38 results on '"McCarten Km"'
Search Results
2. Delayed appearance of right diaphragmatic hernia associated with group B streptococcal infection in newborns
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Borden S th, McCarten Km, Rosenberg Hk, and Mandell Ga
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Male ,medicine.medical_specialty ,Time Factors ,Pleural effusion ,Left hemithorax ,Group B Streptococcal Infection ,Infant, Newborn, Diseases ,Streptococcus agalactiae ,Right hemithorax ,Streptococcal Infections ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Hernia ,Diaphragmatic hernia ,Hernia, Diaphragmatic ,business.industry ,Infant, Newborn ,Pneumonia ,medicine.disease ,Diaphragm (structural system) ,Surgery ,Intestines ,Pleural Effusion ,Radiography ,Anesthesia ,Female ,Gases ,business - Abstract
Right diaphragmatic hernia should be considered when an infant with Group B streptococcal infection shows deterioration. Although the diaphragm appears normal at first, increased density is seen in the right lower lobe shortly thereafter, indicating pneumonia and/or irregular aeration. Pleural effusion may develop over the next few days. Characteristically, the bowel gas on the right and the liver shadow gradually become elevated and the heart and mediastinal structures shift into the left hemithorax; loops of bowel may be seen in the right hemithorax as well. Static plain views should confirm hernia or eventration, necessitating immediate surgery.
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- 1981
3. Enterocolonic fistula as a late complication of necrotizing enterocolitis
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Paley, RH, primary, McCarten, KM, additional, and Cleveland, RH, additional
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- 1979
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4. Automatic Quantification of Serial PET/CT Images for Pediatric Hodgkin Lymphoma Patients Using a Longitudinally-Aware Segmentation Network.
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Tie X, Shin M, Lee C, Perlman SB, Huemann Z, Weisman AJ, Castellino SM, Kelly KM, McCarten KM, Alazraki AL, Hu J, Cho SY, and Bradshaw TJ
- Abstract
Purpose: Automatic quantification of longitudinal changes in PET scans for lymphoma patients has proven challenging, as residual disease in interim-therapy scans is often subtle and difficult to detect. Our goal was to develop a longitudinally-aware segmentation network (LAS-Net) that can quantify serial PET/CT images for pediatric Hodgkin lymphoma patients., Materials and Methods: This retrospective study included baseline (PET1) and interim (PET2) PET/CT images from 297 patients enrolled in two Children's Oncology Group clinical trials (AHOD1331 and AHOD0831). LAS-Net incorporates longitudinal cross-attention, allowing relevant features from PET1 to inform the analysis of PET2. Model performance was evaluated using Dice coefficients for PET1 and detection F1 scores for PET2. Additionally, we extracted and compared quantitative PET metrics, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in PET1, as well as qPET and ΔSUVmax in PET2, against physician measurements. We quantified their agreement using Spearman's ρ correlations and employed bootstrap resampling for statistical analysis., Results: LAS-Net detected residual lymphoma in PET2 with an F1 score of 0.606 (precision/recall: 0.615/0.600), outperforming all comparator methods (P<0.01). For baseline segmentation, LAS-Net achieved a mean Dice score of 0.772. In PET quantification, LAS-Net's measurements of qPET, ΔSUVmax, MTV and TLG were strongly correlated with physician measurements, with Spearman's ρ of 0.78, 0.80, 0.93 and 0.96, respectively. The performance remained high, with a slight decrease, in an external testing cohort., Conclusion: LAS-Net achieved high performance in quantifying PET metrics across serial scans, highlighting the value of longitudinal awareness in evaluating multi-time-point imaging datasets.
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- 2024
5. Prognostic value of chest x-ray- and CT-defined large mediastinal adenopathy in high-risk pediatric Hodgkin lymphoma: A report from the Children's Oncology Group Study AHOD0831.
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Lo AC, Lee I, Pei Q, Wu Y, McCarten KM, Hoppe BS, Hodgson DC, Roberts K, Milgrom S, Kessel S, Cole PD, Kelly KM, and Cho SY
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- Humans, Child, Child, Preschool, Adolescent, Young Adult, Adult, Prognosis, X-Rays, Neoplasm Recurrence, Local drug therapy, Tomography, X-Ray Computed, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Hodgkin Disease diagnostic imaging, Hodgkin Disease drug therapy, Hodgkin Disease pathology, Lymphadenopathy
- Abstract
Purpose/objective: We compared the prognostic value of chest radiograph (CXR)- and computed tomography (CT)-derived definition of large mediastinal adenopathy (LMA) in pediatric Hodgkin lymphoma (HL)., Materials/methods: Total 143 patients treated for stage IIIB/IVB HL on COG AHOD0831 were included in this study. Six definitions of LMA were investigated: (i) mediastinal mass ratio on CXR (MR
CXR ) > 1/3; (ii) mediastinal mass ratio on CT (MRCT ) > 1/3; (iii) mediastinal mass volume on CT (MVCT ) > 200 mL; (iv) normalized mediastinal mass volume (MVCT /thoracic diameter [TD]) > 1 mL/mm; (v) mediastinal mass diameter on CT (MDCT ) > 10 cm; and (vi) normalized mediastinal mass diameter (MDCT /TD) > 1/3., Results: Median age at diagnosis was 15.8 years (range: 5.2-21.3 years). In patients with a slow early response (SER) to chemotherapy, MVCT > 200 mL, MDCT > 10 cm, and MDCT /TD > 1/3 were associated with worse relapse-free survival (RFS) on MVA, while MRCXR > 1/3, MRCT > 1/3, and MVCT /TD > 1 mL/mm trended toward worse RFS; MDCT /TD was the most strongly prognostic for inferior RFS, with a hazard ratio of 6.41 for MDCT /TD > 1/3 versus ≤1/3 on MVA (p = .02)., Conclusion: LMA according to MVCT > 200 mL, MDCT > 10 cm, and MDCT /TD > 1/3 is associated with poor prognosis in advanced-stage HL patients with SER. The normalized mediastinal diameter, MDCT /TD > 1/3 appears to be the strongest predictor of inferior RFS., (© 2023 Wiley Periodicals LLC.)- Published
- 2023
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6. Importance of Central Imaging Review in a Pediatric Hodgkin Lymphoma Trial Using Positron Emission Tomography Response Adapted Radiation Therapy.
