Objective Langerhans cell histiocytosis (LCH) in pediatric patients presents with single‐system or multisystem disease. Accurate staging is essential for selecting the most appropriate therapy ranging from local surgery to chemotherapy. Methods A retrospective review was undertaken of reported fludeoxyglucose (FDG) positron emission tomography ‐ computed tomography (PET‐CT) scans performed in children with LCH from June 2006 to February 2017. Findings were compared with a reference standard of biopsy or informed clinical follow‐up. Results One hundred nine scans were performed in 33 patients (age 7 weeks to 18 years). Nineteen patients had single‐system, bone unifocal disease; seven patients had single‐system, bone multifocal disease; four patients had single‐system, skin unifocal disease; two patients had multisystem disease; and one patient had single‐system, lymph node disease. Twenty‐six scans were performed to stage biopsy‐proven LCH, and 83 scans were performed during follow‐up to assess treatment response or recurrence after therapy completion. At staging, FDG PET‐CT detected all sites of biopsy‐proven LCH (except where bone unifocal disease had been resected). There was one false‐positive thymic finding that resolved without therapy. The per‐patient false‐positive rate of FDG PET‐CT at staging was 4% (1/26). During follow‐up, five LCH recurrences and one case of progressive disease on therapy occurred, all positive on FDG PET‐CT. During follow‐up two patients had FDG PET‐CT scans with false‐positive findings and one patient with a magnetic resonance imaging false‐positive finding. The per‐scan false‐positive rate of FDG PET‐CT during follow‐up was 2% (2/83). Conclusions FDG PET‐CT is highly sensitive for the staging and follow‐up of pediatric patients with LCH, and has a very low false‐positive rate.
Background Presenting features, biology and outcome for childhood leukaemia are known to vary by ethnic origin, geographic location and socioeconomic group. This study aimed to compare presentation patterns, follow‐up and clinical outcomes in Indigenous and non‐Indigenous children with acute leukaemia in Australia, and to assess the impact of remoteness and area‐based socioeconomic disadvantage on outcome. Methods A retrospective review of children aged between 1 day and 18 years who were diagnosed with acute leukaemia in South Australia (SA), Northern Territory (NT) and Western Australia (WA) between 2009 and 2018 was performed. Data were collected from children treated at the Women's and Children's Hospital, Adelaide and Perth Children's Hospital. Results Analysis of 455 children treated for acute leukaemia showed that children from remote/very remote localities had inferior overall survival (p = .004). Five‐year overall survival was 91.7% (95% CI: 87.9–94.3%) for children with acute lymphoblastic leukaemia (ALL) and 69.8% (56.7–79.5%) for acute myeloid leukaemia (AML). A larger proportion of Indigenous children from SA/NT were diagnosed with AML compared to non‐Indigenous children (60.0% vs. 14.4%, p = .001). Indigenous children were less likely to be enrolled on clinical trials (34.5% vs. 53.1%, p = .03) and more likely to be lost to follow‐up (26.1% vs. 9.2%, p = .009). Conclusion Geographic remoteness of residence is associated with inferior overall survival for Australian children with leukaemia. Indigenous children with acute leukaemia suffer from disparities in outcomes. These findings provide evidence to guide national policy in supporting appropriate resource allocation to overcome the challenges faced by children within these groups.
Introduction:The Australian Bragg Centre for Proton Therapy and Research (ABCPTR) will be Australia's first proton beam therapy (PBT) facility. A model was developed to predict associated public hospital care requirements for patients during PBT, to facilitate resource planning for pediatric, adolescent and young adult (AYA), and adult public hospitals in South Australia. Methods: National incidence rates for specific cancer indications were obtained from the Australian Childhood Cancer Registry, Australian Institute of Health and Welfare and published data. Australian Bureau of Statistics national population projections were used to estimate new cases in 2025 and beyond. Radiation oncologists and pediatric oncologists from the Central Adelaide Local and Women's and Children's Health Network, along with international colleagues, provided guidance on chemotherapy utilization and inpatient admission estimates. Results: It was estimated 180 patients (40.4%) within the adult population (≥25 years)and 265 patients (59.6%) within the pediatric/AYA population (<25 years) would be eligible for PBT in 2025. There was no indication adult cancers would require concurrent outpatient/inpatient chemotherapy, in contrast with pediatric and AYA patients (59.5% and 62.8% outpatient and 18.9% and 41.9% inpatient, respectively). It was estimated 53% and 29% of pediatric and AYA patients could require inpatient admission for toxicity related to disease, concurrent chemotherapy or PBT. Conclusion:Associated public hospital care requirements related to the delivery of a national PBT service were estimated. This has particular implications for planning of the new Women's and Children's hospital, co-located with the ABCPTR. True data accuracy will be determined on future data generation and analysis.
Aim To identify barriers in the understanding and provision of optimal palliative care to Aboriginal children with cancer by health‐care staff, with the aim to support education and training that highlights the importance of cultural, physical and spiritual needs at end‐of‐life. Methods Medical and nursing staff working in Departments of Palliative Care, Metabolic Medicine and Haematology/Oncology at the Women's and Children's Hospital in Adelaide, South Australia, were asked to complete a survey regarding their experience in treating Aboriginal children receiving palliative care. The survey addressed the understanding of cultural and spiritual needs, barriers encountered and opinions for improved services. Results The survey was completed by 34 participants. 91.2% (n = 31) had provided care to Aboriginal children who were receiving care during palliative and end‐of‐life phases for a diagnosis of cancer, 58.8% (n = 20) of which had supported children returning home. Only 23.5% of participants reported comfort in communicating about spiritual/cultural needs with patients and families. There was minimal previous exposure to education (17.6%), yet all participants were interested in future education opportunities. Conclusion This study highlights a paucity in understanding and comfort among health‐care workers in treating Aboriginal children at end‐of‐life. New models, including the training of staff, educational resources and involvement of Aboriginal health‐care workers, may improve care.
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