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Management and early complications of totally implantable venous access port systems in 81 children diagnosed with cancer
S146
Abstracts
neurosurgical expertise, limited neuro-oncological centers and high rate of treatment abandonment are the major challenges leading to poor overall survival. Survival can be improved by addressing and improving above mentioned challenges. No conflict of interest.
1404 POSTER The shift from delayed radiotherapy to localized radiotherapy strategy in treatment of infantile medulloblastoma − challenging experience from LMIC S.A. Ahmed1 , M. Zaghloul2 , H. Hafez3 , A. El Hemaly3 , H. Taha4 , A. Refat5 , M. Elbeltagy6 , N. Elkhateeb7 . 1 Children’s Cancer Hospital Egypt − Aswan University, Clinical Oncology and Nuclear medicine, Cairo, Egypt; 2 Children’s Cancer Hospital Egypt-NCI, Radiotherapy, Cairo, Egypt; 3 Children’s Cancer Hospital Egypt-NCI, Pediatric Oncology, Cairo, Egypt; 4 Children’s Cancer Hospital Egypt-NCI, Pathology, Cairo, Egypt; 5 Children’s Cancer Hospital Egypt-NCI, Radiology, Cairo, Egypt; 6 Children’s Cancer Hospital Egypt- Cairo University, Neuro-surgury, Cairo, Egypt; 7 Children’s Cancer Hospital Egypt, Statistics, Cairo, Egypt Background and Objectives: Medulloblastoma patients below 3 years had inferior survival rates due to several reasons. We aim to investigate the treatment end-results of medulloblastoma under 3 years old and determine the factors affecting its prognosis. Design and Methods: Twenty-eight children below the age of 3 years were treated at Children’s Cancer Hospital Egypt during the period from July 2007 to October 2015. Gross total resection was performed in 19 children (67.8%), subtotal excision in 10 children (35.7%) and biopsy in one patient. Twenty (71.4%) were non-metastatic, while 8 (28.6%) metastatic M1−3 . Twelve (42.8%) children received infantile medulloblastoma chemotherapy protocol and localized posterior fossa irradiation, while the other 16 (57%) delayed craniospinal radiotherapy protocol post chemotherapy. Eight metastatic children received craniospinal irradiation (CSI). Twelve of the M0 patients received posterior fossa (PF) irradiation, while the other 8 received CSI at age of 3 years. Results: The 4 year OS for non-metastatic was 80±6.7% and 37.5.9±13% for M+ children. The EFS for nonmetastatic was 58.4±8.3% and 37.4.0±11.8% respectively. The infantile chemotherapy protocol with localized radiotherapy in M0 patients led to 4-year OS of 78.6±7.9% compared to 62.5±12.6% for delayed craniospinal radiotherapy for M0 patients. The OS for delayed CSI for M+ was 37.5±13%. OS of GTR and less than GTR is 78.6±8.2%, 62.5±8.8% respectively. EFS for localized PF radiotherapy protocol as 83.3±7, and 37.5±12.3. EFS for delayed CSI M+ was 25±11.8. Two patients of the CSI group developed CNS relapse and other two patients had spinal relapse. No relapse in patients who received PF irradiation. Non of the these detected differences were statistically significant. Conclusion: Nonmetastatic status in infantile medulloblastoma carries better OAS and EFS than metastatic category irrespective of the treatment protocol. Shift from delayed CSI post chemotherapy to the localized PF protocol is unique experience that improved survival profile and tr decrease toxicity profile. No conflict of interest.
1405 POSTER Effect of delaying local control radiotherapy on outcome of localized pediatric bladder/prostate rhabdomyosarcoma S.A. Ahmed1 , H. Hafez2 , E. El Nadi3 , R.M. Labib34 , A. Younes5 , G. Ahmed6 , M. Zaghloul7 , H. Taha8 , A. El Haddad2 . 1 Children’s Cancer Hospital Egypt -Aswan University, Clinical Oncology and Nuclear medicine, Cairo, Egypt; 2 Children’s Cancer Hospital Egypt- NCI, Pediatric Oncology, Cairo, Egypt; 3 Children’s Cancer Hospital Egypt, 2Pediatric Oncology Department- Beni suef University and Children’s Cancer Hospital Egypt, Cairo, Egypt; 4 Children’s Cancer Hospital Egypt, research, Cairo, Egypt; 5 Children’s Cancer Hospital Egypt- NCI, Surgical Oncology, Cairo, Egypt; 6 Children’s Cancer Hospital Egypt- Helwan University, Surgica Oncology, Cairo, Egypt; 7 Children’s Cancer Hospital Egypt- NCI, Radiotherapy, Cairo, Egypt; 8 Children’s Cancer Hospital Egypt- NCI, Pathology, Cairo, Egypt Background and Objectives: Multidisciplinary treatment approach is used in treatment of bladder/prostate rhabdomyosarcoma (RMS), yet it is unclear, which treatment strategy is optimal for local control. Radiotherapy is one of the treatment local control methods. The study evaluate the impact of timing of radiotherapy (RTH) and Intensity modulated radiotherapy (IMRT) technique on cancer control outcomes for children with bladder/ prostate RMS.