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Hoppe BS, McCarten KM, Pei Q, Kessel S, Alazraki A, Mhlanga JC, Lai HA, Eutsler E, Hodgson DC, Roberts KB, Charpentier AM, Keller FG, Voss SD, Wu Y, Cho SY, Kelly KM, and Castellino SM
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- Humans, Child, Positron Emission Tomography Computed Tomography methods, Positron-Emission Tomography methods, Fluorodeoxyglucose F18, Hodgkin Disease diagnostic imaging, Hodgkin Disease drug therapy, Hodgkin Disease radiotherapy
- Abstract
Purpose: We investigated the effects of central review of the interim fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan response (iPET) assessment on treatment allocation in the risk-based, response-adapted, Children's Oncology Group study AHOD1331 (ClinicalTrials.gov identifier: NCT02166463) for pediatric patients with high-risk Hodgkin lymphoma., Methods and Materials: Per protocol, after 2 cycles of systemic therapy, patients underwent iPET, with visual response assessment by 5-point Deauville score (DS) at their treating institution and a real-time central review, with the latter considered the reference standard. An area of disease with a DS of 1 to 3 was considered a rapid-responding lesion, whereas a DS of 4 to 5 was considered a slow-responding lesion (SRL). Patients with 1 or more SRLs were considered iPET positive, whereas patients with only rapid-responding lesions were considered iPET negative. We conducted a predefined exploratory evaluation of concordance in iPET response assessment between institutional and central reviews of 573 patients. The concordance rate was evaluated using the Cohen κ statistic (κ > 0.80 was considered very good agreement and κ > 0.60-0.80, good agreement)., Results: The concordance rate (514 of 573 [89.7%]) had a κ of 0.685 (95% CI, 0.610-0.759), consistent with good agreement. In terms of the direction of discordance, among the 126 patients who were considered iPET positive by institutional review, 38 (30.2%) were categorized as iPET negative by central review, preventing overtreatment with radiation therapy. Conversely, among the 447 patients who were considered iPET negative by institutional review, 21 patients (4.7%) were categorized as iPET positive by the central review and would have been undertreated without radiation therapy., Conclusions: Central review is integral to PET response-adapted clinical trials for children with Hodgkin lymphoma. Continued support of central imaging review and education about DS are needed., (Copyright © 2023 Elsevier Inc. All rights reserved.)
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- 2023
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7. Baseline metabolic tumour burden improves risk stratification in Hodgkin lymphoma: A Children's Oncology Group study.
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Milgrom SA, Kim J, Pei Q, Lee I, Hoppe BS, Wu Y, Hodgson D, Kessel S, McCarten KM, Roberts K, Lo AC, Cole PD, Kelly KM, and Cho SY
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- Humans, Child, Tumor Burden, Fluorodeoxyglucose F18 metabolism, Positron-Emission Tomography methods, Risk Assessment, Prognosis, Retrospective Studies, Radiopharmaceuticals, Positron Emission Tomography Computed Tomography, Glycolysis, Hodgkin Disease diagnostic imaging, Hodgkin Disease drug therapy, Hodgkin Disease pathology
- Abstract
The Children's Oncology Group AHOD0831 study used a positron emission tomography (PET) response-adapted approach in high-risk Hodgkin lymphoma, whereby slow early responders (SERs) received more intensive therapy than rapid early responders (RERs). We explored if baseline PET-based characteristics would improve risk stratification. Of 166 patients enrolled in the COG AHOD0831 study, 94 (57%) had baseline PET scans evaluable for quantitative analysis. For these patients, total body metabolic tumour volume (MTV), total lesion glycolysis (TLG), maximum standardized uptake value (SUV
max ) and peak SUV (SUVpeak ) were obtained. MTV/TLG thresholds were an SUV of 2.5 (MTV2.5 /TLG2.5 ) and 40% of the tumour SUVmax (MTV40% /TLG40% ). TLG2.5 was associated with event-free survival (EFS) in the complete cohort (p = 0.04) and in RERs (p = 0.01), but not in SERs (p = 0.8). The Youden index cut-off for TLG2.5 was 1841. Four-year EFS was 92% for RER/TLG2.5 up to 1841, 60% for RER/TLG2.5 greater than 1841, 74% for SER/TLG2.5 up to 1841 and 79% for SER/TLG2.5 greater than 1841. Second EFS for RER/TLG2.5 up to 1841 was 100%. Thus, RERs with a low baseline TLG2.5 experienced excellent EFS with less intensive therapy, whereas RERs with a high baseline TLG2.5 experienced poor EFS. These findings suggest that patients with a high upfront tumour burden may benefit from intensified therapy, even if they achieve a RER., (© 2023 British Society for Haematology and John Wiley & Sons Ltd.)- Published
- 2023
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8. Targeted radiotherapy for early-stage, low-risk pediatric Hodgkin lymphoma slow early responders: a COG AHOD0431 analysis.
