Pancreas, Muscle, and Subcutaneous Fat Atrophy in Patients Undergoing Radiation for Neuroblastoma
Radiation improves survival in high-risk neuroblastoma
clinicalSophia Schermerhorn0:00 ↗
This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy
clinicalSophia Schermerhorn0:13 ↗
The authors use CT and MRI body segmentation to measure pancreatic volume, subcutaneous fat, and muscle area before and after treatment
clinicalSophia Schermerhorn0:19 ↗
There was a significant decrease in pancreatic volume after radiation
clinicalSophia Schermerhorn0:27 ↗
Very few patients developed clinically apparent pancreatic insufficiency
clinicalSophia Schermerhorn0:31 ↗
Pancreatic insufficiency wasn't systematically screened for in this study
clinicalSophia Schermerhorn0:31 ↗
Follow-up may not be long enough to detect pancreatic effects, especially given the young average age of these patients
opinionSophia Schermerhorn0:31 ↗
Pancreatic dysfunction could be an under-recognized late effect
opinionSophia Schermerhorn0:43 ↗
Patients had a significant drop in weight percentile with smaller decreases in fat and muscle
clinicalSophia Schermerhorn0:48 ↗
Body composition changes likely reflect the overall impact of cancer therapy overall rather than radiation alone
opinionSophia Schermerhorn0:48 ↗
These findings highlight the importance of nutritional screening during cancer treatments
opinionSophia Schermerhorn0:48 ↗
As survival improves, understanding and screening for long-term effects is becoming just as important as curing the cancer itself
opinionSophia Schermerhorn1:03 ↗
Neuroblastoma: Update Course 2014
Survival rate for high-risk neuroblastoma patients is in the 38 to 40% range
epidemiologicalDaniel von Allmen0:42 ↗
Surgeon-reported degree of resection showed only 66% concordance with radiologist assessment of postoperative imaging in tandem transplant pilot study
clinicalDaniel von Allmen6:52 ↗
Repeat study in recent COG high-risk trial showed same 66% concordance rate between surgeon op notes and postoperative imaging, with surgeons underestimating and radiologists overcalling resection completeness
clinicalDaniel von Allmen7:33 ↗
Memorial Sloan Kettering data suggests biggest volume response of neuroblastoma tumor occurs with first two cycles of chemotherapy, with very little response after that
Host summaryDaniel von Allmen summarizing the discussion — not the host's own clinical position10:00 ↗
More chemotherapy or other agents like MIBG may make tumor more fibrotic and make subadventitial dissection more difficult
opinionDaniel von Allmen10:17 ↗
Complication rate for aggressive neuroblastoma resection is approximately 30% morbidity with mortality less than 1%
epidemiologicalDaniel von Allmen13:07 ↗
Riley Hospital study showed only survivors with stage 4 neuroblastoma were those who had primary tumor resection
clinical14:07 ↗
Sloan Kettering study suggests stage 4 neuroblastoma patients do better with primary tumor resection
Host summaryThe host summarizing the discussion — not the host's own clinical position14:27 ↗
Kylie's study showed no difference in survival based on completeness of neuroblastoma resection
Host summaryThe host summarizing the discussion — not the host's own clinical position14:33 ↗
European studies show no difference in survival based on completeness of neuroblastoma resection
Host summaryThe host summarizing the discussion — not the host's own clinical position14:35 ↗
Most recent COG study shows probably no difference in survival based on completeness of neuroblastoma resection
Host summaryThe host summarizing the discussion — not the host's own clinical position14:35 ↗
High-risk neuroblastoma patients receive 9 different drugs, bone marrow transplantation, and some receive total body radiation
clinical14:55 ↗
High-risk neuroblastoma treatment includes tandem peripheral blood stem cell transplants, with second transplant given as soon as patient recovers from first, followed by immunotherapy and Retin-A
clinicalDaniel von Allmen15:10 ↗
High-risk neuroblastoma survival increased from 10% to 30-40% with treatment intensification
epidemiological16:01 ↗
Georgia study showed 46% survival in high-risk neuroblastoma with transplantation plus immunotherapy plus differentiating agents
Host summaryThe host summarizing the discussion — not the host's own clinical position16:22 ↗
Many deaths in intensified high-risk neuroblastoma treatment were due to the treatment itself rather than cancer
Host summaryThe host summarizing the discussion — not the host's own clinical position16:22 ↗
German study of 278 stage 4 high-risk neuroblastoma patients achieved complete resection in almost half and >90% resection in another quarter (75% total with >90% resection)
Host summaryDaniel von Allmen summarizing the discussion — not the host's own clinical position16:48 ↗
German study showed overall survival 45%, event-free survival 33%, and local progression-free survival 58% in stage 4 neuroblastoma
Host summaryDaniel von Allmen summarizing the discussion — not the host's own clinical position17:13 ↗