Sophia Schermerhorn

403 timestamped statements across 10 topics — auto-found in recorded discussions, each timestamp jumps to the exact moment.

Liver Tumors (Hepatoblastoma/HCC) · guest expert Neuroblastoma · guest expert Sarcoma (Ewing/Rhabdo) · guest expert Single Ventricle / HLHS · episode host Soft Tissue Sarcoma (lymph nodes) · guest expert Wilms Tumor · episode host

Featured statements

▶ Ep 2 · 0:57
This pattern suggests that solitary pulmonary relapse may represent a biologically more favorable type of recurrence, one that's more amenable to achieving meaningful local control, with metacystectomy playing an important role as part of multimodal therapy.
quote · Ewing Sarcoma
▶ Ep 14 · 0:55
The key takeaways long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation. This means that the surgical strategy can really be focused on oncologic control.
quote · Hepatoblastoma
▶ Ep 25 · 0:41
The presence of an IDRF doesn't mean that a tumor can't be resected, but it does signal that the surgery may be technically more complex, and patients often receive neoadjuvant therapy first to try to shrink the tumor.
quote · Neuroblastoma
▶ Ep 640 · 0:56
The takeaway image-guided percutaneous biopsy is safe, accurate, and should be strongly considered the diagnostic modality of choice for pediatric bone and soft tissue tumors.
quote · Pediatric Oncology
▶ Ep 12 · 0:28
Children who received cisplatin as part of their salvage therapy had a much better survival than those who did not, about 80% compared to 25%.
quote · Hepatoblastoma
▶ Ep 13 · 0:55
ICG is a valuable tool that can help increase confidence in achieving a complete resection for both primary and metastatic hepatoblastoma.
quote · Liver Tumors (Hepatoblastoma/HCC)

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Sophia's statements about Common Pediatric Surgical Conditions 12 statements

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Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients

▶ Ep 3 · 0:00
quote So just how accurate is ICG for detecting sentinel lymph nodes in pediatric oncology? ↗
▶ Ep 3 · 0:05
clinical The study was a multi-center prospective study conducted by PeaceOC evaluating indocyanine green (ICG) for identifying sentinel lymph nodes in pediatric patients with skin and soft tissue malignancies ↗
▶ Ep 3 · 0:21
clinical Peritumoral injection of ICG demonstrated almost 80% sensitivity for detecting a sentinel node ↗
▶ Ep 3 · 0:28
quote all sentinel nodes that contained malignancy were ICG avid ↗
▶ Ep 3 · 0:28
clinical All sentinel nodes that contained malignancy were ICG avid ↗
▶ Ep 3 · 0:33
opinion ICG may outperform blue dye localization based on previously reported literature ↗
▶ Ep 3 · 0:33
clinical ICG diagnostic performance is similar to smaller pediatric studies previously evaluating ICG and sentinel lymph node biopsy ↗
▶ Ep 3 · 0:45
clinical The study did not directly compare the effectiveness of ICG to blue dye localization ↗
▶ Ep 3 · 0:49
clinical ICG in most cases was used in conjunction with standard localization techniques such as technetium ↗
▶ Ep 3 · 0:58
clinical No adverse reactions to ICG were identified within 30 days of surgery ↗
▶ Ep 3 · 1:02
opinion ICG has a favorable safety profile and lacks the permanent tattooing associated with blue dye, making it an attractive visualization adjunct for pediatric sentinel lymph node biopsy ↗
▶ Ep 3 · 1:02
clinical Blue dye can cause permanent tattooing ↗
Sophia's statements about Ewing Sarcoma 13 statements

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Current management of pulmonary relapse in Ewing sarcoma: A report from the Pediatric Surgical Oncology Research Collaborative

▶ Ep 2 · 0:05
clinical Writer et al. published a multi-center retrospective study in the Journal of Pediatric Surgery through PeaceSOC in 2024 ↗
▶ Ep 2 · 0:07
clinical PeaceSOC is a network of over 50 centers in North America that work together to improve outcomes in pediatric surgical oncology ↗
▶ Ep 2 · 0:20
clinical The study examined patients less than 22 years old with initially localized Ewing sarcoma who developed first pulmonary relapse between 2007 and 2020 across 19 different centers ↗
▶ Ep 2 · 0:32
epidemiological Among 33 patients studied, about 2/3 had relapse limited to the lungs ↗
▶ Ep 2 · 0:32
epidemiological Nearly half of patients with lung-limited relapse had just a solitary pulmonary nodule ↗
▶ Ep 2 · 0:39
epidemiological Patients with solitary pulmonary nodule had the highest overall three-year survival at 73% ↗
▶ Ep 2 · 0:39
clinical Patients with solitary pulmonary nodule were more likely to undergo metastasectomy and whole lung radiation ↗
▶ Ep 2 · 0:50
epidemiological Three-year survival for patients with extrapulmonary disease was 23% ↗
▶ Ep 2 · 0:50
epidemiological Three-year survival for patients with multiple nodules was 40% ↗
▶ Ep 2 · 0:57
opinion Solitary pulmonary relapse is more amenable to achieving meaningful local control ↗
▶ Ep 2 · 0:57
opinion Solitary pulmonary relapse may represent a biologically more favorable type of recurrence ↗
▶ Ep 2 · 0:57
opinion Metastasectomy plays an important role as part of multimodal therapy for solitary pulmonary relapse in Ewing sarcoma ↗
▶ Ep 2 · 0:57
quote This pattern suggests that solitary pulmonary relapse may represent a biologically more favorable type of recurrence, one that's more amenable to achieving meaningful local control, with metacystectomy playing an important role as part of multimodal therapy. ↗
Sophia's statements about Hepatoblastoma 41 statements

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Early Postoperative Fever in Pediatric Oncology Patients Undergoing Solid Tumor Resection

▶ Ep 11 · 0:00
quote Your patients post-op day one from a hepatoblastoma resection, and they spike a fever. Do you think they need a big fever workup? ↗
▶ Ep 11 · 0:12
epidemiological 42% of 220 oncology patients had a fever in the 48 hours following tumor resection ↗
▶ Ep 11 · 0:19
clinical The two patients with actual infection were hemodynamically unstable with positive blood cultures ↗
▶ Ep 11 · 0:19
epidemiological Only 2 of the febrile patients (2.8%) had an actual infection ↗
▶ Ep 11 · 0:30
epidemiological About a third of patients received empiric antibiotics that they did not need ↗
▶ Ep 11 · 0:30
epidemiological Most fevers triggered a workup that costs on average about $500 per patient ↗
▶ Ep 11 · 0:39
quote So here's the big takeaway. In the 48 hours following a tumor resection, a fever alone may not be a reason to panic. ↗
▶ Ep 11 · 0:40
opinion In the 48 hours following tumor resection, fever alone may not be a reason to panic ↗
▶ Ep 11 · 0:45
guideline Extensive workup should be reserved for patients who are hemodynamically unstable or have more overt signs of infection ↗

Retreatment with Cisplatin May Provide a Survival Advantage for Children with Relapsed/Refractory Hepatoblastoma: An Institutional Experience