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Parekh A, Keller FG, McCarten KM, Kessel S, Cho S, Pei Q, Wu Y, Castellino SM, Constine LS, Schwartz CL, Hodgson D, Kelly KM, and Hoppe BS
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- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bleomycin therapeutic use, Child, Cyclophosphamide therapeutic use, Doxorubicin therapeutic use, Etoposide therapeutic use, Humans, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prednisone therapeutic use, Vincristine therapeutic use, Hodgkin Disease drug therapy, Hodgkin Disease pathology, Hodgkin Disease radiotherapy
- Abstract
Children's Oncology Group (COG) trial AHOD0431 reduced systemic therapy and used response-adapted involved-field radiotherapy (IFRT) in early-stage pediatric classic Hodgkin lymphoma. We investigated the impact of positron emission tomographic response after 1 cycle (PET1) and on IFRT outcomes and pattern of relapse. Patients in AHOD0431 underwent PET1 response assessment after AVPC (doxorubicin, vincristine, prednisone, and cyclophosphamide). "Rapid early responders" (RERs) had a negative PET1 (PET1-); "slow early responders" (SERs) had a positive PET1 (PET1+). Patients with a partial response by computed tomographic and functional imaging after 3 chemotherapy cycles received 21-Gy IFRT, whereas complete responders had no IFRT. Progression-free survival (PFS) was evaluated for RERs and SERs treated with or without IFRT. Recurrence sites were initial, new, or both. Relapses involving initial sites were characterized as "within the PET1+ site" or "initially involved but outside the PET1+ site." Median follow-up was 118 months. The 10-year PFS rate among RERs was 96.6% with IFRT and 84.1% without IFRT (P = .10), whereas SERs were 80.9% with IFRT and 64.0% without IFRT (P = .03). Among 90 RERs who did not receive IFRT, all 14 relapses included an initial site. Among 45 SERs receiving no IFRT, 14 of 16 relapses were in the initial site (9 PET1+ site only). Among 58 patients receiving IFRT, 5 of 10 relapses were in the PET1+ site. After 3 cycles of AVPC alone, RERs showed favorable results. Conversely, SERs had unfavorable outcomes with AVPC alone, although they improved with 21-Gy IFRT. RT remains an important component of treatment for SERs. This trial was registered at www.clinicaltrials.gov as #NCT00302003., (© 2022 by The American Society of Hematology.)
- Published
- 2022
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9. Durable remission for four pediatric patients with high-risk relapsed classical Hodgkin lymphoma treated with brentuximab vedotin plus gemcitabine but without autologous stem cell transplantation: A report from the Children's Oncology Group.
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Buhtoiarov IN, Mba NI, Santos CDL, McCarten KM, Metzger ML, Pei Q, Bush R, Baker K, Kelly KM, and Cole PD
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- Antineoplastic Combined Chemotherapy Protocols adverse effects, Brentuximab Vedotin, Child, Deoxycytidine analogs & derivatives, Humans, Neoplasm Recurrence, Local drug therapy, Salvage Therapy, Stem Cell Transplantation, Transplantation, Autologous, Gemcitabine, Hematopoietic Stem Cell Transplantation, Hodgkin Disease drug therapy, Hodgkin Disease pathology, Immunoconjugates therapeutic use
- Abstract
Patients with therapy-refractory or high-risk relapsed classical Hodgkin lymphoma are typically treated with the high-dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) to consolidate the response to salvage therapy. The combination of brentuximab vedotin with gemcitabine has recently been shown to be an effective and safe salvage regimen. While the majority of patients with complete responses to this regimen ultimately underwent HDC/ASCT consolidation, four subjects, reported herein, achieved durable complete remissions lasting more than 4 years after the study treatment but without ASCT consolidation. Further investigation of treatment strategies incorporating targeted agents may allow omission of HDC/ASCT for select patients., (© 2022 Wiley Periodicals LLC.)
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- 2022
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10. Patterns of Initial Relapse from a Phase 3 Study of Response-Based Therapy for High-Risk Hodgkin Lymphoma (AHOD0831): A Report from the Children's Oncology Group.