Poster Session, Saturday 28 January 2017 Design and Methods: Retrospective analysis of 29 patients treated as local control by RTH at Children’s Cancer Hospital Egypt in August 2007December 2015. Seventeen patients (58.6%) were treated by conformal radiotherapy and 12 patients (41.3%) treated by IMRT technique. Results: Seventeen (58.6%) patients started Local radiotherapy before/at week 12 and 12 (41.4%) patients started after. Four years failure-free survival (FFS) and Overall survival (OS) for those who had early and delayed local control are (94.1±7% vs. 33.3±15.1%, p = 0.007), (100% vs. 56.8±6.5%, p = 0.007), respectively. Failure free survival for patients who treated Over treatment time (OTT) >5 weeks and <5 weeks is (49.4±14%, 81.5±9.8%) respectively. Although they show difference, yet not statistically significant (0.6). Ten patients (83.3%) who had OTT <5 weeks were treated by IMRT. Conclusion: Earlier local control was associated with better outcome in children with bladder/Prostate RMS. IMRT shows tendency to improve survival profile due to decrease toxicity yet decrease OTT. No conflict of interest. 1406 POSTER Management and early complications of totally implantable venous access port systems in 81 children diagnosed with cancer I. Astigarraga1 , M. Menchaca1 , M.J. Lopez-delaSerna1 , S. Garcia-Obregon2 , R. Adan1 , A. Echebarria1 , M. Garcia-Ariza1 , R. Lopez-Almaraz1 , G. Chocarro3 , E. Solorzano3 , A. Azpeitia3 . 1 Hospital De Cruces, Pediatrics. Pediatric Oncology Unit, Bilbao-Vizcaya, Spain; 2 BioCruces Health Research Institute, Pediatric Oncology Group, Bilbao-Vizcaya, Spain; 3 Hospital De Cruces, Pediatrics. Pediatric Surgery Service, Bilbao-Vizcaya, Spain Background: Port systems for permanent central venous are recommended in patients with cancer for long-term use of chemotherapy and other procedures. Placement and postoperative care of Totally Implantable Venous Access Port Systems (TIVAPS) require a collaborative and interdisciplinary effort, especially in childhood. The aim of the study is to investigate changes in the implantation surgical procedures, initial management, morbidity and infectious complications in the first month after TIVAPS implantation in children and adolescents diagnosed with cancer. Material and Methods: Retrospective study of the epidemiological and clinical data of 145 paediatric patients with cancer and analysis of early TIVAPS related complications in 81 cases diagnosed with cancer from 2013 to 2015. SPSS software was used for statistical analysis. Results: Clinical data of the 81 patients: 45 males and 36 females; median age at cancer diagnosis: 5.62 years-old (range: 0–16.41 yearsold). Type of neoplasm: 27 leukemia, 17 sarcoma, 11 lymphoma, 10 brain tumour, 9 neuroblastoma, 1 Wilms tumour, and 6 other oncologic diseases. Before TIVAPS implantation, all patients received intravenous antibiotic prophylaxis. Also sterile technique was used for TIVAPS manipulation in all cases. Surgical placement was closed in 50 and open in 31 patients. The main vein for TIVAPS insertion was right internal jugular in 49 following by right external jugular. Three surgical complications were documented: accidental subclavian artery dissection, bent catheter and suture dehiscence. Re-surgery was needed in four for catheter removal due to infection (3) and catheter migration (1). TIVAPS functionality was good (permeable and blood flowed out) in 80, only one did not flow out. During the first month, 30 patients developed fever associated with multiple factors. Neutrophils median at the time of surgical procedure was 2,800 cell/mm3 . Blood cultures were collected from TIVAPS and venipuncture approach in 27 cases, from TIVAPS in 2 and 1 venipuncture. Seven microbiological studies were positive (5 Gram+, 1 fungi and 1 virus). One surgical wound infections with positive culture were found (Bacillus sp.). Conclusions: Changes in the technical surgical procedures and initial management of Totally Implantable Venous Access Port Systems (TIVAPS) were implemented in children diagnosed with cancer in the last two years. Functionality was good in nearly all patients (80/81) and initial early complications were low (3.7%). The most infectious complications were found in patients diagnosed with leukemia but there were many other additional risk factors apart from TIVAPS. An early implantation of TIVAPS is strongly recommended in patients with cancer for a safe administration of chemotherapy and for other procedures, especially in young children. No conflict of interest.
