How is treating a paediatric patient different from an adult?
- consider parents
- kids dont understand
- different dose limits and secondary malignancies
- tumour types different
- kids more at risk of late side effects
neurocognitive effects - muscle developement
What are the symptoms of medulloblastoma? (8)
- headaches
- nausea and vomitting in the morning
- problems with motor skills (clumsiness or poor handwriting)
- tiredness
- tilting of head to one side
- walking difficulty and balance problems
- back pain
- inability to control bladder and bowel
How do you diagnosis medulloblastoma?
- symptom history
- MRI with and without contrast
- lumbar puncture (to see if tumour has progressed down CNS)
- surgery/biopsy
- pathology report
What is the classification of high risk Medulloblastoma?
- <3 yrs at diagnosis
- tumour remaining following surgery is more than 1.5cm^2
- M1-4
What is M0-M4 classification of Medulloblastoma?
M0 - no evidence of mets M1 - tumour cells in the spinal fluid M2 - tumour spread within the brain M3 - tumour has spread to the spine M4 - tumour has spread away from brain or spine
What are the survival rates of Medulloblastoma?
- M0- 70-80%
- if disease has spread to spinal cord, SR 60%
- children under 3 often lower SR due to more aggressive disease
Who is involved in a paediatrics multi-disciplinary team?
- occupational therapists
- physiotherapists
- medical oncologists
- paediatric nurses
- GA team
- RT
- Dieticians
- Speech pathologists
- teacher
What is play therapy?
- play-based procedural support and preparation refers to a specific child life intervention that aims to promote the child’s coping with new and unfamiliar medical experiences
What does RT play therapy involve?
- delivery a social story by the OT
- practice making a mask and vacbag on toy or parent
- playing in the treatment room including using the controls
- watching parents on the monitor from outside the treatment room
- practice leaving the child in the room by themselves
What type of child is likely to require GA?
- children under 3
- behavioural issues
- compliance issue due to condition (e.g. posterior fossa syndrome)
What is posterior fossa syndrome?
- most commonly from surgery for posterior fossa tumours in paeds
- occurs in 8-24% cases
- absence of reduction in speech
- axial hypotonia and ataxia
- mild to completely disabling symptoms
What is GA is not an option?
- get the child to be very hungry then feed and then will fall into a deep sleep and then set up with straps
What was the old RT method of treating CNS?
- prone
- lateral skull fields
- single post spinal fields
- moving junction
What is the CT set-up of a CNS?
- supine
- full shell (mask)
- vacbag from head to pelvis
- knee bolster
- footstocks
What are some anatomical considerations when setting up a CNS?
- head tilt in neutral position with VBL = ITN to colmella
- spine straight and level
- arms are slighly anterior to spine
- shoulders should be level and relaxed inferil=oly
- no nappy as it effects pelvic tilt
Should paediatrics receive tattoos?
- prefer not as it is a traumatic reminder of experience
- can use point guards instead
- take a lot of measurements from landmarks
What is the prescription for low-risk Stratum W1?
- 15Gy/13# with boost up to 51Gy/30#
What is the prescription for standard-risk Stratum W2, S1, N1, N2?
- CSI 23.4Gy + cumulative primary site dose of 54Gy/30#
What is the prescription for high-risk Stratum W3, S2, N3?
- CSI 36-39.6Gy + cumulative primary site dose of 54Gy/30#
What are the treatment fields?
- 2x skull
- 2x upper spine
- 2x lower spine
Why is the whole spine treated with equal dose?
- to decrease the risk of abnormal growth by separate sections of the same vertebre causing serious back issues
What are some CSI planning challenges?
- treatment must start 36 days from surgery
- challenging and time consuming plan
- numerous challenging objectives for the optimiser
What is involved in the straightening and levelling of a CSI patient?
- length check from SSN to zifi and verify with marks on the bag
What image verification is needed?
- kV skull (0 action level)
- upper spine and lower spine (0.5mm action level)
