Background:
Retinoblastoma (RB) is the most common primary intraocular malignancy of childhood. Magnetic resonance imaging (MRI) of the orbit and brain is the preferred imaging modality to diagnose and define extent of disease as well as to assess response to therapy. Sometimes, it may be difficult to differentiate the presence of active residual disease from therapy-related changes based on posttreatment completion MRI.
Materials and Methods:
RB patients who completed treatment between January 2017 and October 2019 were retrospectively analyzed. We evaluated the utility of F-18-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) to predict active disease in RB patients who continued to have residual disease on MRI at completion of treatment.
Results:
Out of the 89 patients who completed treatment, dilemma regarding remission status was present in 11 children. All 11 patients underwent FDG-PET-CT. None of them had evidence of metabolically active disease in the orbit, optic nerve, brain, or rest of the body. After a median follow-up of 24 months, no children developed any evidence of disease progression in the form of local or distant relapse.
Conclusion:
Our results showed that in MRI doubtful cases, a nonavid FDG-PET is reassuring in avoiding further therapy as long as close follow-up can be ensured. FDG-PET-CT may emerge as a useful functional modality to predict disease activity in RB.
Background: Data of neurocognitive deficits in survivors of acute lymphoblastic leukemia (ALL) is scarce from low middle-income countries (LMICs), and is influenced by biological and cultural variations. The objective of this study was to assess the prevalence and spectrum of neurocognitive deficits in a cohort of survivors from India.Procedure: Seventy survivors of childhood ALL were evaluated for neurocognitive deficits by the Indian adaptation of Wechsler Intelligence Scale for Children -Fourth Edition (WISC-IV INDIA ). The prevalence of neurocognitive deficits was calculated based on the full-scale intelligence quotient (FSIQ), and scores in discrete domains like verbal comprehension, perceptual reasoning, working memory, and processing speed were calculated and compared to demographics, treatment, and sociocultural factors.
Results:The mean (SD) current age and time since diagnosis was 10.5 (±3.2) years and 5 (±2.8) years, respectively. The mean FSIQ was 86.1 ± 20.5, with significant neurocognitive deficit (FSIQ <90) being prevalent in 50% (95% CI: 38%-62%) of the cohort. The proportion of survivors with deficits in individual domains of verbal comprehension, perceptual reasoning, working memory, and processing speed were 49%, 50%, 47%, and 44%, respectively. The odds of having neurocognitive deficits were higher when a child belonged to lower socioeconomic strata (OR 5.7, p = .004), parents with lower education attainment (OR 4.3, p = .041), and whose birth order was higher (OR 20.1, p = .005). Age at diagnosis/assessment, chemotherapy received, or dose of radiotherapy did not have a direct impact on neurocognition.Conclusions and relevance: Rates of neurocognitive deficits are higher in survivors in LMICs, with socioeconomic variables contributing more than the direct neurotoxic effects of treatment.
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