Abstracts
neurosurgical expertise, limited neuro-oncological centers and high rate of treatment abandonment are the major challenges leading to poor overall survival. Survival can be improved by addressing and improving above mentioned challenges. No conflict of interest.
1404 POSTER The shift from delayed radiotherapy to localized radiotherapy strategy in treatment of infantile medulloblastoma − challenging experience from LMIC S.A. Ahmed1 , M. Zaghloul2 , H. Hafez3 , A. El Hemaly3 , H. Taha4 , A. Refat5 , M. Elbeltagy6 , N. Elkhateeb7 . 1 Children’s Cancer Hospital Egypt − Aswan University, Clinical Oncology and Nuclear medicine, Cairo, Egypt; 2 Children’s Cancer Hospital Egypt-NCI, Radiotherapy, Cairo, Egypt; 3 Children’s Cancer Hospital Egypt-NCI, Pediatric Oncology, Cairo, Egypt; 4 Children’s Cancer Hospital Egypt-NCI, Pathology, Cairo, Egypt; 5 Children’s Cancer Hospital Egypt-NCI, Radiology, Cairo, Egypt; 6 Children’s Cancer Hospital Egypt- Cairo University, Neuro-surgury, Cairo, Egypt; 7 Children’s Cancer Hospital Egypt, Statistics, Cairo, Egypt Background and Objectives: Medulloblastoma patients below 3 years had inferior survival rates due to several reasons. We aim to investigate the treatment end-results of medulloblastoma under 3 years old and determine the factors affecting its prognosis. Design and Methods: Twenty-eight children below the age of 3 years were treated at Children’s Cancer Hospital Egypt during the period from July 2007 to October 2015. Gross total resection was performed in 19 children (67.8%), subtotal excision in 10 children (35.7%) and biopsy in one patient. Twenty (71.4%) were non-metastatic, while 8 (28.6%) metastatic M1−3 . Twelve (42.8%) children received infantile medulloblastoma chemotherapy protocol and localized posterior fossa irradiation, while the other 16 (57%) delayed craniospinal radiotherapy protocol post chemotherapy. Eight metastatic children received craniospinal irradiation (CSI). Twelve of the M0 patients received posterior fossa (PF) irradiation, while the other 8 received CSI at age of 3 years. Results: The 4 year OS for non-metastatic was 80±6.7% and 37.5.9±13% for M+ children. The EFS for nonmetastatic was 58.4±8.3% and 37.4.0±11.8% respectively. The infantile chemotherapy protocol with localized radiotherapy in M0 patients led to 4-year OS of 78.6±7.9% compared to 62.5±12.6% for delayed craniospinal radiotherapy for M0 patients. The OS for delayed CSI for M+ was 37.5±13%. OS of GTR and less than GTR is 78.6±8.2%, 62.5±8.8% respectively. EFS for localized PF radiotherapy protocol as 83.3±7, and 37.5±12.3. EFS for delayed CSI M+ was 25±11.8. Two patients of the CSI group developed CNS relapse and other two patients had spinal relapse. No relapse in patients who received PF irradiation. Non of the these detected differences were statistically significant. Conclusion: Nonmetastatic status in infantile medulloblastoma carries better OAS and EFS than metastatic category irrespective of the treatment protocol. Shift from delayed CSI post chemotherapy to the localized PF protocol is unique experience that improved survival profile and tr decrease toxicity profile. No conflict of interest.
1405 POSTER Effect of delaying local control radiotherapy on outcome of localized pediatric bladder/prostate rhabdomyosarcoma S.A. Ahmed1 , H. Hafez2 , E. El Nadi3 , R.M. Labib34 , A. Younes5 , G. Ahmed6 , M. Zaghloul7 , H. Taha8 , A. El Haddad2 . 1 Children’s Cancer Hospital Egypt -Aswan University, Clinical Oncology and Nuclear medicine, Cairo, Egypt; 2 Children’s Cancer Hospital Egypt- NCI, Pediatric Oncology, Cairo, Egypt; 3 Children’s Cancer Hospital Egypt, 2Pediatric Oncology Department- Beni suef University and Children’s Cancer Hospital Egypt, Cairo, Egypt; 4 Children’s Cancer Hospital Egypt, research, Cairo, Egypt; 5 Children’s Cancer Hospital Egypt- NCI, Surgical Oncology, Cairo, Egypt; 6 Children’s Cancer Hospital Egypt- Helwan University, Surgica Oncology, Cairo, Egypt; 7 Children’s Cancer Hospital Egypt- NCI, Radiotherapy, Cairo, Egypt; 8 Children’s Cancer Hospital Egypt- NCI, Pathology, Cairo, Egypt Background and Objectives: Multidisciplinary treatment approach is used in treatment of bladder/prostate rhabdomyosarcoma (RMS), yet it is unclear, which treatment strategy is optimal for local control. Radiotherapy is one of the treatment local control methods. The study evaluate the impact of timing of radiotherapy (RTH) and Intensity modulated radiotherapy (IMRT) technique on cancer control outcomes for children with bladder/ prostate RMS.
