IMPACT de la déprivation sociale sur les difficultés psychosociales au décours d’un cancer pédiatrique:uneétude prospective IMPACT of the Social Deprivation on Psychosocial Difficulties of Pediatric Cancer Survivors:A Prospective Study

The posttreatment period is a key part of the management of pediatric cancer.During this time,school and psychological difficulties have been described in childhood cancer survivors(CCS)and can be prognostic for the success of social reintegration.This study estimated the influence of the household’s socioeconomic status(SES)on these psychosocial difficulties.This study is based on a prospective multicentric database and focused on children who received a psychosocial evaluation during their follow-up from 2013 to 2020.We retrieved data on school and psychological difficulties.Household SES was estimated by a social deprivation score.Data from1003 patients were analyzed.School difficulties were noted in 22%of CCS.A greater social deprivation was significantly associated with school difficulty.Tumor relapse,treatment with hematopoietic stem cell transplantation,and central nervous system(CNS)tumors remained significant risk factors.In the subgroup of CNS tumors,school difficulties were increased and associated with greater social deprivation.Psychological difficulties were not associated with the deprivation score.There is a link between SES and school difficulties in CCS.Further investigations should be carried out for children with CNS tumors,which is the population of the greatest concern.

Pneumothorax Complicating Port-a-Cath and Groshong Catheter Positioning in Children: Our Experience before Routine Ultrasound-Guided Puncture

Objective: To study incidence and management of long term central venous catheter (CVC) placement related pneumothorax (PNX) in children. Aim: To construct a baseline value before the introduction of systematic use of ultrasound guidance, which requires specific training and equipment. Background: Anesthesia Service and Pediatric Oncology of the Italian National Cancer Center;patients were children (age ≤ 18 years) with solid tumors, needing long-term central venous catheters (Groshong or Port-a-Cath). Materials/Methods: Catheter placement was performed, mostly under general anesthesia, utilizing a micropuncture 5-7 Fr needle and fluoroscopy. In the study period ultrasound was used only in case of previously failed attempts. Relevant data were collected retrospectively. Results: From August 2008 to December 2011, 452 catheters were implanted to our patients. The prevalent approach was from subclavian vein (left 85.7%, right 9.7%);in few cases internal jugular vein was chosen (right 2.4%, left 2.2%). Pneumothorax occurred in 14 patients (3.1%;95%CI 1.9-5.1). In 4/14 children the PNX was considered minimal and not treated. In 10 patients the PNX was drained. In 7 cases a traditional, surgical thoracostomy was performed, while in 3 children a 14-Ga polyurethane catheter (Arrow International&#174) was inserted over a wire guide in the pleural space by anaesthetists. Conclusions: In our centre rates of PNX are the same as those described in literature and are expected to lower when ultrasound guidance of the puncture will be routinely applied. Percutaneous drainage of PNX seems as effective as surgically placed thoracostomy catheter, but less invasive.

Psychosocial Lived Experience of Parents with Children Diagnosed with Cancer in Lubumbashi

Objective: To determine the psychosocial problems, social acceptance and the impact of the costs of parents whose child has cancer. Method: We carried out a descriptive cross-sectional study over two-year periods (from January 3, 2018 to March 31, 2020) in the pediatric oncology unit of clinics at the University of Lubumbashi, in DR Congo. Results: 129 parents of children with cancer in the pediatric oncology unit were included in our study. Most children with cancer (53%) were accompanied by their mothers who had a low level of education (53.0%). Emotional shock was the most observed reaction (68%) to the announcement of the disease (cancer). Retinoblastoma has had a significant economic impact on families without medical coverage. Only 38% received psychological support from parents. Sadness was the most common feeling (77%) of households. Support workers consider their relationship with the medical profession acceptable in 67% and difficult in 11%. The majority of parents (78%) felt that the time to provide medical care was longer than expected. Conclusion: Parents of children with cancer had different feelings and reactions. This observation may be useful for the development of a health policy, in particular that of pediatric cancer in DR Congo.

Paratesticular Rhabdomyosarcoma in a 30 Months Old Child at the Lagoon Mother and Child Teaching Hospital (CHUMEL) in Cotonou

