Giant cell tumor of cervical spine in an adolescent Michalowski, Mariana B.; Pagnier-Clémence, Anne; Chirossel, Jean Paul ...
Medical and pediatric oncology,
July 2003, Letnik:
41, Številka:
1
Journal Article, Conference Proceeding
Among the 108 non-metastatic neuroblastomas treated at the Institut Gustave Roussy between 1982 and 1987, 25 dumbbell neuroblastomas were observed. Therapeutics included: 1) an initial laminectomy in ...forms with neurological deficit; 2) surgical excision of the primary tumor; 3) preoperative chemotherapy in children in which the primary tumor was considered as unresectable at diagnosis and postoperative chemotherapy in cases of incomplete resection; and 4) radiation therapy on macroscopic residual disease. Fifteen out of 25 (60%) presented a neurological deficit. A laminectomy was performed in 14 cases. Neurological recovery was good in 4 cases, partial in 4 cases, and absent in 4 cases. Two patients were worse after the procedure. The event-free survival was 88%. This high survival rate is linked: 1) to the non-metastatic stage; 2) to a high proportion of children under 1 year of age (18/25) (median age = 7 months); and 3) to a high proportion of thoracic location (12/25). The high incidence of macroscopically incomplete excision (13/25) did not jeopardize the prognosis. Out of the 22 survivors, there were 8 cases of major neurological sequellae (36%) and 5 cases of major orthopedic ones (26%). The coexistence of a serious functional prognosis and an excellent vital prognosis for these patients has led us to analyse the therapeutic modalities, to reevaluate the necessity of routine initial neurosurgical removal by laminectomy and to discuss the use of first line chemotherapy.
Five year survival rates among childhood cancer rose to 80%. Relapses are rare after five years of remission. Long term follow-up should also detect treatment related late adverse effects. Repeated ...cardiac evaluations are necessary, due to cumulative dose dependent cardiotoxicity of anthracycline. Endocrinological disorders and problems of fertility are mainly related to radiotherapy or high dose chemotherapy. Bone mineral density can be altered. Cognitive function, academic level and social outcome of irradiated patients and patients treated for cerebral tumors should be closely assessed and helped. Second neoplasms related to previous treatments may occur. One of the major on going treatment objective is to preserve the quality of life of cured patients, and to improve their information in the framework of a shared-care model involving the general practionner, the adult medicine specialists and the oncologic pediatric centre.