▶ Ep 12 · 0:12
quote In relapse hepatoblastoma, there's no established standard salvage therapy regimen. ↗
▶ Ep 12 · 0:12
guideline There is no established standard salvage therapy regimen for relapsed hepatoblastoma ↗
▶ Ep 12 · 0:17
epidemiological The Cincinnati Children's retrospective review of 30 patients represents one of the largest published cohorts evaluating patients with refractory or recurrent hepatoblastoma ↗
▶ Ep 12 · 0:25
clinical The overall survival for the cohort was about 50% ↗
▶ Ep 12 · 0:28
clinical Children who received cisplatin as part of their salvage therapy had survival of about 80% compared to 25% for those who did not receive cisplatin ↗
▶ Ep 12 · 0:28
quote Children who received cisplatin as part of their salvage therapy had a much better survival than those who did not, about 80% compared to 25%. ↗
▶ Ep 12 · 0:36
opinion The improved survival outcomes with cisplatin may be due to persistent platinum sensitivity or better tumor biology rather than proving causality ↗
▶ Ep 12 · 0:49
clinical Most patients underwent additional surgery as part of their salvage therapy, either liver resection, liver transplant, or pulmonary metastasectomy ↗
▶ Ep 12 · 0:57
quote This highlights that salvage therapy is multimodal. ↗
▶ Ep 12 · 0:57
clinical Salvage therapy for relapsed hepatoblastoma is multimodal ↗
▶ Ep 12 · 0:59
opinion Cisplatin retreatment should be balanced with the risk of cumulative toxicity ↗

Indocyanine green is a sensitive adjunct in the identification and surgical management of local and metastatic hepatoblastoma

▶ Ep 13 · 0:00
quote Are you actually seeing all the hepatoblastoma during your resection? ↗
▶ Ep 13 · 0:12
clinical This is a single institution retrospective review of patients who received ICG prior to either pulmonary metastatectomy or liver resection for hepatoblastoma ↗
▶ Ep 13 · 0:22
clinical ICG was highly sensitive for detecting hepatoblastoma, about 90% ↗
▶ Ep 13 · 0:27
clinical In a meaningful number of cases, ICG was able to detect tumor deposits that were not visible, palpable, or detectable on preoperative imaging ↗
▶ Ep 13 · 0:39
clinical Specificity was lower than sensitivity with false positives ↗
▶ Ep 13 · 0:43
clinical False positives often represented vascular changes or inflammation ↗
▶ Ep 13 · 0:46
clinical There were no adverse outcomes associated with any of the additional resections guided by ICG ↗
▶ Ep 13 · 0:50
clinical ICG was effective in both open and minimally invasive surgery ↗
▶ Ep 13 · 0:50
clinical ICG was effective in both relapse and primary disease ↗
▶ Ep 13 · 0:55
quote ICG is a valuable tool that can help increase confidence in achieving a complete resection for both primary and metastatic hepatoblastoma. ↗

Quality of Life Outcomes for Patients Who Underwent Conventional Resection and Liver Transplantation for Locally Advanced Hepatoblastoma

▶ Ep 14 · 0:18
opinion Long-term quality of life is becoming a more important outcome as hepatoblastoma survival improves. ↗
▶ Ep 14 · 0:18
epidemiological Survival for hepatoblastoma continues to improve. ↗
▶ Ep 14 · 0:24
clinical This is a single institution cross-sectional study using validated pediatric quality of life surveys to evaluate long-term survivors of hepatoblastoma. ↗
▶ Ep 14 · 0:31
clinical There was no significant difference in emotional, social, physical, or school functioning outcomes between transplant and resection groups. ↗
▶ Ep 14 · 0:31
clinical Overall quality of life outcomes were similar between liver transplant and resection groups for hepatoblastoma. ↗
▶ Ep 14 · 0:39
quote This challenges the assumption that liver transplantation necessarily leads to a worse. Long-term quality of life. ↗
▶ Ep 14 · 0:47
clinical Patients who underwent resection had lower overall procedure anxiety scores than transplant patients. ↗
▶ Ep 14 · 0:53
clinical The finding of lower procedural anxiety in resection patients was mirrored in the parents' surveys. ↗
▶ Ep 14 · 0:55
quote The key takeaways long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation. This means that the surgical strategy can really be focused on oncologic control. ↗
▶ Ep 14 · 0:55
clinical Long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation for hepatoblastoma. ↗
▶ Ep 14 · 1:02
opinion Surgical strategy for hepatoblastoma can be focused on oncologic control given comparable quality of life outcomes. ↗
Sophia's statements about High-risk Neuroblastoma 15 statements

Open the High-risk Neuroblastoma collection →

Pancreas, Muscle, and Subcutaneous Fat Atrophy in Patients Undergoing Radiation for Neuroblastoma

▶ Ep 4 · 0:00
quote So, we know radiation improves survival in high-risk neuroblastoma, but what does it do to the rest of the body? ↗
▶ Ep 4 · 0:00
clinical Radiation improves survival in high-risk neuroblastoma ↗
▶ Ep 4 · 0:13
clinical This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy ↗
▶ Ep 4 · 0:19
clinical The authors use CT and MRI body segmentation to measure pancreatic volume, subcutaneous fat, and muscle area before and after treatment ↗
▶ Ep 4 · 0:27
clinical There was a significant decrease in pancreatic volume after radiation ↗
▶ Ep 4 · 0:31
clinical Pancreatic insufficiency wasn't systematically screened for in this study ↗
▶ Ep 4 · 0:31
clinical Very few patients developed clinically apparent pancreatic insufficiency ↗
▶ Ep 4 · 0:31
opinion Follow-up may not be long enough to detect pancreatic effects, especially given the young average age of these patients ↗
▶ Ep 4 · 0:43
opinion Pancreatic dysfunction could be an under-recognized late effect ↗
▶ Ep 4 · 0:43
quote So this raises concern that pancreatic dysfunction could be an Recognized late effect. ↗
▶ Ep 4 · 0:48
clinical Patients had a significant drop in weight percentile with smaller decreases in fat and muscle ↗
▶ Ep 4 · 0:48
opinion Body composition changes likely reflect the overall impact of cancer therapy overall rather than radiation alone ↗
▶ Ep 4 · 0:48
opinion These findings highlight the importance of nutritional screening during cancer treatments ↗
▶ Ep 4 · 1:03
quote So, as survival improves, understanding and screening for these long-term effects is becoming just as important as curing the cancer itself. ↗
▶ Ep 4 · 1:03
opinion As survival improves, understanding and screening for long-term effects is becoming just as important as curing the cancer itself ↗
Sophia's statements about Liver Tumors (Hepatoblastoma/HCC) 42 statements

Open the Liver Tumors (Hepatoblastoma/HCC) collection →

Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma

▶ Ep 11 · 0:03
quote How much does a child's social factors influence their chance of surviving cancer? ↗
▶ Ep 11 · 0:12
epidemiological Study was a retrospective analysis of 12,000 patients with neuroblastoma, Wilms tumor, and hepatoblastoma from the National Cancer Database ↗
▶ Ep 11 · 0:20
epidemiological Socioeconomic disadvantage score was created for each patient based on median household income and education level in their local communities ↗
▶ Ep 11 · 0:31
epidemiological The most disadvantaged children were more likely to have worse survival for Wilms tumor and neuroblastoma ↗
▶ Ep 11 · 0:37
epidemiological After adjusting for tumor size, grade, treatment, and comorbidities, socioeconomic effects on survival remained present ↗
▶ Ep 11 · 0:44
epidemiological Hazard ratio for socioeconomic disadvantage was 1.29 for hepatoblastoma ↗
▶ Ep 11 · 0:44
epidemiological Hazard ratio for socioeconomic disadvantage was 2.02 for Wilms tumor ↗
▶ Ep 11 · 0:51
opinion Pediatric oncology outcomes depend on tumor biology, treatment received, and social determinants of health ↗
▶ Ep 11 · 0:51
quote Pediatric oncology outcomes aren't just about tumor biology or treatment received. It's about the social determinants of health for these children as well. ↗
▶ Ep 11 · 1:00
opinion Identifying socioeconomic risk factors is necessary to close equity gaps and improve survival for all children with solid tumors ↗

