Showing papers by "Sue C. Kaste published in 2010"
TL;DR: 10 steps that radiologists and radiologic technologists, with the assistance of their medical physicist, can take to obtain good quality CT images while properly managing radiation dose for children undergoing CT are suggested.
Abstract: AJR:194, April 2010 This article suggests 10 steps that radiologists and radiologic technologists, with the assistance of their medical physicist, can take to obtain good quality CT images while properly managing radiation dose for children undergoing CT. The first six steps ideally should be completed before performing any CT on a pediatric patient. The final four steps address the unique consideration that should be given for each scanned patient.
269 citations
TL;DR: Overall, older age, lower albumin, higher lipid levels, and dexamethasone exposure were associated with osteonecrosis and may be linked by inherited genomic variation.
220 citations
TL;DR: The bivariable analysis of vascular endothelial growth factor (VEGF) before and during therapy showed that patients with higher levels of VEGF before therapy had a longer progression-free survival (PFS), whereas patients with increases in V EGF during treatment had a shorter PFS.
Abstract: Purpose To evaluate the safety, maximum-tolerated dose, pharmacokinetics, and pharmacodynamics of vandetanib, an oral vascular endothelial growth factor receptor 2 (VEGFR2) and epidermal growth factor receptor inhibitor, administered once daily during and after radiotherapy in children with newly diagnosed diffuse intrinsic pontine glioma. Patients and Methods Radiotherapy was administered as 1.8-Gy fractions (total cumulative dose of 54 Gy). Vandetanib was administered concurrently with radiotherapy for a maximum of 2 years. Dose-limiting toxicities (DLTs) were evaluated during the first 6 weeks of therapy. Pharmacokinetic studies were obtained for all patients. Plasma angiogenic factors and VEGFR2 phosphorylation in mononuclear cells were analyzed before and during therapy. Results Twenty-one patients were administered 50 (n = 3), 65 (n = 3), 85 (n = 3), 110 (n = 6), and 145 mg/m2 (n = 6) of vandetanib. Only one patient developed DLT (grade 3 diarrhea) at dosage level 5. An expanded cohort of patients w...
103 citations
Cincinnati Children's Hospital Medical Center1, Emory University2, Children's National Medical Center3, American College of Radiology4, Boston Children's Hospital5, Nationwide Children's Hospital6, Duke University7, American Society of Radiologic Technologists8, Monroe Carell Jr. Children's Hospital at Vanderbilt9, St. Jude Children's Research Hospital10
TL;DR: The Alliance for Radiation Safety in Pediatric Imaging is an organization of over 45 international professional societies and agencies with the goal of promoting radiation safety for children.
Abstract: The Alliance for Radiation Safety in Pediatric Imaging is an organization of over 45 international professional societies and agencies with the goal of promoting radiation safety for children. The Alliance, through the Image Gently campaign, uses social marketing techniques and critical partnerships with vendors, government agencies, and not-for-profit organizations, to advocate best practices in radiation use and safety. Advocacies include improving education regarding radiation risk to patients from medical imaging for radiologists, technologists, and referring physicians; promoting standardization of dose measurements and display across vendor equipment; and improving medical literacy for parents.
41 citations
TL;DR: Pediatric Hodgkin lymphoma is a highly curable disease; however, prognostic factors for the survival of patients who develop recurrent disease have not been clearly defined.
Abstract: BACKGROUND:
Pediatric Hodgkin lymphoma (HL) is a highly curable disease; however, prognostic factors for the survival of patients who develop recurrent disease have not been clearly defined.
METHODS:
This was a retrospective analysis of 50 pediatric patients with HL who relapsed or progressed between 1990 and 2006 and who were retrieved with intense cytoreductive treatment regimens followed by autologous stem cell transplantation and radiation therapy. A Cox proportional hazards model was used to determine risk factors for second treatment failure and death.
RESULTS:
The median patient age was 16.1 years (range, 4.9-22.1 years) at the time of HL diagnosis. Fifteen patients developed progressive disease during therapy, 14 patients relapsed early, and 21 patients relapsed late. Patients who remained alive at the time of this study had been followed for a median of 4.4 years (range, 1.2-16.6 years). The 5-year overall survival rate for patients who had an inadequate response (n = 14) to initial salvage therapy was only 17.9% (95% confidence interval [CI], 3.1%-42.5%) compared with 97.2% (95% CI, 81.9%-99.6%) for patients who responded (n = 36; P < .0001). In a multivariate Cox regression analysis of overall survival, an inadequate response to initial salvage therapy was the only significant variable (hazard ratio, 43.6; 95% CI, 5.4-354; P = .0004).
