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Childhood Cancer: Prognostic Factor in Determining the Choice of TreatmentBY: Ritu Choudhary | Category: Childhood Cancer | Submitted: 2010-10-23 20:37:16
The management of childhood cancer uses the same methods of treatment in adults i.e. chemotherapy, surgery, radiotherapy. After careful analysis of prognostic factors, the therapeutic strategy is developed, so multidisciplinary teams in specialized pediatric cancer. It should be emphasized in children on the major role of chemotherapy, particularly effective on embryonic tumors, and whose advances have completely changed the place of other treatment modalities. The improved results, largely related to the practice of controlled clinical trials meeting the requirements of medical ethics, provides overall cure rates of around 75-80%. Chemotherapy is adapted to the weight and age of the child i.e. reduced dosages in infants younger than 1 year, in particular. It is often in children, in solid tumors neoadjuvant chemotherapy with the main objective remains the reduction of tumor volume to further local therapy safer and satisfactory. Neoadjuvant chemotherapy can also enjoy the tumor response to treatment, which will determine the prognostic significance therapeutic strategy (Ewing's sarcoma, osteosarcoma). Adjuvant chemotherapy, delivered in a child without apparent residual disease after treatment with loco-regional or local, is to prevent the occurrence and treat any secondary sites. Based on the concept of dose intensity, correlation between the effectiveness of chemotherapy and the amount of drug administered, the treatment of certain malignant tumors at very high risk may include high-dose chemotherapy, under cover of autologous cell Hematopoietic stem. In children, side effects of early chemotherapy hematologic complications include: neutropenia, anemia, thrombocytopenia, gastrointestinal complications: vomiting, malnutrition, mucositis, infectious complications include bacterial, fungal, parasitic or viral infections and their management are based on same principles as in adults and should be monitored more closely whether the child is young. Although its indications are decreasing, radiotherapy will fit in the therapeutic strategy for childhood cancer in about 1 / 3 of cases and in 80% of brain tumors. Pediatric radiotherapy is characterized by the importance of immediately putting in psychological condition to obtain good cooperation from the child, cooperation essential to the success of treatment and respect a strict immobility. The methods of irradiation behave like adults, external beam radiotherapy, the most used, and so much more special, internal radiation or brachytherapy. If the determination of tumor volume is the same way as in adults then determining the volume to be irradiated will differ from the age of the child, type of tumor and dose to issue. Indeed, some complications of radiotherapy are specific to the child. The slowdown in growth related to irradiation of the growth plates causing static spinal disorders or shortening of long bones, unsightly and responsible for a functional disability. The existence of intellectual sequelae after cranial irradiation. Delayed onset and progressive, dose dependent, they are more stringent than the irradiation occurs early (especially before the age of 4 years). They result in a delay of IQ, slow learning in school. Endocrine outcomes include pituitary insufficiency, causing a faltering stature, thyroid dysfunction, gonadal failure. The surgical expertise, to be part of multidisciplinary project, may intervene at different stages of this project: the diagnosis, when local treatment or locoregional after treatment to verify the existence of a residual tumor in any case, the surgery can be a gesture or therapeutic technique alone. Initially, to determine the nature of a solid tumor, a biopsy is exceptions, essential. It can sometimes be advantageously replaced by an aspiration biopsy, fine needle aspiration, performed under radiological detection, less invasive. The material collected should be sufficient to allow, however, in addition to pathological examination to confirm the diagnosis, a comprehensive analysis of tumor biology conventional cytogenetics, molecular biology tests which can be a prognostic factor in determining the choice of treatment protocol. Article Source: http://www.cancer-surgery.com/ About Author / Additional Info: Comments on this article: (0 comments so far)
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