- Email: [email protected]
Outcome of children with medulloblastoma at a tertiary care hospital in Karachi, Pakistan
Poster Session, Saturday 28 January 2017 and supracalvicular retroperitoenal lymphadenopathy. The biopsy report of the lesion was compatible with CCCR. I was administrated sunitinib and observed regression of the metastasis and disease stabilization. However, an irregular follow-up care of the patient permitted the development of a severe cardiac dysfunction and TSH above 100. He was admitted to the Pediatric ICU, but died of cardiogenic shock. Conclusions: CCCR is a rare condition in children and sunitinib as a target therapy has proved to be an efficient and safe treatment, once the survival rate of these patients has been increased by a close monitoring of adverse effects. No conflict of interest. 1402A POSTER Retinoblastoma − pattern, presentation and management − a quintessential experience of 5 years A.K. Yalavarthy1 . 1 Vydehi Institute of Medical Sciences and Research Centre, Medical Oncology, Bengaluru, India Background: Retinoblastoma is the most common primary intraocular malignancy of childhood. The diagnosis is mainly clinical, but histology determines the diagnosis and the extent of the tumour. Prompt referral and appropriate management by a multidisciplinary team are necessary to optimize visual outcome and survival. Objective: To determine the pattern of presentation and management of retinoblastoma patients at a tertiary cancer care centre in South India, during a period of 5 years (1st November 2009 to 1st December 2014). Materials and Methods: The study is a retrospective case series. It was carried out primarily by identifying the hospital number of relevant records of retinoblastoma patients from attendance, admission and discharge/death at the cancer care centre. The hospital number was used to retrieve relevant files from the records department with the help of a records clerk. Relevant clinical information recorded was extracted and entered into a structured data excel sheet for analysis. Information sought is demographic characteristics, clinical presentation, investigations done, the methods of management of retinoblastoma patients and the discharge/death records. Data collected was analysed. Descriptive statistics were used to summarize the data and results were presented. Results: Total number of cases studied was 31. Out of which, 18 (58%) were female and 13 (42%) were male. Of the 31 cases, 16 (52%) had bilateral involvement and 15 (48%) had unilateral involvement. Age of onset of 13 (42%) cases was less than or equal to 12 months. Age of onset of 11 (35%) was between more than 12 months to less than or equal to 36 months. Age of onset of 7 cases (22%) was more than 36 months. History of consanguinity in the parents was found in 2 cases (6.5%). Both of these cases had bilateral eye involvement. The commonest mode of presentation was a white reflex in the eye (17out of 31 cases 55%). Other presentations included defective vision and swelling of the eye. Out of 47 eyes studied, 1 (2%) was in Group A, 1 (2%) was in Group B, 4 (9%) were in Group C, 14 (30%) were in Group D and 27 (57%) were in Group E. Out of the 47 eyes, 20 (43%) eyes were enucleated. Out of 47 eyes, 13 (28%) eyes were irradiated. 7 (23%) out of 31 cases were metastatic at presentation. Out of the 10 metastatic eyes, 5 eyes were Group D and 5 eyes were Group E. 6 (19%) out of 31 cases succumbed to death. Conclusion: Retinoblastoma continues to be a challenge both diagnostically and therapeutically. Many factors enter into management decisions such as patient age, tumour laterality, size, location, and extent, and anticipated visual prognosis. Chemotherapy has changed the approach to retinoblastoma in recent years and have permitted many children to maintain their eye(s) and avoid external beam radiotherapy. Enucleation still proves to be useful for advanced tumour. No conflict of interest. 1403 POSTER Does post-induction chemotherapy PET/CT response predict outcome in young adult nasopharyngeal carcinoma? Prospective study from CCHE S.A. Ahmed1 , M. Amr Abdelwahab2 , E.A. El-Kholy2 , S.A. Fadel3 , W. Zekry3 , H. Taha4 , I. Zaky5 , A. Elnashar6 . 1 Children’s Cancer Hospital Egypt − Aswan University, Clinical Oncology and Nuclear medicine, Cairo, Egypt; 2 Children’s Cancer Hospital Egypt -NCI, Nuclear medicine, 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, Radiodiagnosis, Cairo, Egypt; 6 Children’s Cancer Hospital Egypt, Statistics, Cairo, Egypt Background: To evaluate the predictive value of 18 F fluorodeoxyglucose positron emission tomography (18 F-FDG PET/CT), reflected in terms of