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Parikh RR, Kelly KM, Hodgson DC, Hoppe BS, McCarten KM, Karolczuk K, Pei Q, Wu Y, Cho SY, Schwartz C, Cole PD, and Roberts K
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- Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bleomycin adverse effects, Child, Cyclophosphamide therapeutic use, Doxorubicin therapeutic use, Humans, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prednisone adverse effects, Retrospective Studies, Vincristine adverse effects, Young Adult, Hodgkin Disease diagnostic imaging, Hodgkin Disease drug therapy, Hodgkin Disease radiotherapy
- Abstract
Purpose: The Children's Oncology Group protocol AHOD0831, for pediatric patients with high-risk classical Hodgkin lymphoma (cHL), used response-adapted radiation fields, rather than larger involved-field radiation therapy (IFRT) that were historically used. This retrospective analysis of patterns of relapse among patients enrolled in the study was conducted to study the potential effect of a reduction in RT exposure., Methods and Materials: From December 2009 to January 2012, 164 eligible patients under 22 years old with stage IIIB (43%) and stage IVB (57%) enrolled on AHOD0831. All patients received 4 cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC). Those patients with a slow early response (SER) after the first 2 ABVE-PC courses were nonrandomly assigned to 2 intensification cycles with ifosfamide/vinorelbine before the final 2 ABVE-PC cycles. Response-adapted RT (21 Gy) was prescribed to initial areas of bulky disease and SER sites. Rapid early response (RER) sites without bulk were not targeted. Imaging studies at the time of progression or relapse were reviewed centrally for this retrospective analysis. Relapses were characterized with respect to site (initial, new, or both; and initial bulk or initial nonbulk), initial chemotherapy response, and radiation field (in-field, out-of-field, or both)., Results: Of the entire cohort, 140 patients were evaluable for the patterns of failure analyses. To investigate the pattern of failure, this analysis focuses on 23 patients who followed protocol treatment and suffered relapses at a median 1.05 years with 7.97-year median follow-up time. These 23 patients (11 RER and 12 SER) experienced a relapse in 105 total sites (median, 4; range, 1-11). Of the 105 relapsed sites, 67 sites (64%) occurred within an initial site of involvement, with 12 of these 67 sites (18%) at an initial site of bulky disease and 63 of these 67 relapses (94%) occurring in sites that were not fluorodeoxyglucose (FDG)-avid after 2 cycles of ABVE-PC (PET2-negative). Of the 105 relapsed sites, 34 sites (32%) occurred in a new site of disease (that would not have been covered by RT); and, overall, only 4 of 140 patients (2.8%) (occurring in 3 RER and 1 SER) experienced isolated out-of-field relapses that would have been covered by historical IFRT., Conclusions: For a cohort of high-risk patients with cHL patients, most failures occurred in nonbulky, initially involved sites, largely due to response-based consolidation RT delivered to patients with bulky disease. In this analysis, we discovered low rates of failures outside of these modern risk-adapted radiation treatment volumes. Also, FDG uptake on PET2 did not identify most relapse sites., (Copyright © 2021 Elsevier Inc. All rights reserved.)
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- 2022
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11. Prognostic value of baseline metabolic tumor volume in children and adolescents with intermediate-risk Hodgkin lymphoma treated with chemo-radiation therapy: FDG-PET parameter analysis in a subgroup from COG AHOD0031.
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Milgrom SA, Kim J, Chirindel A, Kim J, Pei Q, Chen L, Buxton A, Kessel S, Leal J, McCarten KM, Hoppe BS, Wolden SL, Schwartz CL, Friedman DL, Kelly KM, and Cho SY
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- Adolescent, Child, Humans, Positron-Emission Tomography, Prognosis, Radiopharmaceuticals, Retrospective Studies, Tumor Burden, Fluorodeoxyglucose F18, Hodgkin Disease diagnostic imaging, Hodgkin Disease drug therapy, Hodgkin Disease radiotherapy
- Abstract
Background: Positron emission tomography (PET)-based measures of baseline total-body tumor burden may improve risk stratification in intermediate-risk Hodgkin lymphoma (HL)., Materials and Methods: Evaluable patients were identified from a cohort treated homogeneously with the same combined modality regimen on the Children's Oncology Group AHOD0031 study. Eligible patients had high-quality baseline PET scans. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were each measured based on 15 thresholds for every patient. Univariate and multivariable Cox regression and Kaplan-Meier survival analyses assessed for an association of MTV and TLG with event-free survival (EFS)., Results: From the AHOD0031 cohort (n = 1712), 86 patients were identified who (i) were treated with four cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide (ABVE-PC) chemotherapy followed by involved field radiotherapy, and (ii) had a baseline PET scan that was amenable to quantitative analysis. Based on univariate Cox regression analysis, six PET-derived parameters were significantly associated with EFS. For each of these, Kaplan-Meier analyses and the log-rank test were used to compare patients with highest tumor burden (i.e., highest 15%) to the remainder of the cohort. EFS was significantly associated with all six PET parameters (all p < .029). In a multivariable model controlling for important covariates including disease bulk and response to chemotherapy, MTV
2BP was significantly associated with EFS (p = .012)., Conclusion: Multiple baseline PET-derived volumetric parameters were associated with EFS. MTV2BP was highly associated with EFS when controlling for disease bulk and response to chemotherapy. Incorporation of baseline MTV into risk-based treatment algorithms may improve outcomes in intermediate-risk HL., (© 2021 Wiley Periodicals LLC.)- Published
- 2021
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12. Automated quantification of baseline imaging PET metrics on FDG PET/CT images of pediatric Hodgkin lymphoma patients.
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Weisman AJ, Kim J, Lee I, McCarten KM, Kessel S, Schwartz CL, Kelly KM, Jeraj R, Cho SY, and Bradshaw TJ
- Abstract
Purpose: For pediatric lymphoma, quantitative FDG PET/CT imaging features such as metabolic tumor volume (MTV) are important for prognosis and risk stratification strategies. However, feature extraction is difficult and time-consuming in cases of high disease burden. The purpose of this study was to fully automate the measurement of PET imaging features in PET/CT images of pediatric lymphoma., Methods:
18 F-FDG PET/CT baseline images of 100 pediatric Hodgkin lymphoma patients were retrospectively analyzed. Two nuclear medicine physicians identified and segmented FDG avid disease using PET thresholding methods. Both PET and CT images were used as inputs to a three-dimensional patch-based, multi-resolution pathway convolutional neural network architecture, DeepMedic. The model was trained to replicate physician segmentations using an ensemble of three networks trained with 5-fold cross-validation. The maximum SUV (SUVmax ), MTV, total lesion glycolysis (TLG), surface-area-to-volume ratio (SA/MTV), and a measure of disease spread (Dmaxpatient ) were extracted from the model output. Pearson's correlation coefficient and relative percent differences were calculated between automated and physician-extracted features., Results: Median Dice similarity coefficient of patient contours between automated and physician contours was 0.86 (IQR 0.78-0.91). Automated SUVmax values matched exactly the physician determined values in 81/100 cases, with Pearson's correlation coefficient (R) of 0.95. Automated MTV was strongly correlated with physician MTV (R = 0.88), though it was slightly underestimated with a median (IQR) relative difference of - 4.3% (- 10.0-5.7%). Agreement of TLG was excellent (R = 0.94), with median (IQR) relative difference of - 0.4% (- 5.2-7.0%). Median relative percent differences were 6.8% (R = 0.91; IQR 1.6-4.3%) for SA/MTV, and 4.5% (R = 0.51; IQR - 7.5-40.9%) for Dmaxpatient , which was the most difficult feature to quantify automatically., Conclusions: An automated method using an ensemble of multi-resolution pathway 3D CNNs was able to quantify PET imaging features of lymphoma on baseline FDG PET/CT images with excellent agreement to reference physician PET segmentation. Automated methods with faster throughput for PET quantitation, such as MTV and TLG, show promise in more accessible clinical and research applications.- Published
- 2020
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13. Response-adapted therapy for the treatment of children with newly diagnosed high risk Hodgkin lymphoma (AHOD0831): a report from the Children's Oncology Group.