Poster Session, Saturday 28 January 2017 Design and Methods: Retrospective analysis of 29 patients treated as local control by RTH at Children’s Cancer Hospital Egypt in August 2007December 2015. Seventeen patients (58.6%) were treated by conformal radiotherapy and 12 patients (41.3%) treated by IMRT technique. Results: Seventeen (58.6%) patients started Local radiotherapy before/at week 12 and 12 (41.4%) patients started after. Four years failure-free survival (FFS) and Overall survival (OS) for those who had early and delayed local control are (94.1±7% vs. 33.3±15.1%, p = 0.007), (100% vs. 56.8±6.5%, p = 0.007), respectively. Failure free survival for patients who treated Over treatment time (OTT) >5 weeks and <5 weeks is (49.4±14%, 81.5±9.8%) respectively. Although they show difference, yet not statistically significant (0.6). Ten patients (83.3%) who had OTT <5 weeks were treated by IMRT. Conclusion: Earlier local control was associated with better outcome in children with bladder/Prostate RMS. IMRT shows tendency to improve survival profile due to decrease toxicity yet decrease OTT. No conflict of interest. 1406 POSTER Management and early complications of totally implantable venous access port systems in 81 children diagnosed with cancer I. Astigarraga1 , M. Menchaca1 , M.J. Lopez-delaSerna1 , S. Garcia-Obregon2 , R. Adan1 , A. Echebarria1 , M. Garcia-Ariza1 , R. Lopez-Almaraz1 , G. Chocarro3 , E. Solorzano3 , A. Azpeitia3 . 1 Hospital De Cruces, Pediatrics. Pediatric Oncology Unit, Bilbao-Vizcaya, Spain; 2 BioCruces Health Research Institute, Pediatric Oncology Group, Bilbao-Vizcaya, Spain; 3 Hospital De Cruces, Pediatrics. Pediatric Surgery Service, Bilbao-Vizcaya, Spain Background: Port systems for permanent central venous are recommended in patients with cancer for long-term use of chemotherapy and other procedures. Placement and postoperative care of Totally Implantable Venous Access Port Systems (TIVAPS) require a collaborative and interdisciplinary effort, especially in childhood. The aim of the study is to investigate changes in the implantation surgical procedures, initial management, morbidity and infectious complications in the first month after TIVAPS implantation in children and adolescents diagnosed with cancer. Material and Methods: Retrospective study of the epidemiological and clinical data of 145 paediatric patients with cancer and analysis of early TIVAPS related complications in 81 cases diagnosed with cancer from 2013 to 2015. SPSS software was used for statistical analysis. Results: Clinical data of the 81 patients: 45 males and 36 females; median age at cancer diagnosis: 5.62 years-old (range: 0–16.41 yearsold). Type of neoplasm: 27 leukemia, 17 sarcoma, 11 lymphoma, 10 brain tumour, 9 neuroblastoma, 1 Wilms tumour, and 6 other oncologic diseases. Before TIVAPS implantation, all patients received intravenous antibiotic prophylaxis. Also sterile technique was used for TIVAPS manipulation in all cases. Surgical placement was closed in 50 and open in 31 patients. The main vein for TIVAPS insertion was right internal jugular in 49 following by right external jugular. Three surgical complications were documented: accidental subclavian artery dissection, bent catheter and suture dehiscence. Re-surgery was needed in four for catheter removal due to infection (3) and catheter migration (1). TIVAPS functionality was good (permeable and blood flowed out) in 80, only one did not flow out. During the first month, 30 patients developed fever associated with multiple factors. Neutrophils median at the time of surgical procedure was 2,800 cell/mm3 . Blood cultures were collected from TIVAPS and venipuncture approach in 27 cases, from TIVAPS in 2 and 1 venipuncture. Seven microbiological studies were positive (5 Gram+, 1 fungi and 1 virus). One surgical wound infections with positive culture were found (Bacillus sp.). Conclusions: Changes in the technical surgical procedures and initial management of Totally Implantable Venous Access Port Systems (TIVAPS) were implemented in children diagnosed with cancer in the last two years. Functionality was good in nearly all patients (80/81) and initial early complications were low (3.7%). The most infectious complications were found in patients diagnosed with leukemia but there were many other additional risk factors apart from TIVAPS. An early implantation of TIVAPS is strongly recommended in patients with cancer for a safe administration of chemotherapy and for other procedures, especially in young children. No conflict of interest.