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disease free survival (DFS) and overall survival (OS), in pediatric patients received post induction chemotherapy for locally advanced nasopharyngeal carcinoma (LANPC). pediatric patients treated definitively with 3 courses of induction Platiniambased chemotherapy followed by concurrent chemoradiation (CRT) with simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT). Materials and Methods: This is a prospective study including LANPC (stage II−III) pediatric patients treated definitively and consecutively between January 2008 and December 2014 with induction chemotherapy; cisplatin, and 5-fluorouracil (PF) followed by SIB-IMRT to a total dose 61.2 Gy with utilizing weekly cisplatin. The volume of radiotherapy was based on tumor response to Induction chemotherapy. All patients had baseline pretreatment and post induction chemotherapy 18 F-FDG PET/CT. Metabolic response of the primary tumor and LN was assessed using maximum standardized uptake value (SUVmax ) that was correlated with treatment outcomes; OS and EFS. Results: The study included 38 eligible pediatric LANPC patients. The 3-year OS and DFS rates were 84.6% and 79.5%, respectively. The median OS and EFS intervals were not reached. On a univariate analysis, the 3-years OS and EFS were significantly higher in patients with post induction metabolic regression of SUVmax >65% for the primary and 57% for the nodal metastases (P = 0.02). Furthermore, OS and EFS were lower in patients with initial high nodal metabolic activity (P = 0.004) and (P = 0.005) with SUVmax cutoff values (14.5) and (6.9) respectively. Also Initial SUV-LN > SUV-Primary showed significant lower OS (P = 0.004) and EFS (P = 0.005). Conclusion: In this study, the degree of metabolic regression in postinduction chemotherapy 18 F-FDG PET/CT was a potential independent prognostic indicator for clinical outcomes in LANC pediatric patients (treated definitively with PF induction chemotherapy followed by CRT). Further controlled clinical trials are worthwhile. No conflict of interest. 1403A POSTER Outcome of children with medulloblastoma at a tertiary care hospital in Karachi, Pakistan S.A. Hamid1 , M. Idrees2 , M.R. Khan1 , I. Qadduomi3 , S. Aziz4 , M.S. Ashraf1 . 1 Indus Children’s Cancer Hospital, Paediatric Oncology, Karachi, Pakistan; 2 Karachi Medical and Dental College and Abbasi Shaheed Hospital, Paediatrics, Karachi, Pakistan; 3 St. Jude Children’s Research Hospital, Neuro Oncology, Memphis, USA; 4 Abbasi Shaheed Hospital- Karachi Medical and Dental College, Paediatrics, Karachi, Pakistan Background: Medulloblastoma is one of the most common central nervous system (CNS) tumours with good prognosis in developed areas. In developing countries like Pakistan, multiple problems exist which compromise the survival. These include delay in presentation, high abandonment rate, lack of multidisciplinary team including expert surgical skills and good supportive care. There is also paucity of data on survival of children with CNS tumours especially Medulloblastoma. To our knowledge, this is the first study on Medulloblastoma in children in Pakistan. The main objective of our study is to determine the overall survival of patients with Medulloblastoma and to identify various factors related to poor survival. Materials and Methods: A retrospective chart review was carried out after IRB approval on all patients of Medulloblastoma and infants with primitive neuroectodermal tumour (PNET) registered at Indus Children Cancer Hospital (ICCH) from June 1997 to November 2016. Ages ranged from 0 to 18 years. Risk stratification, chemotherapy and radiation techniques were according to the standard guidelines. Data was collected from the Health Management Information System (HMIS) and analysed using SPSS 21. The demography, clinical presentation and overall survival were determined and gaps were identified for decrease in survival. Result: Total 63/341 (19%) CNS tumours were Medulloblastoma. Mean age of presentation was 8±4 years. 5/63 (8%) were less than 3 years of age. Male to female ratio 2:1. The most common symptom was headache (20%), followed by vomiting (19%). Mean delay of 4±3.7 months from first symptom till surgery. 38% presented with metastatic disease, leptomeningeal spread being most common site (23%). Because of limitation of data and record availability only 47 out of 63 were risk stratified (75%) in which 19% were standard risk and 56% high risk. 42/63 patients (67%) received treatment at ICCH, remaining had advanced disease at presentation so left before treatment as family opted for supportive care at home. 23/42 (55%) completed treatment. 12/42 (29%) are alive, 8/42 (19%) are alive and on treatment at the time of analysis and remaining died due to relapse or progressive disease. Overall survival of entire cohort is 32% including abandonment and 48% without abandonment. Conclusion: Delay in the diagnosis leading to advance disease at presentation, poor socioeconomic status, lack of infrastructure and
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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.