Retreatment with Cisplatin May Provide a Survival Advantage for Children with Relapsed/Refractory Hepatoblastoma: An Institutional Experience

▶ Ep 12 · 0:12
quote In relapse hepatoblastoma, there's no established standard salvage therapy regimen. ↗
▶ Ep 12 · 0:12
guideline There is no established standard salvage therapy regimen for relapsed hepatoblastoma ↗
▶ Ep 12 · 0:17
epidemiological The Cincinnati Children's retrospective review of 30 patients represents one of the largest published cohorts evaluating patients with refractory or recurrent hepatoblastoma ↗
▶ Ep 12 · 0:25
clinical The overall survival for the cohort was about 50% ↗
▶ Ep 12 · 0:28
quote Children who received cisplatin as part of their salvage therapy had a much better survival than those who did not, about 80% compared to 25%. ↗
▶ Ep 12 · 0:28
clinical Children who received cisplatin as part of their salvage therapy had survival of about 80% compared to 25% for those who did not receive cisplatin ↗
▶ Ep 12 · 0:36
opinion The improved survival outcomes with cisplatin may be due to persistent platinum sensitivity or better tumor biology rather than proving causality ↗
▶ Ep 12 · 0:49
clinical Most patients underwent additional surgery as part of their salvage therapy, either liver resection, liver transplant, or pulmonary metastasectomy ↗
▶ Ep 12 · 0:57
clinical Salvage therapy for relapsed hepatoblastoma is multimodal ↗
▶ Ep 12 · 0:57
quote This highlights that salvage therapy is multimodal. ↗
▶ Ep 12 · 0:59
opinion Cisplatin retreatment should be balanced with the risk of cumulative toxicity ↗

Indocyanine green is a sensitive adjunct in the identification and surgical management of local and metastatic hepatoblastoma

▶ Ep 13 · 0:00
quote Are you actually seeing all the hepatoblastoma during your resection? ↗
▶ Ep 13 · 0:12
clinical This is a single institution retrospective review of patients who received ICG prior to either pulmonary metastatectomy or liver resection for hepatoblastoma ↗
▶ Ep 13 · 0:22
clinical ICG was highly sensitive for detecting hepatoblastoma, about 90% ↗
▶ Ep 13 · 0:27
clinical In a meaningful number of cases, ICG was able to detect tumor deposits that were not visible, palpable, or detectable on preoperative imaging ↗
▶ Ep 13 · 0:39
clinical Specificity was lower than sensitivity with false positives ↗
▶ Ep 13 · 0:43
clinical False positives often represented vascular changes or inflammation ↗
▶ Ep 13 · 0:46
clinical There were no adverse outcomes associated with any of the additional resections guided by ICG ↗
▶ Ep 13 · 0:50
clinical ICG was effective in both relapse and primary disease ↗
▶ Ep 13 · 0:50
clinical ICG was effective in both open and minimally invasive surgery ↗
▶ Ep 13 · 0:55
quote ICG is a valuable tool that can help increase confidence in achieving a complete resection for both primary and metastatic hepatoblastoma. ↗

Quality of Life Outcomes for Patients Who Underwent Conventional Resection and Liver Transplantation for Locally Advanced Hepatoblastoma

▶ Ep 14 · 0:18
epidemiological Survival for hepatoblastoma continues to improve. ↗
▶ Ep 14 · 0:18
opinion Long-term quality of life is becoming a more important outcome as hepatoblastoma survival improves. ↗
▶ Ep 14 · 0:24
clinical This is a single institution cross-sectional study using validated pediatric quality of life surveys to evaluate long-term survivors of hepatoblastoma. ↗
▶ Ep 14 · 0:31
clinical There was no significant difference in emotional, social, physical, or school functioning outcomes between transplant and resection groups. ↗
▶ Ep 14 · 0:31
clinical Overall quality of life outcomes were similar between liver transplant and resection groups for hepatoblastoma. ↗
▶ Ep 14 · 0:39
quote This challenges the assumption that liver transplantation necessarily leads to a worse. Long-term quality of life. ↗
▶ Ep 14 · 0:47
clinical Patients who underwent resection had lower overall procedure anxiety scores than transplant patients. ↗
▶ Ep 14 · 0:53
clinical The finding of lower procedural anxiety in resection patients was mirrored in the parents' surveys. ↗
▶ Ep 14 · 0:55
clinical Long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation for hepatoblastoma. ↗
▶ Ep 14 · 0:55
quote The key takeaways long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation. This means that the surgical strategy can really be focused on oncologic control. ↗
▶ Ep 14 · 1:02
opinion Surgical strategy for hepatoblastoma can be focused on oncologic control given comparable quality of life outcomes. ↗
Sophia's statements about Neuroblastoma 63 statements

Open the Neuroblastoma collection →

Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma

▶ Ep 22 · 0:03
quote How much does a child's social factors influence their chance of surviving cancer? ↗
▶ Ep 22 · 0:12
epidemiological Study was a retrospective analysis of 12,000 patients with neuroblastoma, Wilms tumor, and hepatoblastoma from the National Cancer Database ↗
▶ Ep 22 · 0:20
epidemiological Socioeconomic disadvantage score was created for each patient based on median household income and education level in their local communities ↗
▶ Ep 22 · 0:31
epidemiological The most disadvantaged children were more likely to have worse survival for Wilms tumor and neuroblastoma ↗
▶ Ep 22 · 0:37
epidemiological After adjusting for tumor size, grade, treatment, and comorbidities, socioeconomic effects on survival remained present ↗
▶ Ep 22 · 0:44
epidemiological Hazard ratio for socioeconomic disadvantage was 2.02 for Wilms tumor ↗
▶ Ep 22 · 0:44
epidemiological Hazard ratio for socioeconomic disadvantage was 1.29 for hepatoblastoma ↗
▶ Ep 22 · 0:51
quote Pediatric oncology outcomes aren't just about tumor biology or treatment received. It's about the social determinants of health for these children as well. ↗
▶ Ep 22 · 0:51
opinion Pediatric oncology outcomes depend on tumor biology, treatment received, and social determinants of health ↗
▶ Ep 22 · 1:00
opinion Identifying socioeconomic risk factors is necessary to close equity gaps and improve survival for all children with solid tumors ↗

Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma

▶ Ep 23 · 0:00
quote Did you know there's an ERAS protocol for neuroblastoma? ↗
▶ Ep 23 · 0:03
clinical A multi-center prospective study evaluated a structured ERAS pathway for children undergoing abdominal neuroblastoma resection ↗
▶ Ep 23 · 0:13
clinical The ERAS protocol included 20 evidence-based elements spanning the entire perioperative process ↗
▶ Ep 23 · 0:13
clinical ERAS protocol elements included preoperative counseling, hydrate loading, standardized multimodal analgesia, early feeding, and early mobilization ↗
▶ Ep 23 · 0:27
quote The results were striking. ↗
▶ Ep 23 · 0:28
clinical Length of stay decreased from about 7 days to 3.7 days ↗
▶ Ep 23 · 0:32
clinical Post-operative opioid use dropped by over half ↗
▶ Ep 23 · 0:32
clinical Patients resumed regular diets and ambulated about 3 days earlier ↗
▶ Ep 23 · 0:39
clinical The proportion of patients experiencing any postoperative complication decreased by over 50% ↗
▶ Ep 23 · 0:46
clinical Patients were cleared to resume adjuvant chemotherapy earlier at around 8 days as opposed to 10 days ↗
▶ Ep 23 · 0:51
opinion ERAS represents a tangible opportunity to standardize perioperative care for neuroblastoma resection ↗
▶ Ep 23 · 0:51
opinion A structured ERAS pathway meaningfully improves recovery even after complex neuroblastoma resections ↗