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Kelly KM, Cole PD, Pei Q, Bush R, Roberts KB, Hodgson DC, McCarten KM, Cho SY, and Schwartz C
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- Adolescent, Bleomycin administration & dosage, Child, Child, Preschool, Cyclophosphamide administration & dosage, Doxorubicin administration & dosage, Drug Administration Schedule, Drug Monitoring methods, Etoposide administration & dosage, Female, Hodgkin Disease diagnostic imaging, Hodgkin Disease pathology, Hodgkin Disease radiotherapy, Humans, Ifosfamide administration & dosage, Male, Neoplasm Staging, Positron-Emission Tomography methods, Prednisone administration & dosage, Prospective Studies, Radiotherapy, Adjuvant, Recurrence, Treatment Outcome, Vincristine administration & dosage, Vinorelbine administration & dosage, Young Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Hodgkin Disease drug therapy
- Abstract
The AHOD0831 study for paediatric patients with high risk Hodgkin lymphoma tested a response-based approach designed to limit cumulative alkylator exposure and reduce radiation volumes. Patients (Stage IIIB/IVB) received two cycles of ABVE-PC (doxorubicin, bleomycin, vincristine, etoposide, prednisone, cyclophosphamide). Rapid early responders [RER, no positron emission tomography (PET) activity above mediastinal blood pool] were consolidated with 2 cycles of ABVE-PC. Slow early responders (SER) received 2 cycles of ifosfamide/vinorelbine and 2 cycles of ABVE-PC. Radiotherapy was administered to sites of initial bulk and/or SER. By intent-to-treat analysis, 4-year second event-free survival (EFS; freedom from second relapse or malignancy) was 91·9% [95% confidence interval (CI): 86·1-95·3%], below the projected baseline of 95% (P = 0·038). Five-year first EFS and overall survival (OS) rates are 79·1% (95% CI: 71·5-84·8%) and 95% (95% CI: 88·8-97·8%). Eight of 11 SER patients with persistent PET positive lesions at the end of chemotherapy had clinical evidence of active disease (3 biopsy-proven, 5 with progressive disease or later relapses). Although this response-directed approach did not reach the ambitiously high pre-specified target for second EFS, EFS and OS rates are comparable with results of recent trials despite the reduction in radiotherapy volumes from historical involved fields. Persistent PET at end of chemotherapy identifies a cohort at an especially high risk for relapse/early progression., (© 2019 British Society for Haematology and John Wiley & Sons Ltd.)
- Published
- 2019
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14. Imaging for diagnosis, staging and response assessment of Hodgkin lymphoma and non-Hodgkin lymphoma.
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McCarten KM, Nadel HR, Shulkin BL, and Cho SY
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- Child, Hodgkin Disease pathology, Hodgkin Disease therapy, Humans, Lymphoma, Non-Hodgkin pathology, Lymphoma, Non-Hodgkin therapy, Neoplasm Staging, Hodgkin Disease diagnostic imaging, Lymphoma, Non-Hodgkin diagnostic imaging
- Abstract
Hodgkin lymphoma and non-Hodgkin lymphoma are common malignancies in children and are now highly treatable. Imaging plays a major role in diagnosis, staging and response using conventional CT and MRI and metabolic imaging with positron emission tomography (PET)/CT and PET/MRI. Cross-sectional imaging has replaced staging laparotomy and splenectomy by demonstrating abdominal nodal groups and organ involvement. [F-18]2-fluoro-2-deoxyglucose (FDG) PET provides information on bone marrow involvement, and MRI elucidates details of cortical bone and confirmation of bone marrow involvement. The staging system for Hodgkin lymphoma is the Ann Arbor system with Cotswald modifications and is based on imaging, whereas the non-Hodgkin staging system is the St. Jude Classification by Murphy or the more recent revised International Pediatric Non-Hodgkin Lymphoma Staging System (IPNHLSS). Because all pediatric lymphomas are metabolically FDG-avid and identify all nodal, solid organ, cortical bone and bone marrow disease, staging evaluations require FDG PET as PET/CT or PET/MRI in both Hodgkin and non-Hodgkin lymphoma. Both diseases have in common issues of airway compromise at presentation demonstrated by imaging. Differences exist in that Hodgkin lymphoma has several independent poor prognostic factors seen by imaging such as large mediastinal adenopathy, Stage IV disease, systemic symptoms, pleural effusion and pericardial effusion. Non-Hodgkin lymphoma includes more organ involvement such as renal, ovary, central nervous system and skin. Early or interim PET-negative scans are a reliable indicator of improved clinical outcome and optimize risk-adapted therapy and patient management; imaging may not, however, predict who will relapse. A recent multicenter trial has concluded that it is usually sufficient for pediatric lymphoma at staging and interim assessment to evaluate children with PET imaging from skull base to mid-thigh. Various systems of assessment of presence of disease or response are used, including the Deauville visual scale, where avidity is compared to liver; Lugano, which includes size change as part of response; or quantitative PET, which uses standardized uptake values to define more accurate response. Newer methods of immunotherapy can produce challenges in FDG PET evaluation because of inflammatory changes that may not represent disease.
