Objective: To study the effect of suf®cient energy intake, by means of the protocolized administration of nasogastric tube feeding, on the nutritional status of a child with cancer. Design: A comparative experimental study. Setting: Tertiary care at the Centre for Pediatric Oncology, South East Netherlands, University Hospital, Nijmegen. Subjects: Seven children, newly diagnosed with cancer, were included in the experimental study and all completed the trial period. Fourteen patients were included in the retrospective study. They were randomly chosen from a group of patients previously treated for a malignancy at our department and who had received naso-gastric tube feeding for at least 16 weeks. Intervention: Protocolized (experimental group) vs non-protocolized (retrospective group) administration of naso-gastric tube feeding over a period of 16 weeks. The main difference was the amount of tube feeding administered. In addition to energy from other foods, children in the experimental group received 106 AE 13% of their total daily energy requirements (TDER) by means of tube feeding, whereas children in the retrospective group had received 75 AE 24%. Main outcome measures: Weight as a percentage of weight for height according to the 50th percentile of a healthy reference population ideal weight. Results: Weight, expressed as a percentage of the ideal weight, increased signi®cantly in the experimental group (18.2 AE 8.4; P 0.01) and the retrospective study group (5.2 AE 7.3; P 0.001). However, the increase was statistically signi®cant in favour of the experimental group (P 0.003), in which all the children reached their ideal weight, compared to 21% in the retrospective group. Conclusion: Aggressive protocolized nutritional intervention during the intensive phase of anti-cancer treatment, in the form of naso-gastric tube feeding that provides the child's total daily energy requirements, results in considerable improvement in the nutritional status.
Three patients developed a Fanconi syndrome with impairment of glomerular function (endogenous creatinine clearance 30-60 ml/min per 1.73 m2) during and/or after treatment with ifosfamide according to the SIOP-MMT 84 protocol in which ifosfamide was given in a dose of 3000 mg/m2 every 4 weeks over a 10-month period. The need for early substitution therapy in patients with the Fanconi syndrome is stressed. The renal lesions in our patients were irreversible.
Liposomal daunorubicin (DaunoXome = DNX) has been used in 14 children with recurrent or progressive growing brain tumor. DNX was given as a 1-h intravenous infusion with a dose of 60 mg/m2, once every 4 weeks, up to a cumulative dose of 600 mg/m2. At 3-month intervals the tumor process was evaluated on MRI or CT scan. Tumor response and toxicity of DNX were recorded according to the WHO guidelines. In 6 of the children a response has been established: 2 had complete responses, of which one relapsed again after 3 months; in 3 children a partial response was found. Two children showed stable disease. In 6 children the tumors grew progressively. In all responding children a remarkable subjective response was found. The toxicity of DNX at this dose was mild with a mild bone marrow depression and a slight but certain cardiotoxicity in 3 children. For the whole group the left ventricular function decreased with 13.8%. In 1 child the DNX treatment was stopped because of a decrease of the shortening fraction to 20%. In 4 children some hair loss was observed at the end of the treatment. In 3 children mental depression occurred that was associated with the administration of DNX. DNX is a well-tolerated and effective drug in the treatment of slowly progressive or recurrent brain tumors in children.
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