Long-Term Follow-Up of Surgical Outcomes for Patients With Wilms Tumor and Neuroblastoma

▶ Ep 24 · 0:00
quote You just surgically treated your patient with Wilms tumor or neuroblastoma. Now what? ↗
▶ Ep 24 · 0:11
epidemiological This single institution cohort followed survivors for a mean of 27 years after open oncologic resection for Wilms tumor and neuroblastoma ↗
▶ Ep 24 · 0:20
epidemiological 14% of patients required a repeat laparotomy ↗
▶ Ep 24 · 0:21
clinical The most common indications for repeat laparotomy were small bowel obstruction or tumor recurrence ↗
▶ Ep 24 · 0:26
clinical In Wilms tumor, obstruction typically occurred within the first year ↗
▶ Ep 24 · 0:29
clinical In neuroblastoma, obstruction often developed more than a decade later, well beyond routine follow-up ↗
▶ Ep 24 · 0:34
clinical Radiation dose was not associated with re-operation risk ↗
▶ Ep 24 · 0:37
clinical Hypertension after nephrectomy was not increased compared to population norms ↗
▶ Ep 24 · 0:37
epidemiological Secondary malignancy was uncommon in this cohort ↗
▶ Ep 24 · 0:45
epidemiological Scoliosis occurred in roughly 10 to 13% of patients, higher than the general population ↗
▶ Ep 24 · 0:45
clinical Scoliosis has multi-factorial contributors including surgery and possibly radiation ↗
▶ Ep 24 · 0:55
quote The takeaway is that surgical care does not end at resection. ↗
▶ Ep 24 · 0:58
guideline Even decades after treatment, these patients remain at risk for late complications that warrant long-term counseling and follow-up ↗

The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report

▶ Ep 25 · 0:00
clinical IDRFs are necessary knowledge for clinicians treating neuroblastoma to determine safety of surgical intervention ↗
▶ Ep 25 · 0:00
quote If you're someone who treats neuroblastoma, you need to know about IDRFs to know whether it's safe to go to the operating room. ↗
▶ Ep 25 · 0:14
quote IDRFs are imaging findings on CT or MRIs that predict when a neuroblastoma may be difficult or dangerous to remove surgically. ↗
▶ Ep 25 · 0:14
clinical IDRFs are imaging findings on CT or MRI that predict when neuroblastoma may be difficult or dangerous to remove surgically ↗
▶ Ep 25 · 0:21
guideline The IDRF concept was first introduced in 2009 by the International Neuroblastoma Risk Group ↗
▶ Ep 25 · 0:21
guideline The International Neuroblastoma Risk Group defined 20 specific imaging risk factors ↗
▶ Ep 25 · 0:29
clinical Most IDRFs relate to how the tumor interacts with critical anatomy ↗
▶ Ep 25 · 0:34
clinical In the abdomen, a tumor that infiltrates the portahepati or hepatoduodenal ligament is considered to contain an IDRF ↗
▶ Ep 25 · 0:41
clinical The presence of an IDRF does not mean a tumor cannot be resected ↗
▶ Ep 25 · 0:41
clinical Patients with IDRFs often receive neoadjuvant therapy first to try to shrink the tumor ↗
▶ Ep 25 · 0:41
clinical IDRF presence signals that surgery may be technically more complex ↗
▶ Ep 25 · 0:41
quote The presence of an IDRF doesn't mean that a tumor can't be resected, but it does signal that the surgery may be technically more complex, and patients often receive neoadjuvant therapy first to try to shrink the tumor. ↗
▶ Ep 25 · 0:52
clinical Surgeons use IDRFs to predict surgical risk and guide the safest treatment approach using imaging ↗

Pancreas, Muscle, and Subcutaneous Fat Atrophy in Patients Undergoing Radiation for Neuroblastoma

▶ Ep 26 · 0:00
quote So, we know radiation improves survival in high-risk neuroblastoma, but what does it do to the rest of the body? ↗
▶ Ep 26 · 0:00
clinical Radiation improves survival in high-risk neuroblastoma ↗
▶ Ep 26 · 0:13
clinical This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy ↗
▶ Ep 26 · 0:19
clinical The authors use CT and MRI body segmentation to measure pancreatic volume, subcutaneous fat, and muscle area before and after treatment ↗
▶ Ep 26 · 0:27
clinical There was a significant decrease in pancreatic volume after radiation ↗
▶ Ep 26 · 0:31
opinion Follow-up may not be long enough to detect pancreatic effects, especially given the young average age of these patients ↗
▶ Ep 26 · 0:31
clinical Pancreatic insufficiency wasn't systematically screened for in this study ↗
▶ Ep 26 · 0:31
clinical Very few patients developed clinically apparent pancreatic insufficiency ↗
▶ Ep 26 · 0:43
quote So this raises concern that pancreatic dysfunction could be an Recognized late effect. ↗
▶ Ep 26 · 0:43
opinion Pancreatic dysfunction could be an under-recognized late effect ↗
▶ Ep 26 · 0:48
clinical Patients had a significant drop in weight percentile with smaller decreases in fat and muscle ↗
▶ Ep 26 · 0:48
opinion Body composition changes likely reflect the overall impact of cancer therapy overall rather than radiation alone ↗
▶ Ep 26 · 0:48
opinion These findings highlight the importance of nutritional screening during cancer treatments ↗
▶ Ep 26 · 1:03
quote So, as survival improves, understanding and screening for these long-term effects is becoming just as important as curing the cancer itself. ↗
▶ Ep 26 · 1:03
opinion As survival improves, understanding and screening for long-term effects is becoming just as important as curing the cancer itself ↗
Sophia's statements about Pediatric Oncology 143 statements

Open the Pediatric Oncology collection →

Current management of pulmonary relapse in Ewing sarcoma: A report from the Pediatric Surgical Oncology Research Collaborative

▶ Ep 617 · 0:05
clinical Writer et al. published a multi-center retrospective study in the Journal of Pediatric Surgery through PeaceSOC in 2024 ↗
▶ Ep 617 · 0:07
clinical PeaceSOC is a network of over 50 centers in North America that work together to improve outcomes in pediatric surgical oncology ↗
▶ Ep 617 · 0:20
clinical The study examined patients less than 22 years old with initially localized Ewing sarcoma who developed first pulmonary relapse between 2007 and 2020 across 19 different centers ↗
▶ Ep 617 · 0:32
epidemiological Among 33 patients studied, about 2/3 had relapse limited to the lungs ↗
▶ Ep 617 · 0:32
epidemiological Nearly half of patients with lung-limited relapse had just a solitary pulmonary nodule ↗
▶ Ep 617 · 0:39
clinical Patients with solitary pulmonary nodule were more likely to undergo metastasectomy and whole lung radiation ↗
▶ Ep 617 · 0:39
epidemiological Patients with solitary pulmonary nodule had the highest overall three-year survival at 73% ↗
▶ Ep 617 · 0:50
epidemiological Three-year survival for patients with multiple nodules was 40% ↗
▶ Ep 617 · 0:50
epidemiological Three-year survival for patients with extrapulmonary disease was 23% ↗
▶ Ep 617 · 0:57
quote This pattern suggests that solitary pulmonary relapse may represent a biologically more favorable type of recurrence, one that's more amenable to achieving meaningful local control, with metacystectomy playing an important role as part of multimodal therapy. ↗
▶ Ep 617 · 0:57
opinion Solitary pulmonary relapse may represent a biologically more favorable type of recurrence ↗
▶ Ep 617 · 0:57
opinion Solitary pulmonary relapse is more amenable to achieving meaningful local control ↗
▶ Ep 617 · 0:57
opinion Metastasectomy plays an important role as part of multimodal therapy for solitary pulmonary relapse in Ewing sarcoma ↗