CONCLUSIONS:
The current results indicated that pediatric patients with relapsed HL who have an inadequate response after initial primary salvage chemotherapy have a very poor prognosis and should be considered for novel therapies directed at biologic or immunologic targets. Cancer 2010. © 2010 American Cancer Society.
38 citations
TL;DR: The incidence of joint collapse and/or pain in young patients with hematologic malignancies diagnosed with ON of the knee and the risk factors associated with collapse were determined and the relationship between size and location of osteonecrotic knee lesions and the likelihood of Joint collapse was studied.
Abstract: Background
Osteonecrosis is a major treatment complication of pediatric leukemias owing to its potential to cause joint deterioration. Because of potential long-term effects of osteonecrosis on joints, information regarding its progression and collapse in different patients can be used to identify high-risk groups, advise the patients and parents of this complication, and potentially consider the risk for development of osteonecrosis in planning primary treatment.
21 citations
TL;DR: This case highlights the value of whole-body MR in an adolescent with dermatomyositis who developed multifocal osteonecrosis and has the potential for evaluating nonmalignant multifocal skeletal disease like oste onecrosis.
Abstract: Osteonecrosis is a well-recognized complication of corticosteroid use resulting in significant morbidity, often requiring surgical intervention. Whole-body MRI is a promising method that allows imaging of the whole patient in a reasonable time without the use of ionizing radiation. This technique has the potential for evaluating nonmalignant multifocal skeletal disease like osteonecrosis. This case highlights the value of whole-body MR in an adolescent with dermatomyositis who developed multifocal osteonecrosis.
14 citations
TL;DR: It is concluded that bone marrow biopsy need not be performed at diagnosis in patients who have unfavorable risk features, although this finding should be confirmed by larger prospective studies.
Abstract: Background Bone marrow biopsy is considered essential for the staging and risk-adapted treatment of Hodgkin’s lymphoma with unfavorable risk features. We reviewed the cases of pediatric Hodgkin’s lymphoma in our institution to determine the impact of bone marrow involvement on treatment, relapse, and survival.
Design and Methods We reviewed the clinical characteristics and outcome of 383 patients treated for Hodgkin’s lymphoma at St. Jude Children’s Research Hospital between August 1990 and August 2008. The 5-year survival estimates for patients with and without bone marrow involvement were compared.
Results Of 228 patients who had a bone marrow biopsy at diagnosis, 21 had bone marrow involvement. Bone marrow findings changed the disease stage in only seven patients (3.1%): from IB to IVB (n=1), from IIA (with bulky disease) to IVA (n=1), from IIB to IVB (n=1), and from IIIB to IVB (n=4). One patient’s risk assignment changed from intermediate to unfavorable risk without his chemotherapy being altered. No statistically significant difference was observed between patients with stage IV Hodgkin’s lymphoma who did (n=21) and did not (n=61) have bone marrow involvement in 5-year relapse-free survival (89.6± 7% versus 73.9±6.1%; P =0.25) or 5-year overall survival (95.2±8.2% versus 87.3±4.9%; P =0.82).
Conclusions Although bone marrow involvement changed the stage in 3.1% of pediatric Hodgkin’s lymphoma patients, it did not change risk-adapted treatment or prognosis. We conclude that bone marrow biopsy need not be performed at diagnosis in patients who have unfavorable risk features, although this finding should be confirmed by larger prospective studies.
13 citations
TL;DR: Further reduction of doses in younger patients is needed to consider 201Tl a viable option for imaging osteosarcoma, and excess cancer incidence and mortality associated with thallium bone imaging in pediatric patients is estimated.
Abstract: OBJECTIVE. Little information is available regarding doses of ionizing radiation from medical imaging in the growing population of children undergoing therapy for cancer who are at risk of developing second cancers. The purpose of our study was to estimate the potential excess lifetime cancer incidence and mortality associated with thallium bone imging in pediatric patients.MATERIALS AND METHODS. We retrospectively reviewed the medical records of pediatric patients treated between August 1991 and December 2003 for newly diagnosed osteosarcoma who underwent 201Tl imaging as part of the treatment protocol. According to age at diagnosis and doses of 201Tl, we estimated the excess cancer incidence and cancer mortality for boys and girls at 5 and 15 years old.RESULTS. The study cohort consisted of 73 patients, 32 males (median age at diagnosis, 14.8 years; age range, 8.1–20.1 years) and 41 females (median age at diagnosis, 13.3 years; age range, 6.0–20.7 years). Patients underwent a total of three 201Tl studie...
4 citations