Background Chest computed tomography (CT) findings in children with coronavirus disease 2019 (COVID-19) have been rarely reported in a comprehensive and systematic manner. Objective We investigated the chest CT findings in children with COVID-19, and explored the differences in these findings between symptomatic patients and asymptomatic patients. Materials and methods Demographic findings, clinical characteristics, duration of hospital stay and viral shedding, and chest CT findings in 201 children infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) were retrospectively analyzed from January 15 to March 20, 2020, and divided into two groups: symptomatic group (n=136) and asymptomatic group (n=65). Chi-square test and Student’s t-test were used for statistical analysis. Results Symptomatic patients were mainly young children ≤3 years old (54/63, 86%),while asymptomatic patients were mainly children ≥ 6 years old (51/111, 46%). Fever (41%) and cough (41%) were the most common symptoms. Overall, 119/201 (59%) patients had chest CT findings, and symptomatic patients accounted for 82% (98/119). The CT findings presented as bilateral multiple lesions (60/119, 50.4%), ground-glass opacities (83/119, 70%) and/or consolidation (44/119, 37%) with a peripheral and subpleural distribution (62/83, 75%). Fifteen of 87 (7.2%) patients with lung lesions showed complete lesion absorption, and 42/87 (48%) improved within a mean of 9.1 (standard deviation [SD] 3.2) days. The mean duration of viral shedding was 8.7 (SD 4.9) days. Pleural effusion was very rare. No lymphadenopathy was found in either group. Conclusion Symptoms associated with pulmonary involvement were most common in infants and young children. The lung lesions of most patients were absorbed and improved in about 9 days.
Intra-operative (IORT) or brachytherapy boost is utilized at our institution to facilitate sparing of critical vessels, nerves, or bone when tumor is expected to be adherent at the time of resection (expected R1). This analysis evaluates outcomes and factors associated with local control (LC) and survival in a cohort of patients who underwent aggressive multimodality therapy for NSTS. Materials/Methods: All pediatric patients (<18) with biopsy proven NSTS, diagnosed from 10/1990-1/2018, who received radiation (RT) at our institution were retrospectively identified using the radiation oncology database. Survival analyses were conducted using the Kaplan Meier method, using a statistical discovery tool software Overall survival (OS) analysis was performed on newly diagnosed, localized patients. Local relapse free survival (LRFS) analysis included all patients treated with curative intent. Univariate analyses were conducted to identify factors associated with survival. Secondary malignancies were considered RT associated if they arose in a previously irradiated field. Results: 41 patients representing 13 histologic diagnoses were identified. Synovial, epithelioid, spindle cell, pleomorphic, and fibrosarcoma were the most common subtypes. At presentation, 2 patients had node positive disease, and 6 had metastases (3 of whom had recurrent disease). 38/41 (93%) patients underwent surgical resection with a negative margin achieved in 28/38 (74%), and 17/41 (66%) received chemotherapy. All patients received EBRT (mean EQD2 52.4 Gy), and 17/41 (41%) received an IORT or brachytherapy boost (median 12 Gy, range 5.4-20 Gy). One patient received palliative RT only, and was excluded from subsequent analyses. Median follow up was 7.25 years (range 117 days e 26.6 years). OS at 2, 5, and 10 years was 88.0% AE5.7%, 84.7% AE6.3%, and 84.7% AE6.3%, respectively. On univariate analysis, abdominal location and positive margins were associated with worse OS. Age, histology, T-stage, tumor size (<5cm vs >5cm), +/-chemotherapy, +/-boost, or secondary cancers were not associated with OS or EFS. LRFS was 94.9% AE3.5% at 1 year, and 89.5% AE5.0% at 2 years. All 4 local failures occurred within 2 years (3 R0, 1 R1 resection). 2 year LRFS was 100% and 80.7% (pZ0.06), for IORT or brachytherapy boost vs no boost, respectively. 4 RT associated secondary malignancies were observed in 3 patients resulting in one patient death with mean time to diagnosis of 11.2 years. 4 non-RT associated secondary cancers were observed in 3 patients, all of whom received chemotherapy, with mean time to diagnosis of 9.6 years. Conclusion: IORT or brachytherapy boost may be associated with improved LC in pediatric NSTS. Aggressive multimodality management results in 2 year LC approaching 90% (boost LC 100 %). Secondary cancers appear to be prevalent in this population, including a notable rate of non-RT associated tumors.
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