of imaging but also the complexity and the financial impact on management of such diseases. In children it seems reasonable to consider US as the first imaging examination to perform, especially when the diagnosis of IBD is unknown. However, we believe that recent and future technical progress, especially the ability of MR to display reproducible data, and the need for gold standard evaluation of new medical therapies will increase the role of MR enterography.

Inter-clinician variability in making dosimetric decisions in pediatric treatment: a balance between efficacy and late effects.

PURPOSE: To investigate variability of clinical target volume (CTV) delineation and deviations according to doses delivered in normal tissue for abdominal tumor irradiation in children. MATERIAL AND METHODS: For a case of nephroblastoma six French pediatric radiation oncologists outlined post-operative CTV, on the same dosimetric CT scan according to the International Society for Pediatric Oncology 2001 protocol. On a reference CTV and organs at risk (OAR), we performed dosimetric planning with the constraints as 25.2 Gy for CTV, V(20 max) to 50% for liver, V(12) <15% for kidney. Data were analyzed with Aquilab software. RESULTS: Final CTVs showed inter-clinician variability: 44.85-120.78 cm(3). The recommended liver doses were not respected in four cases: V(20) from 74% to 88% of the volume; for kidney, in two cases: V(12) of 17.6% and 25%, respectively. For vertebral bodies, no deviations were noted. CONCLUSION: Variability not only affected CTV delineation but also dose distribution to OAR with different compromises. This practice training demonstrates the hudge lack of data about correlation between dose, volume and risk of late effects in pediatric radiotherapy. We intend to record prospectively the dose/volume histogram of each OAR in a national database in order to characterize late effects occurring in relation to treatment modalities.

Long-term survival after post-transplant lymphoproliferative disease in children.

Post-transplant lymphoproliferative disease (PTLD) is a well-known complication of immunosuppressive therapy. We present a series of 19 children who developed PTLD, following renal transplantation in 11 and liver transplantation in 8. The mean time between transplantation and the onset of PTLD was 19.5 months. Two patients had T-cell PTLD and died despite intensive chemotherapy. B-cell PTLD was observed in 17 patients and was associated with proven Epstein-Barr virus infection in 9. Despite immediate reduction of immunosuppressive therapy, only 8 of these 17 patients were alive at a 5.6-year mean follow-up. None of these patients had recurrence of PTLD when immunosuppression was resumed.