Introduction: Rhabdomyosarcoma is the most common soft tissue tumor in children. Modern multidisciplinary approaches make it possible to better characterize the different entities and to adapt the treatment accordingly. Paratesticular localization is rare and aggressive. We report here a case of paratesticular localization in a 30 months old boy. Observation: The parents would have noticed a small, painless and rapidly evolving testicular mass in the 6 months old child. Not having health insurance, they went to the hospital only 5 months later. This was followed by a total ablation of the mass (without orchidectomy) and a pleiomorphic rhabdomyosarcoma had been concluded. No chemotherapy was performed and the mass recurred 2 months later. This time, its ablation was followed by a series of non-adapted chemotherapy sessions with irregular follow-ups leading 8 months later to the child’s admission at our department. He presented with a degraded general condition, associating an infectious and anemic syndrome, an important increase of the scrotal mass and the occurrence of a tumoral mass in the left iliac fossa. The tumoral nature of these masses was confirmed on abdominal ultrasound and scan. The tumor was classified stage II (TNM: initial Tumors, Nodes, Metastasis). The multidisciplinary medical staff indicated a total ablation of the two masses, followed by a new session of adapted chemotherapy, in the absence of radiotherapy means. The child died in the immediate surgery follow-ups due to cardiac arrest. Conclusion: In our context of insufficient technical facilities, only early detection and adapted imperative chemotherapy, would have enabled a durable remission in front of the paratesticular rhabdomyosarcoma.

儿童和成人的黑色素瘤是否有区别:对33例来自单一研究机构儿童黑色素瘤的回顾性分析

Objective. To ascertain whether childhood melanoma presents any peculiar clinical features or differences in prognosis with respect to adults, we retrospectively analyzed the data from 33 patients who were up to 14 years of age and treated for cutaneous melanoma at the Istituto Nazionale Tumori, Milan, over a 25-year period. Methods. Primary lesions were amelanotic in half of the cases and raised in 73%. Lower extremities were the most common primary sites. Histologically, 9 cases were classified as nodular type, and median thickness was 2.5 mm. Nine children had nodal involvement at diagnosis, 2 in-transit metastases, and 1 distant spread. Surgery was the mainstay of treatment; 9 patients underwent lymph node dissection, 3 received chemotherapy, and 2 received radiotherapy. Results. With a median follow-up of 122 months, 5-year event-free survival and overall survival were 60%and 70%, respectively. Age seemed to correlate with survival,event-free survival being 90%in children under 10 and 47%in older patients, although the initial microstaging seemed worse in the former. Conclusion. By comparisonwith adult cases, childhood melanoma can have a higher percentage of atypical clinical features (amelanotic and raised lesions), nodular histotype, and thick lesions. Although we have no data to support any suggestion of biological differences between young children and adolescents or adults, our findings give the impression that melanoma behaves differently in the younger age group.

Long-term results of suppressing thyroid-stimulating hormone during radiotherapy to prevent primary hypothyroidism in medulloblastoma/PNET and Hodgkin lymphoma:a prospective cohort study

Primary hypothyroidism commonly occurs after radiotherapy(RT),and coincides with increased circulating thyroid-stimulating hormone(TSH)levels.We tested therefore the protective effect of suppressing TSH with L-thyroxine during RT for medulloblastoma/PNET and Hodgkin lymphoma(HL)in a prospective cohort study.From 1998 to 2001,a total of 37 euthyroid children with medulloblastoma/PNET plus 14 with HL,scheduled for craniospinal irradiation and mediastinum/neck radiotherapy,respectively,underwent thyroid ultrasound and free triiodothyronine(FT3),free thyroxine(FT4),and TSH evaluation at the beginning and end of craniospinal iiradiation.From 14 days before and up to the end of radiotherapy,patients were administered L-thyroxine checking every 3 days TSH to ensure a value<0.3μIU/mL.During follow-up,blood tests and ultrasound were repeated;primary hypothyroidism was considered an increased TSH level greater than normal range.Twenty-two/37 patients with medulloblastoma/PNET and all the 14 patients with HL were alive after a median 231 months from radiotherapy with 7/22 and 8/14 having correctly reached TSH levels˂0.3μIU/mL and well matched for other variables.Twenty years on,hypothyroidism-free survival rates differed significantly,being 60%±15%and 15.6%±8.2%in TSH-suppressed vs.not-TSH suppressed patients,respectively(P=0.001).These findings suggest that hypothyroidism could be durably prevented in two populations at risk of late RT sequelae,but it should be confirmed in a larger cohort.

Pharmacogenetics implementation in the clinics:information and guidelines for germline variants

The aim of this work was to supply an overview of the germline Pharmacogenetics that can be already implemented in the oncology clinical practice.An explanation of the three pillars considered necessary for determining which genetic polymorphisms should be used has been provided.These are PharmGKB single nucleotide polymorphism(SNP)-Drug Clinical Annotations with levels of evidence 1 or 2;the genetic information provided in the drug labels by the drug regulatory main agencies(Food and Drug Administration and European Medicines Agency,mainly);and the guidelines elaborated by international expert consortia(mainly Clinical Pharmacogenetics Implementation Consortium and Dutch Pharmacogenetics Working Group).A summary of the relevant SNPs and the recommendations on how to apply their results has also been compiled.