Early Postoperative Fever in Pediatric Oncology Patients Undergoing Solid Tumor Resection

▶ Ep 619 · 0:00
quote Your patients post-op day one from a hepatoblastoma resection, and they spike a fever. Do you think they need a big fever workup? ↗
▶ Ep 619 · 0:12
epidemiological 42% of 220 oncology patients had a fever in the 48 hours following tumor resection ↗
▶ Ep 619 · 0:19
clinical The two patients with actual infection were hemodynamically unstable with positive blood cultures ↗
▶ Ep 619 · 0:19
epidemiological Only 2 of the febrile patients (2.8%) had an actual infection ↗
▶ Ep 619 · 0:30
epidemiological Most fevers triggered a workup that costs on average about $500 per patient ↗
▶ Ep 619 · 0:30
epidemiological About a third of patients received empiric antibiotics that they did not need ↗
▶ Ep 619 · 0:39
quote So here's the big takeaway. In the 48 hours following a tumor resection, a fever alone may not be a reason to panic. ↗
▶ Ep 619 · 0:40
opinion In the 48 hours following tumor resection, fever alone may not be a reason to panic ↗
▶ Ep 619 · 0:45
guideline Extensive workup should be reserved for patients who are hemodynamically unstable or have more overt signs of infection ↗

Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma

▶ Ep 620 · 0:03
quote How much does a child's social factors influence their chance of surviving cancer? ↗
▶ Ep 620 · 0:12
epidemiological Study was a retrospective analysis of 12,000 patients with neuroblastoma, Wilms tumor, and hepatoblastoma from the National Cancer Database ↗
▶ Ep 620 · 0:20
epidemiological Socioeconomic disadvantage score was created for each patient based on median household income and education level in their local communities ↗
▶ Ep 620 · 0:31
epidemiological The most disadvantaged children were more likely to have worse survival for Wilms tumor and neuroblastoma ↗
▶ Ep 620 · 0:37
epidemiological After adjusting for tumor size, grade, treatment, and comorbidities, socioeconomic effects on survival remained present ↗
▶ Ep 620 · 0:44
epidemiological Hazard ratio for socioeconomic disadvantage was 1.29 for hepatoblastoma ↗
▶ Ep 620 · 0:44
epidemiological Hazard ratio for socioeconomic disadvantage was 2.02 for Wilms tumor ↗
▶ Ep 620 · 0:51
quote Pediatric oncology outcomes aren't just about tumor biology or treatment received. It's about the social determinants of health for these children as well. ↗
▶ Ep 620 · 0:51
opinion Pediatric oncology outcomes depend on tumor biology, treatment received, and social determinants of health ↗
▶ Ep 620 · 1:00
opinion Identifying socioeconomic risk factors is necessary to close equity gaps and improve survival for all children with solid tumors ↗

Retreatment with Cisplatin May Provide a Survival Advantage for Children with Relapsed/Refractory Hepatoblastoma: An Institutional Experience

▶ Ep 621 · 0:12
quote In relapse hepatoblastoma, there's no established standard salvage therapy regimen. ↗
▶ Ep 621 · 0:12
guideline There is no established standard salvage therapy regimen for relapsed hepatoblastoma ↗
▶ Ep 621 · 0:17
epidemiological The Cincinnati Children's retrospective review of 30 patients represents one of the largest published cohorts evaluating patients with refractory or recurrent hepatoblastoma ↗
▶ Ep 621 · 0:25
clinical The overall survival for the cohort was about 50% ↗
▶ Ep 621 · 0:28
clinical Children who received cisplatin as part of their salvage therapy had survival of about 80% compared to 25% for those who did not receive cisplatin ↗
▶ Ep 621 · 0:28
quote Children who received cisplatin as part of their salvage therapy had a much better survival than those who did not, about 80% compared to 25%. ↗
▶ Ep 621 · 0:36
opinion The improved survival outcomes with cisplatin may be due to persistent platinum sensitivity or better tumor biology rather than proving causality ↗
▶ Ep 621 · 0:49
clinical Most patients underwent additional surgery as part of their salvage therapy, either liver resection, liver transplant, or pulmonary metastasectomy ↗
▶ Ep 621 · 0:57
quote This highlights that salvage therapy is multimodal. ↗
▶ Ep 621 · 0:57
clinical Salvage therapy for relapsed hepatoblastoma is multimodal ↗
▶ Ep 621 · 0:59
opinion Cisplatin retreatment should be balanced with the risk of cumulative toxicity ↗

Indocyanine green is a sensitive adjunct in the identification and surgical management of local and metastatic hepatoblastoma

▶ Ep 626 · 0:00
quote Are you actually seeing all the hepatoblastoma during your resection? ↗
▶ Ep 626 · 0:12
clinical This is a single institution retrospective review of patients who received ICG prior to either pulmonary metastatectomy or liver resection for hepatoblastoma ↗
▶ Ep 626 · 0:22
clinical ICG was highly sensitive for detecting hepatoblastoma, about 90% ↗
▶ Ep 626 · 0:27
clinical In a meaningful number of cases, ICG was able to detect tumor deposits that were not visible, palpable, or detectable on preoperative imaging ↗
▶ Ep 626 · 0:39
clinical Specificity was lower than sensitivity with false positives ↗
▶ Ep 626 · 0:43
clinical False positives often represented vascular changes or inflammation ↗
▶ Ep 626 · 0:46
clinical There were no adverse outcomes associated with any of the additional resections guided by ICG ↗
▶ Ep 626 · 0:50
clinical ICG was effective in both open and minimally invasive surgery ↗
▶ Ep 626 · 0:50
clinical ICG was effective in both relapse and primary disease ↗
▶ Ep 626 · 0:55
quote ICG is a valuable tool that can help increase confidence in achieving a complete resection for both primary and metastatic hepatoblastoma. ↗

Quality of Life Outcomes for Patients Who Underwent Conventional Resection and Liver Transplantation for Locally Advanced Hepatoblastoma

▶ Ep 628 · 0:18
opinion Long-term quality of life is becoming a more important outcome as hepatoblastoma survival improves. ↗
▶ Ep 628 · 0:18
epidemiological Survival for hepatoblastoma continues to improve. ↗
▶ Ep 628 · 0:24
clinical This is a single institution cross-sectional study using validated pediatric quality of life surveys to evaluate long-term survivors of hepatoblastoma. ↗
▶ Ep 628 · 0:31
clinical Overall quality of life outcomes were similar between liver transplant and resection groups for hepatoblastoma. ↗
▶ Ep 628 · 0:31
clinical There was no significant difference in emotional, social, physical, or school functioning outcomes between transplant and resection groups. ↗
▶ Ep 628 · 0:39
quote This challenges the assumption that liver transplantation necessarily leads to a worse. Long-term quality of life. ↗
▶ Ep 628 · 0:47
clinical Patients who underwent resection had lower overall procedure anxiety scores than transplant patients. ↗
▶ Ep 628 · 0:53
clinical The finding of lower procedural anxiety in resection patients was mirrored in the parents' surveys. ↗
▶ Ep 628 · 0:55
quote The key takeaways long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation. This means that the surgical strategy can really be focused on oncologic control. ↗
▶ Ep 628 · 0:55
clinical Long-term quality of life outcomes appear comparable between patients who undergo resection and liver transplantation for hepatoblastoma. ↗
▶ Ep 628 · 1:02
opinion Surgical strategy for hepatoblastoma can be focused on oncologic control given comparable quality of life outcomes. ↗

