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8. Positron emission tomography-computed tomography for staging and follow-up of pediatric nasopharyngeal carcinoma

Author

Cheuk, Daniel KL, Sabin, Noah D, Hossain, Moinul, Wozniak, Amy, Naik, Mihir, Rodriguez-Galindo, Carlos, Krasin, Matthew J, and Shulkin, Barry L

Subjects
Male, Nasopharyngeal Carcinoma, Adolescent, Carcinoma, Nasopharyngeal Neoplasms, Chemoradiotherapy, Magnetic Resonance Imaging, Multimodal Imaging, Article, Fluorodeoxyglucose F18, Positron-Emission Tomography, Antineoplastic Combined Chemotherapy Protocols, Humans, Female, Fluorouracil, Cisplatin, Radiopharmaceuticals, Tomography, X-Ray Computed, Follow-Up Studies, Neoplasm Staging
Abstract

While FDG PET/CT for the evaluation of nasopharyngeal carcinoma (NPC) in adult patients has documented advantages and disadvantages compared with conventional imaging, to our knowledge, no studies of FDG PET/CT for the evaluation of NPC in pediatric patients have been performed. In this investigation, we studied the utility of FDG PET/CT in children with NPC.The study group comprised 18 children with biopsy-proven NPC who underwent FDG PET/CT and MRI (total 38 pairs of images). All baseline and follow-up FDG PET/CT and MRI studies were independently reviewed for restaging of disease.The concordance between FDG PET/CT and MRI in T, N, and overall staging was 29%, 64%, and 43%, respectively. Compared with MRI, FDG PET/CT yielded lower T and overall staging and showed less cervical and retropharyngeal lymphadenopathy. The concordance between follow-up FDG PET/CT and MRI was 79% overall and 100% 9 months after therapy. In patients who achieved complete remission, FDG PET/CT showed disease clearance 3-6 months earlier than MRI. There were no false-positive or false-negative FDG PET/CT scans during follow-up.FDG PET/CT may underestimate tumor extent and regional lymphadenopathy compared with MRI at the time of diagnosis, but it helps to detect metastases and clarify ambiguous findings. FDG PET/CT is sensitive and specific for follow-up and enables earlier determination of disease remission. FDG PET/CT is a valuable imaging modality for the evaluation and monitoring of NPC in pediatric patients.

Published
2012

37. Risk factors for drug allergies in Chinese children.

Author

Duque JSR, Cheuk DK, Chong PC, Ip P, Wong WH, Lee PP, Wong IC, Chan GC, Lau YL, and Ho MH

Subjects
Age of Onset, Biomarkers, Child, Child, Preschool, China epidemiology, Drug Hypersensitivity diagnosis, Drug Hypersensitivity therapy, Female, Humans, Immunoglobulin E, Male, Odds Ratio, Prevalence, Public Health Surveillance, Risk Assessment, Risk Factors, Drug Hypersensitivity epidemiology, Drug Hypersensitivity etiology
Abstract

Background: Drug allergy, or drug hypersensitivity, is a potentially fatal disorder, and patients labeled with drug allergies have restricted access to first-line treatments. Full knowledge of the characteristics associated with drug allergies and severe reactions during allergy evaluation is beneficial for appropriate risk stratification., Objective: We sought to determine whether certain clinical characteristics are associated with drug allergies in Chinese children., Methods: Charts were reviewed for ethnic Chinese patients less than 18 years old referred to our tertiary allergy center for suspected drug allergies and completed skin and drug provocative testing between 2005 to 2017. Univariate and multivariate analyses were performed on the age of onset of drug allergies, gender, and other atopy versus drug allergies., Results: Out of 75 children, 18 (24%) had IgE-mediated drug allergies, while 8 (10.7%) had delayed drug hypersensitivities, with a cumulative 26 subjects (34.7%) with any drug hypersensitivity. There were positive independent associations between drug hypersensitivities onset age vs IgE-mediated drug allergies (odds ratio (OR) = 14.9, 95% confidence intervals (CIs) = 1.5-148.3, P = 0.017) and between male gender and IgE-mediated drug allergies (OR = 4.4, CIs = 1.2-16.4, P = 0.019). Age 13 years was the best cut-off for IgE-mediated drug allergies according to the receiver operating characteristic curve (P = 0.026). Older age group (OR = 24.0, CIs = 1.4-417.8, P = 0.024) and atopic dermatitis (OR = 8.2, CIs = 1.4-49.8, P = 0.015) were correlated with delayed drug hypersensitivities., Conclusions: While several previous studies suggested a higher prevalence of IgE-mediated drug allergies in younger adult females, older boys were more likely to have drug allergies for Chinese children.

Published
2020
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