- Published
- 2019
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15. Significance of pleural effusion at diagnosis in pediatric Hodgkin lymphoma: a report from Children's Oncology Group protocol AHOD0031.
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McCarten KM, Metzger ML, Drachtman RA, Pei Q, Friedman DL, Schwartz CL, and Kelly KM
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- Adolescent, Child, Female, Fluorodeoxyglucose F18, Hodgkin Disease drug therapy, Hodgkin Disease pathology, Humans, Male, Neoplasm Staging, Positron Emission Tomography Computed Tomography, Prognosis, Radiopharmaceuticals, Retrospective Studies, Risk Factors, Hodgkin Disease diagnostic imaging, Pleural Effusion diagnostic imaging
- Abstract
Background: Pleural effusion at presentation in Hodgkin lymphoma has been associated with inferior outcome but has not been systematically evaluated., Objective: To determine whether pleural effusion at presentation in children with Hodgkin lymphoma is a primary indicator of poor prognosis or secondary to associated factors., Materials and Methods: Children's Oncology Group (COG) AHOD0031, a randomized, response-based, centrally reviewed protocol, enrolled 1,712 eligible patients <22 years of age with initial presentation of intermediate risk, biopsy-proven Hodgkin lymphoma; 1,423 had available imaging for retrospective review. We coded effusions as fluid-only or with associated pleural nodule or adjacent lung or bone involvement and correlated this with disease stage, tumor response, large mediastinal adenopathy, and mass effect on the superior vena cava (SVC) and left innominate vein. We recorded change in size and character of effusions post-chemotherapy., Results: Pleural effusions were present in 217, with 204 having fluid-only and 13 having associated solid components. Patients with effusions were more likely to have large mediastinal adenopathy (P<0.0001), be slow early responders (P<0.0001) and have higher relapse rate (P<0.0001). Vascular compression was not significantly correlated with pleural effusion. Of 121 patients with adequate [F-18]2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/CT imaging, no FDG PET avidity was seen in any pleural effusion but was present in solid components. The side of the pleural effusion in those with moderate or large effusions was highly associated with the side of large mediastinal adenopathy (P<0.0001). Statistical analysis indicates that pleural effusion is an independent risk factor for poorer response and relapse., Conclusion: Pleural effusion in Hodgkin lymphoma is an important independent poor prognostic indicator for response and relapse.
- Published
- 2018
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16. Pericardial effusion in Hodgkin lymphoma: a report from the Children's Oncology Group AHOD0031 protocol.
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Marks LJ, McCarten KM, Pei Q, Friedman DL, Schwartz CL, and Kelly KM
- Subjects
- Adolescent, Bleomycin administration & dosage, Bleomycin adverse effects, Chemoradiotherapy methods, Child, Cisplatin administration & dosage, Cisplatin adverse effects, Cyclophosphamide administration & dosage, Cyclophosphamide adverse effects, Cytarabine administration & dosage, Cytarabine adverse effects, Dexamethasone administration & dosage, Dexamethasone adverse effects, Etoposide administration & dosage, Etoposide adverse effects, Female, Humans, Male, Prednisone administration & dosage, Prednisone adverse effects, Vincristine administration & dosage, Vincristine adverse effects, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Antineoplastic Combined Chemotherapy Protocols adverse effects, Chemoradiotherapy adverse effects, Hodgkin Disease epidemiology, Hodgkin Disease therapy, Pericardial Effusion epidemiology, Pericardial Effusion etiology
- Published
- 2018
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17. Brentuximab vedotin with gemcitabine for paediatric and young adult patients with relapsed or refractory Hodgkin's lymphoma (AHOD1221): a Children's Oncology Group, multicentre single-arm, phase 1-2 trial.