Enhanced Recovery After Surgery (ERAS) Improves Length of Stay and Decreases Complications After Resection of Abdominal Neuroblastoma

▶ Ep 639 · 0:00
quote Did you know there's an ERAS protocol for neuroblastoma? ↗
▶ Ep 639 · 0:03
clinical A multi-center prospective study evaluated a structured ERAS pathway for children undergoing abdominal neuroblastoma resection ↗
▶ Ep 639 · 0:13
clinical The ERAS protocol included 20 evidence-based elements spanning the entire perioperative process ↗
▶ Ep 639 · 0:13
clinical ERAS protocol elements included preoperative counseling, hydrate loading, standardized multimodal analgesia, early feeding, and early mobilization ↗
▶ Ep 639 · 0:27
quote The results were striking. ↗
▶ Ep 639 · 0:28
clinical Length of stay decreased from about 7 days to 3.7 days ↗
▶ Ep 639 · 0:32
clinical Patients resumed regular diets and ambulated about 3 days earlier ↗
▶ Ep 639 · 0:32
clinical Post-operative opioid use dropped by over half ↗
▶ Ep 639 · 0:39
clinical The proportion of patients experiencing any postoperative complication decreased by over 50% ↗
▶ Ep 639 · 0:46
clinical Patients were cleared to resume adjuvant chemotherapy earlier at around 8 days as opposed to 10 days ↗
▶ Ep 639 · 0:51
opinion A structured ERAS pathway meaningfully improves recovery even after complex neuroblastoma resections ↗
▶ Ep 639 · 0:51
opinion ERAS represents a tangible opportunity to standardize perioperative care for neuroblastoma resection ↗

Pediatric and Young Adult Image-Guided Percutaneous Bone Biopsy-A New Standard of Care?

▶ Ep 640 · 0:00
quote Are you still doing open biopsy for pediatric bone tumors? ↗
▶ Ep 640 · 0:13
clinical The study evaluated 169 biopsies in 141 patients over a 10-year period at a single institution. ↗
▶ Ep 640 · 0:19
clinical Nearly 90% of the biopsies were core-needle biopsies. ↗
▶ Ep 640 · 0:22
clinical All biopsies were performed with image guidance, most commonly CT, sometimes combined with fluoroscopy and ultrasound. ↗
▶ Ep 640 · 0:28
clinical All biopsies were performed by interventional radiologists. ↗
▶ Ep 640 · 0:31
quote The diagnostic yield was impressive. ↗
▶ Ep 640 · 0:33
clinical Only 3 patients required repeat biopsy. ↗
▶ Ep 640 · 0:33
clinical 97.9% of biopsies were diagnostic. ↗
▶ Ep 640 · 0:40
clinical There was one patient with transient sciatic nerve paresis, which resolved. ↗
▶ Ep 640 · 0:43
clinical The complication rate was 0.7%. ↗
▶ Ep 640 · 0:46
clinical Immunostains and molecular studies are increasingly essential for modern risk stratification and targeted therapy. ↗
▶ Ep 640 · 0:46
clinical The approach provided sufficient tissue for histology, immunostains, and molecular studies. ↗
▶ Ep 640 · 0:56
quote The takeaway image-guided percutaneous biopsy is safe, accurate, and should be strongly considered the diagnostic modality of choice for pediatric bone and soft tissue tumors. ↗
▶ Ep 640 · 0:56
opinion Image-guided percutaneous biopsy should be strongly considered the diagnostic modality of choice for pediatric bone and soft tissue tumors. ↗

Long-Term Follow-Up of Surgical Outcomes for Patients With Wilms Tumor and Neuroblastoma

▶ Ep 644 · 0:00
quote You just surgically treated your patient with Wilms tumor or neuroblastoma. Now what? ↗
▶ Ep 644 · 0:11
epidemiological This single institution cohort followed survivors for a mean of 27 years after open oncologic resection for Wilms tumor and neuroblastoma ↗
▶ Ep 644 · 0:20
epidemiological 14% of patients required a repeat laparotomy ↗
▶ Ep 644 · 0:21
clinical The most common indications for repeat laparotomy were small bowel obstruction or tumor recurrence ↗
▶ Ep 644 · 0:26
clinical In Wilms tumor, obstruction typically occurred within the first year ↗
▶ Ep 644 · 0:29
clinical In neuroblastoma, obstruction often developed more than a decade later, well beyond routine follow-up ↗
▶ Ep 644 · 0:34
clinical Radiation dose was not associated with re-operation risk ↗
▶ Ep 644 · 0:37
epidemiological Secondary malignancy was uncommon in this cohort ↗
▶ Ep 644 · 0:37
clinical Hypertension after nephrectomy was not increased compared to population norms ↗
▶ Ep 644 · 0:45
clinical Scoliosis has multi-factorial contributors including surgery and possibly radiation ↗
▶ Ep 644 · 0:45
epidemiological Scoliosis occurred in roughly 10 to 13% of patients, higher than the general population ↗
▶ Ep 644 · 0:55
quote The takeaway is that surgical care does not end at resection. ↗
▶ Ep 644 · 0:58
guideline Even decades after treatment, these patients remain at risk for late complications that warrant long-term counseling and follow-up ↗

The International Neuroblastoma Risk Group (INRG) staging system: an INRG Task Force report

▶ Ep 659 · 0:00
clinical IDRFs are necessary knowledge for clinicians treating neuroblastoma to determine safety of surgical intervention ↗
▶ Ep 659 · 0:00
quote If you're someone who treats neuroblastoma, you need to know about IDRFs to know whether it's safe to go to the operating room. ↗
▶ Ep 659 · 0:14
clinical IDRFs are imaging findings on CT or MRI that predict when neuroblastoma may be difficult or dangerous to remove surgically ↗
▶ Ep 659 · 0:14
quote IDRFs are imaging findings on CT or MRIs that predict when a neuroblastoma may be difficult or dangerous to remove surgically. ↗
▶ Ep 659 · 0:21
guideline The IDRF concept was first introduced in 2009 by the International Neuroblastoma Risk Group ↗
▶ Ep 659 · 0:21
guideline The International Neuroblastoma Risk Group defined 20 specific imaging risk factors ↗
▶ Ep 659 · 0:29
clinical Most IDRFs relate to how the tumor interacts with critical anatomy ↗
▶ Ep 659 · 0:34
clinical In the abdomen, a tumor that infiltrates the portahepati or hepatoduodenal ligament is considered to contain an IDRF ↗
▶ Ep 659 · 0:41
quote The presence of an IDRF doesn't mean that a tumor can't be resected, but it does signal that the surgery may be technically more complex, and patients often receive neoadjuvant therapy first to try to shrink the tumor. ↗
▶ Ep 659 · 0:41
clinical The presence of an IDRF does not mean a tumor cannot be resected ↗
▶ Ep 659 · 0:41
clinical Patients with IDRFs often receive neoadjuvant therapy first to try to shrink the tumor ↗
▶ Ep 659 · 0:41
clinical IDRF presence signals that surgery may be technically more complex ↗
▶ Ep 659 · 0:52
clinical Surgeons use IDRFs to predict surgical risk and guide the safest treatment approach using imaging ↗