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disease free survival (DFS) and overall survival (OS), in pediatric patients received post induction chemotherapy for locally advanced nasopharyngeal carcinoma (LANPC). pediatric patients treated definitively with 3 courses of induction Platiniambased chemotherapy followed by concurrent chemoradiation (CRT) with simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT). Materials and Methods: This is a prospective study including LANPC (stage II−III) pediatric patients treated definitively and consecutively between January 2008 and December 2014 with induction chemotherapy; cisplatin, and 5-fluorouracil (PF) followed by SIB-IMRT to a total dose 61.2 Gy with utilizing weekly cisplatin. The volume of radiotherapy was based on tumor response to Induction chemotherapy. All patients had baseline pretreatment and post induction chemotherapy 18 F-FDG PET/CT. Metabolic response of the primary tumor and LN was assessed using maximum standardized uptake value (SUVmax ) that was correlated with treatment outcomes; OS and EFS. Results: The study included 38 eligible pediatric LANPC patients. The 3-year OS and DFS rates were 84.6% and 79.5%, respectively. The median OS and EFS intervals were not reached. On a univariate analysis, the 3-years OS and EFS were significantly higher in patients with post induction metabolic regression of SUVmax >65% for the primary and 57% for the nodal metastases (P = 0.02). Furthermore, OS and EFS were lower in patients with initial high nodal metabolic activity (P = 0.004) and (P = 0.005) with SUVmax cutoff values (14.5) and (6.9) respectively. Also Initial SUV-LN > SUV-Primary showed significant lower OS (P = 0.004) and EFS (P = 0.005). Conclusion: In this study, the degree of metabolic regression in postinduction chemotherapy 18 F-FDG PET/CT was a potential independent prognostic indicator for clinical outcomes in LANC pediatric patients (treated definitively with PF induction chemotherapy followed by CRT). Further controlled clinical trials are worthwhile. No conflict of interest. 1403A POSTER Outcome of children with medulloblastoma at a tertiary care hospital in Karachi, Pakistan S.A. Hamid1 , M. Idrees2 , M.R. Khan1 , I. Qadduomi3 , S. Aziz4 , M.S. Ashraf1 . 1 Indus Children’s Cancer Hospital, Paediatric Oncology, Karachi, Pakistan; 2 Karachi Medical and Dental College and Abbasi Shaheed Hospital, Paediatrics, Karachi, Pakistan; 3 St. Jude Children’s Research Hospital, Neuro Oncology, Memphis, USA; 4 Abbasi Shaheed Hospital- Karachi Medical and Dental College, Paediatrics, Karachi, Pakistan Background: Medulloblastoma is one of the most common central nervous system (CNS) tumours with good prognosis in developed areas. In developing countries like Pakistan, multiple problems exist which compromise the survival. These include delay in presentation, high abandonment rate, lack of multidisciplinary team including expert surgical skills and good supportive care. There is also paucity of data on survival of children with CNS tumours especially Medulloblastoma. To our knowledge, this is the first study on Medulloblastoma in children in Pakistan. The main objective of our study is to determine the overall survival of patients with Medulloblastoma and to identify various factors related to poor survival. Materials and Methods: A retrospective chart review was carried out after IRB approval on all patients of Medulloblastoma and infants with primitive neuroectodermal tumour (PNET) registered at Indus Children Cancer Hospital (ICCH) from June 1997 to November 2016. Ages ranged from 0 to 18 years. Risk stratification, chemotherapy and radiation techniques were according to the standard guidelines. Data was collected from the Health Management Information System (HMIS) and analysed using SPSS 21. The demography, clinical presentation and overall survival were determined and gaps were identified for decrease in survival. Result: Total 63/341 (19%) CNS tumours were Medulloblastoma. Mean age of presentation was 8±4 years. 5/63 (8%) were less than 3 years of age. Male to female ratio 2:1. The most common symptom was headache (20%), followed by vomiting (19%). Mean delay of 4±3.7 months from first symptom till surgery. 38% presented with metastatic disease, leptomeningeal spread being most common site (23%). Because of limitation of data and record availability only 47 out of 63 were risk stratified (75%) in which 19% were standard risk and 56% high risk. 42/63 patients (67%) received treatment at ICCH, remaining had advanced disease at presentation so left before treatment as family opted for supportive care at home. 23/42 (55%) completed treatment. 12/42 (29%) are alive, 8/42 (19%) are alive and on treatment at the time of analysis and remaining died due to relapse or progressive disease. Overall survival of entire cohort is 32% including abandonment and 48% without abandonment. Conclusion: Delay in the diagnosis leading to advance disease at presentation, poor socioeconomic status, lack of infrastructure and
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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.