- Author
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Cole PD, McCarten KM, Pei Q, Spira M, Metzger ML, Drachtman RA, Horton TM, Bush R, Blaney SM, Weigel BJ, and Kelly KM
- Subjects
- Adolescent, Age Factors, Antineoplastic Combined Chemotherapy Protocols adverse effects, Brentuximab Vedotin, Canada, Deoxycytidine administration & dosage, Deoxycytidine adverse effects, Drug Administration Schedule, Drug Resistance, Neoplasm, Female, Hodgkin Disease pathology, Humans, Immunoconjugates adverse effects, Male, Recurrence, Time Factors, Treatment Outcome, United States, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Deoxycytidine analogs & derivatives, Hodgkin Disease drug therapy, Immunoconjugates administration & dosage
- Abstract
Background: Patients with primary refractory Hodgkin's lymphoma or early relapse have a poor prognosis. Although many salvage regimens have been developed, there is no standard of care. Brentuximab vedotin and gemcitabine have been shown to be active in patients with relapsed or refractory Hodgkin's lymphoma when used as monotherapy, and each has been successfully used in combination with other agents. Preclinical data suggest that brentuximab vedotin can sensitise lymphoma cells to gemcitabine, supporting the use of the combination. We aimed to define the safety and efficacy of brentuximab vedotin with gemcitabine in children and young adults with primary refractory Hodgkin's lymphoma or early relapse., Methods: In this Children's Oncology Group, multicentre, single-arm, phase 1-2 trial, we recruited patients with Hodgkin's lymphoma from hospitals across the USA and Canada. Eligible patients were aged younger than 30 years, had no previous brentuximab vedotin exposure, and had primary refractory disease or relapse of less than 1 year from completion of initial treatment. Each 21-day cycle consisted of 1000 mg/m
2 intravenous gemcitabine on days 1 and 8 and intravenous brentuximab vedotin on day 1 at 1·4 mg/kg or 1·8 mg/kg. The primary objectives were to establish the recommended phase 2 dose of brentuximab vedotin in this combination, the safety of the combination, and the proportion of patients who achieved a complete response among those treated at the recommended phase 2 level, within four cycles of treatment. This trial is registered with ClinicalTrials.gov, number NCT01780662., Findings: Between Feb 5, 2013, and Aug 19, 2016, 46 patients were enrolled, including one who was found to be ineligible, in the two phases of the study. The recommended phase 2 dose of brentuximab vedotin was 1·8 mg/kg in combination with gemcitabine 1000 mg/m2 . 24 (57%) of 42 evaluable patients (95% CI 41-72) given this dose level had a complete response within the first four cycles of treatment. Four (31%) of 13 patients with a partial response or stable disease had all target lesions with Deauville scores of 3 or less after cycle 4. By modern response criteria, these were also complete responses (total number with complete response 28 [67%] of 42 [95% CI 51-80]). The most common grade 3-4 adverse events in all 42 participants treated at the recommended phase 2 dose were neutropenia (15 [36%]), rash (15 [36%]), transaminitis (9 [21%]), and pruritus (4 [10%]). There were no treatment-related deaths., Interpretation: Brentuximab vedotin with gemcitabine is a safe combination treatment with a tolerable toxicity profile for patients with primary refractory Hodgkin's lymphoma or high-risk relapse. The preliminary activity of this combination shown in this trial warrants further investigation in randomised controlled trials., Funding: National Institutes of Health and the St. Baldrick's Foundation., (Copyright © 2018 Elsevier Ltd. All rights reserved.)- Published
- 2018
- Full Text
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18. Results of the AHOD0431 trial of response adapted therapy and a salvage strategy for limited stage, classical Hodgkin lymphoma: A report from the Children's Oncology Group.
- Author
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Keller FG, Castellino SM, Chen L, Pei Q, Voss SD, McCarten KM, Senn SL, Buxton AB, Bush R, Constine LS, and Schwartz CL
- Subjects
- Adolescent, Adult, Blood Sedimentation drug effects, Child, Child, Preschool, Combined Modality Therapy methods, Female, Hodgkin Disease epidemiology, Hodgkin Disease pathology, Hodgkin Disease radiotherapy, Humans, Male, Neoplasm Recurrence, Local epidemiology, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local radiotherapy, Positron-Emission Tomography, Progression-Free Survival, Remission Induction, Young Adult, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Hodgkin Disease drug therapy, Neoplasm Recurrence, Local drug therapy, Salvage Therapy methods
- Abstract
Background: The Children's Oncology Group AHOD0431 study evaluated a response-directed treatment paradigm in which minimal initial chemotherapy and low-dose radiation was received only by patients who did not achieve a complete remission, and a chemotherapy/low-dose radiation salvage regimen was received by those who had a protocol-defined, low-risk recurrence., Methods: Patients younger than 21 years who had stage IA or IIA nonbulky disease were eligible. The treatment strategy was evaluated by determining the proportion that received minimal chemotherapy alone, the proportion that had a first or second remission without the receipt of high-dose chemotherapy/stem cell rescue or higher dose involved-field radiation therapy (>21 grays), and overall survival., Results: In total, 278 patients were eligible. At 4 years, 49.0% had received minimal chemotherapy and no radiation, 88.8% were in remission without receiving high-dose chemotherapy with stem cell rescue or >21 grays of involved-field radiation therapy, and the overall survival rate was 99.6%. Patients who had mixed cellularity histology had a 4-year event-free survival (EFS) rate of 95.2%, which was significantly better than the 75.8% EFS for those who had nodular sclerosis histology (P = .008). A red blood cell sedimentation rate ≤20 mm/hour and a negative fluorodeoxyglucose-positron emission tomography scan after 1 cycle of chemotherapy (PET1) were associated with a favorable EFS outcome. The study was closed early when the receipt of radiation therapy exceeded the predefined monitoring boundary., Conclusions: This limited chemotherapy response-based approach was successful in patients who had a negative PET1 result, had MC histology, or had a low red blood cell sedimentation rate. In this treatment paradigm, evaluation of increased chemotherapy intensity or the integration of active new agents is indicated for patients who have nodular sclerosis histology with a high ESR or who have a positive PET1 result. Cancer 2018. © 2018 American Cancer Society., (© 2018 American Cancer Society.)
- Published
- 2018
- Full Text
- View/download PDF
19. Patterns of relapse from a phase 3 Study of response-based therapy for intermediate-risk Hodgkin lymphoma (AHOD0031): a report from the Children's Oncology Group.