Pancreas, Muscle, and Subcutaneous Fat Atrophy in Patients Undergoing Radiation for Neuroblastoma

▶ Ep 670 · 0:00
quote So, we know radiation improves survival in high-risk neuroblastoma, but what does it do to the rest of the body? ↗
▶ Ep 670 · 0:00
clinical Radiation improves survival in high-risk neuroblastoma ↗
▶ Ep 670 · 0:13
clinical This is a retrospective study of 50 children with high-risk neuroblastoma undergoing abdominal radiation therapy ↗
▶ Ep 670 · 0:19
clinical The authors use CT and MRI body segmentation to measure pancreatic volume, subcutaneous fat, and muscle area before and after treatment ↗
▶ Ep 670 · 0:27
clinical There was a significant decrease in pancreatic volume after radiation ↗
▶ Ep 670 · 0:31
opinion Follow-up may not be long enough to detect pancreatic effects, especially given the young average age of these patients ↗
▶ Ep 670 · 0:31
clinical Pancreatic insufficiency wasn't systematically screened for in this study ↗
▶ Ep 670 · 0:31
clinical Very few patients developed clinically apparent pancreatic insufficiency ↗
▶ Ep 670 · 0:43
quote So this raises concern that pancreatic dysfunction could be an Recognized late effect. ↗
▶ Ep 670 · 0:43
opinion Pancreatic dysfunction could be an under-recognized late effect ↗
▶ Ep 670 · 0:48
clinical Patients had a significant drop in weight percentile with smaller decreases in fat and muscle ↗
▶ Ep 670 · 0:48
opinion Body composition changes likely reflect the overall impact of cancer therapy overall rather than radiation alone ↗
▶ Ep 670 · 0:48
opinion These findings highlight the importance of nutritional screening during cancer treatments ↗
▶ Ep 670 · 1:03
quote So, as survival improves, understanding and screening for these long-term effects is becoming just as important as curing the cancer itself. ↗
▶ Ep 670 · 1:03
opinion As survival improves, understanding and screening for long-term effects is becoming just as important as curing the cancer itself ↗

Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients

▶ Ep 680 · 0:00
quote So just how accurate is ICG for detecting sentinel lymph nodes in pediatric oncology? ↗
▶ Ep 680 · 0:05
clinical The study was a multi-center prospective study conducted by PeaceOC evaluating indocyanine green (ICG) for identifying sentinel lymph nodes in pediatric patients with skin and soft tissue malignancies ↗
▶ Ep 680 · 0:21
clinical Peritumoral injection of ICG demonstrated almost 80% sensitivity for detecting a sentinel node ↗
▶ Ep 680 · 0:28
quote all sentinel nodes that contained malignancy were ICG avid ↗
▶ Ep 680 · 0:28
clinical All sentinel nodes that contained malignancy were ICG avid ↗
▶ Ep 680 · 0:33
clinical ICG diagnostic performance is similar to smaller pediatric studies previously evaluating ICG and sentinel lymph node biopsy ↗
▶ Ep 680 · 0:33
opinion ICG may outperform blue dye localization based on previously reported literature ↗
▶ Ep 680 · 0:45
clinical The study did not directly compare the effectiveness of ICG to blue dye localization ↗
▶ Ep 680 · 0:49
clinical ICG in most cases was used in conjunction with standard localization techniques such as technetium ↗
▶ Ep 680 · 0:58
clinical No adverse reactions to ICG were identified within 30 days of surgery ↗
▶ Ep 680 · 1:02
opinion ICG has a favorable safety profile and lacks the permanent tattooing associated with blue dye, making it an attractive visualization adjunct for pediatric sentinel lymph node biopsy ↗
▶ Ep 680 · 1:02
clinical Blue dye can cause permanent tattooing ↗
Sophia's statements about Sarcoma (Ewing/Rhabdo) 39 statements

Open the Sarcoma (Ewing/Rhabdo) collection →

Current management of pulmonary relapse in Ewing sarcoma: A report from the Pediatric Surgical Oncology Research Collaborative

▶ Ep 31 · 0:05
clinical Writer et al. published a multi-center retrospective study in the Journal of Pediatric Surgery through PeaceSOC in 2024 ↗
▶ Ep 31 · 0:07
clinical PeaceSOC is a network of over 50 centers in North America that work together to improve outcomes in pediatric surgical oncology ↗
▶ Ep 31 · 0:20
clinical The study examined patients less than 22 years old with initially localized Ewing sarcoma who developed first pulmonary relapse between 2007 and 2020 across 19 different centers ↗
▶ Ep 31 · 0:32
epidemiological Nearly half of patients with lung-limited relapse had just a solitary pulmonary nodule ↗
▶ Ep 31 · 0:32
epidemiological Among 33 patients studied, about 2/3 had relapse limited to the lungs ↗
▶ Ep 31 · 0:39
epidemiological Patients with solitary pulmonary nodule had the highest overall three-year survival at 73% ↗
▶ Ep 31 · 0:39
clinical Patients with solitary pulmonary nodule were more likely to undergo metastasectomy and whole lung radiation ↗
▶ Ep 31 · 0:50
epidemiological Three-year survival for patients with multiple nodules was 40% ↗
▶ Ep 31 · 0:50
epidemiological Three-year survival for patients with extrapulmonary disease was 23% ↗
▶ Ep 31 · 0:57
opinion Metastasectomy plays an important role as part of multimodal therapy for solitary pulmonary relapse in Ewing sarcoma ↗
▶ Ep 31 · 0:57
quote This pattern suggests that solitary pulmonary relapse may represent a biologically more favorable type of recurrence, one that's more amenable to achieving meaningful local control, with metacystectomy playing an important role as part of multimodal therapy. ↗
▶ Ep 31 · 0:57
opinion Solitary pulmonary relapse is more amenable to achieving meaningful local control ↗
▶ Ep 31 · 0:57
opinion Solitary pulmonary relapse may represent a biologically more favorable type of recurrence ↗

Pediatric and Young Adult Image-Guided Percutaneous Bone Biopsy-A New Standard of Care?

▶ Ep 33 · 0:00
quote Are you still doing open biopsy for pediatric bone tumors? ↗
▶ Ep 33 · 0:13
clinical The study evaluated 169 biopsies in 141 patients over a 10-year period at a single institution. ↗
▶ Ep 33 · 0:19
clinical Nearly 90% of the biopsies were core-needle biopsies. ↗
▶ Ep 33 · 0:22
clinical All biopsies were performed with image guidance, most commonly CT, sometimes combined with fluoroscopy and ultrasound. ↗
▶ Ep 33 · 0:28
clinical All biopsies were performed by interventional radiologists. ↗
▶ Ep 33 · 0:31
quote The diagnostic yield was impressive. ↗
▶ Ep 33 · 0:33
clinical 97.9% of biopsies were diagnostic. ↗
▶ Ep 33 · 0:33
clinical Only 3 patients required repeat biopsy. ↗
▶ Ep 33 · 0:40
clinical There was one patient with transient sciatic nerve paresis, which resolved. ↗
▶ Ep 33 · 0:43
clinical The complication rate was 0.7%. ↗
▶ Ep 33 · 0:46
clinical The approach provided sufficient tissue for histology, immunostains, and molecular studies. ↗
▶ Ep 33 · 0:46
clinical Immunostains and molecular studies are increasingly essential for modern risk stratification and targeted therapy. ↗
▶ Ep 33 · 0:56
opinion Image-guided percutaneous biopsy should be strongly considered the diagnostic modality of choice for pediatric bone and soft tissue tumors. ↗
▶ Ep 33 · 0:56
quote The takeaway image-guided percutaneous biopsy is safe, accurate, and should be strongly considered the diagnostic modality of choice for pediatric bone and soft tissue tumors. ↗

Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients

▶ Ep 34 · 0:00
quote So just how accurate is ICG for detecting sentinel lymph nodes in pediatric oncology? ↗
▶ Ep 34 · 0:05
clinical The study was a multi-center prospective study conducted by PeaceOC evaluating indocyanine green (ICG) for identifying sentinel lymph nodes in pediatric patients with skin and soft tissue malignancies ↗
▶ Ep 34 · 0:21
clinical Peritumoral injection of ICG demonstrated almost 80% sensitivity for detecting a sentinel node ↗
▶ Ep 34 · 0:28
quote all sentinel nodes that contained malignancy were ICG avid ↗
▶ Ep 34 · 0:28
clinical All sentinel nodes that contained malignancy were ICG avid ↗
▶ Ep 34 · 0:33
clinical ICG diagnostic performance is similar to smaller pediatric studies previously evaluating ICG and sentinel lymph node biopsy ↗
▶ Ep 34 · 0:33
opinion ICG may outperform blue dye localization based on previously reported literature ↗
▶ Ep 34 · 0:45
clinical The study did not directly compare the effectiveness of ICG to blue dye localization ↗
▶ Ep 34 · 0:49
clinical ICG in most cases was used in conjunction with standard localization techniques such as technetium ↗
▶ Ep 34 · 0:58
clinical No adverse reactions to ICG were identified within 30 days of surgery ↗
▶ Ep 34 · 1:02
opinion ICG has a favorable safety profile and lacks the permanent tattooing associated with blue dye, making it an attractive visualization adjunct for pediatric sentinel lymph node biopsy ↗
▶ Ep 34 · 1:02
clinical Blue dye can cause permanent tattooing ↗
Sophia's statements about Soft Tissue Sarcoma (lymph nodes) 12 statements

Open the Soft Tissue Sarcoma (lymph nodes) collection →

Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients

▶ Ep 15 · 0:00
quote So just how accurate is ICG for detecting sentinel lymph nodes in pediatric oncology? ↗
▶ Ep 15 · 0:05
clinical The study was a multi-center prospective study conducted by PeaceOC evaluating indocyanine green (ICG) for identifying sentinel lymph nodes in pediatric patients with skin and soft tissue malignancies ↗
▶ Ep 15 · 0:21
clinical Peritumoral injection of ICG demonstrated almost 80% sensitivity for detecting a sentinel node ↗
▶ Ep 15 · 0:28
clinical All sentinel nodes that contained malignancy were ICG avid ↗
▶ Ep 15 · 0:28
quote all sentinel nodes that contained malignancy were ICG avid ↗
▶ Ep 15 · 0:33
opinion ICG may outperform blue dye localization based on previously reported literature ↗
▶ Ep 15 · 0:33
clinical ICG diagnostic performance is similar to smaller pediatric studies previously evaluating ICG and sentinel lymph node biopsy ↗
▶ Ep 15 · 0:45
clinical The study did not directly compare the effectiveness of ICG to blue dye localization ↗
▶ Ep 15 · 0:49
clinical ICG in most cases was used in conjunction with standard localization techniques such as technetium ↗
▶ Ep 15 · 0:58
clinical No adverse reactions to ICG were identified within 30 days of surgery ↗
▶ Ep 15 · 1:02
clinical Blue dye can cause permanent tattooing ↗
▶ Ep 15 · 1:02
opinion ICG has a favorable safety profile and lacks the permanent tattooing associated with blue dye, making it an attractive visualization adjunct for pediatric sentinel lymph node biopsy ↗
Sophia's statements about Wilms Tumor 23 statements

Open the Wilms Tumor collection →

Social Determinants of Health Influence on Survival in Wilms Tumor, Neuroblastoma, and Hepatoblastoma

▶ Ep 17 · 0:03
quote How much does a child's social factors influence their chance of surviving cancer? ↗
▶ Ep 17 · 0:12
epidemiological Study was a retrospective analysis of 12,000 patients with neuroblastoma, Wilms tumor, and hepatoblastoma from the National Cancer Database ↗
▶ Ep 17 · 0:20
epidemiological Socioeconomic disadvantage score was created for each patient based on median household income and education level in their local communities ↗
▶ Ep 17 · 0:31
epidemiological The most disadvantaged children were more likely to have worse survival for Wilms tumor and neuroblastoma ↗
▶ Ep 17 · 0:37
epidemiological After adjusting for tumor size, grade, treatment, and comorbidities, socioeconomic effects on survival remained present ↗
▶ Ep 17 · 0:44
epidemiological Hazard ratio for socioeconomic disadvantage was 1.29 for hepatoblastoma ↗
▶ Ep 17 · 0:44
epidemiological Hazard ratio for socioeconomic disadvantage was 2.02 for Wilms tumor ↗
▶ Ep 17 · 0:51
quote Pediatric oncology outcomes aren't just about tumor biology or treatment received. It's about the social determinants of health for these children as well. ↗
▶ Ep 17 · 0:51
opinion Pediatric oncology outcomes depend on tumor biology, treatment received, and social determinants of health ↗
▶ Ep 17 · 1:00
opinion Identifying socioeconomic risk factors is necessary to close equity gaps and improve survival for all children with solid tumors ↗

Long-Term Follow-Up of Surgical Outcomes for Patients With Wilms Tumor and Neuroblastoma

▶ Ep 18 · 0:00
quote You just surgically treated your patient with Wilms tumor or neuroblastoma. Now what? ↗
▶ Ep 18 · 0:11
epidemiological This single institution cohort followed survivors for a mean of 27 years after open oncologic resection for Wilms tumor and neuroblastoma ↗
▶ Ep 18 · 0:20
epidemiological 14% of patients required a repeat laparotomy ↗
▶ Ep 18 · 0:21
clinical The most common indications for repeat laparotomy were small bowel obstruction or tumor recurrence ↗
▶ Ep 18 · 0:26
clinical In Wilms tumor, obstruction typically occurred within the first year ↗
▶ Ep 18 · 0:29
clinical In neuroblastoma, obstruction often developed more than a decade later, well beyond routine follow-up ↗
▶ Ep 18 · 0:34
clinical Radiation dose was not associated with re-operation risk ↗
▶ Ep 18 · 0:37
clinical Hypertension after nephrectomy was not increased compared to population norms ↗
▶ Ep 18 · 0:37
epidemiological Secondary malignancy was uncommon in this cohort ↗
▶ Ep 18 · 0:45
epidemiological Scoliosis occurred in roughly 10 to 13% of patients, higher than the general population ↗
▶ Ep 18 · 0:45
clinical Scoliosis has multi-factorial contributors including surgery and possibly radiation ↗
▶ Ep 18 · 0:55
quote The takeaway is that surgical care does not end at resection. ↗
▶ Ep 18 · 0:58
guideline Even decades after treatment, these patients remain at risk for late complications that warrant long-term counseling and follow-up ↗