- Author
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Dharmarajan KV, Friedman DL, Schwartz CL, Chen L, FitzGerald TJ, McCarten KM, Kessel SK, Iandoli M, Constine LS, and Wolden SL
- Subjects
- Adolescent, Bleomycin administration & dosage, Child, Combined Modality Therapy methods, Cyclophosphamide administration & dosage, Doxorubicin administration & dosage, Drug Administration Schedule, Etoposide administration & dosage, Follow-Up Studies, Hodgkin Disease pathology, Humans, Male, Prednisone administration & dosage, Recurrence, Risk, Treatment Outcome, Vincristine administration & dosage, Young Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Hodgkin Disease drug therapy, Hodgkin Disease radiotherapy
- Abstract
Purpose: The study was designed to determine whether response-based therapy improves outcomes in intermediate-risk Hodgkin lymphoma. We examined patterns of first relapse in the study., Patients and Methods: From September 2002 to July 2010, 1712 patients <22 years old with stage I-IIA with bulk, I-IIAE, I-IIB, and IIIA-IVA with or without doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide were enrolled. Patients were categorized as rapid (RER) or slow early responders (SER) after 2 cycles of doxorubicin, bleomycin, vincristine, etoposide, prednisone, and cyclophosphamide (ABVE-PC). The SER patients were randomized to 2 additional ABVE-PC cycles or augmented chemotherapy with 21 Gy involved field radiation therapy (IFRT). RER patients were stipulated to undergo 2 additional ABVE-PC cycles and were then randomized to 21 Gy IFRT or no further treatment if complete response (CR) was achieved. RER without CR patients were non-randomly assigned to 21 Gy IFRT. Relapses were characterized without respect to site (initial, new, or both; and initial bulk or initial nonbulk), and involved field radiation therapy field (in-field, out-of-field, or both). Patients were grouped by treatment assignment (SER; RER/no CR; RER/CR/IFRT; and RER/CR/no IFRT). Summary statistics were reported., Results: At 4-year median follow-up, 244 patients had experienced relapse, 198 of whom were fully evaluable for review. Those who progressed during treatment (n=30) or lacked relapse imaging (n=16) were excluded. The median time to relapse was 12.8 months. Of the 198 evaluable patients, 30% were RER/no CR, 26% were SER, 26% were RER/CR/no IFRT, 16% were RER/CR/IFRT, and 2% remained uncategorized. The 74% and 75% relapses involved initially bulky and nonbulky sites, respectively. First relapses rarely occurred at exclusively new or out-of-field sites. By contrast, relapses usually occurred at nodal sites of initial bulky and nonbulky disease., Conclusion: Although response-based therapy has helped define treatment for selected RER patients, it has not improved outcome for SER patients or facilitated refinement of IFRT volumes or doses., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
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20. Radiotherapy quality assurance report from children's oncology group AHOD0031.
- Author
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Dharmarajan KV, Friedman DL, FitzGerald TJ, McCarten KM, Constine LS, Chen L, Kessel SK, Iandoli M, Laurie F, Schwartz CL, and Wolden SL
- Subjects
- Adolescent, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bleomycin administration & dosage, Child, Child, Preschool, Cyclophosphamide administration & dosage, Doxorubicin administration & dosage, Etoposide administration & dosage, Hodgkin Disease diagnostic imaging, Hodgkin Disease drug therapy, Humans, Infant, Infant, Newborn, Prednisone administration & dosage, Radiography, Vincristine administration & dosage, Young Adult, Guideline Adherence, Hodgkin Disease radiotherapy, Quality Assurance, Health Care
- Abstract
Purpose: A phase 3 trial assessing response-based therapy in intermediate-risk Hodgkin lymphoma mandated real-time central review of involved field radiation therapy (IFRT) and imaging records by a centralized review center to maximize protocol compliance. We report the impact of centralized radiation therapy review on protocol compliance., Methods and Materials: Review of simulation films, port films, and dosimetry records was required before and after treatment. Records were reviewed by study-affiliated or review center-affiliated radiation oncologists. A deviation of 6% to 10% from protocol-specified dose was scored as "minor"; a deviation of >10% was "major." A volume deviation was scored as "minor" if margins were less than specified or "major" if fields transected disease-bearing areas. Interventional review and final compliance review scores were assigned to each radiation therapy case and compared., Results: Of 1712 patients enrolled, 1173 underwent IFRT at 256 institutions in 7 countries. An interventional review was performed in 88% of patients and a final review in 98%. Overall, minor and major deviations were found in 12% and 6% of patients, respectively. Among the cases for which ≥1 pre-IFRT modification was requested by the Quality Assurance Review Center and subsequently made by the treating institution, 100% were made compliant on final review. By contrast, among the cases for which ≥1 modification was requested but not made by the treating institution, 10% were deemed compliant on final review., Conclusions: In a large trial with complex treatment pathways and heterogeneous radiation therapy fields, central review was performed in a large percentage of cases before IFRT and identified frequent potential deviations in a timely manner. When suggested modifications were performed by the institutions, deviations were almost eliminated., Competing Interests: Conflicts: None, (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
- View/download PDF
21. Lemierre's syndrome in 15-year-old female.
- Author
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LoVerme W and McCarten KM
- Subjects
- Adolescent, Female, Fever etiology, Humans, Lemierre Syndrome complications, Magnetic Resonance Imaging, Neck Pain etiology, Tomography, X-Ray Computed, Lemierre Syndrome diagnosis
- Published
- 2013
22. Long-term followup of primary nonrefluxing megaureter.
- Author
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Di Renzo D, Aguiar L, Cascini V, Di Nicola M, McCarten KM, Ellsworth PI, Chiesa PL, and Caldamone AA
- Subjects
- Child, Child, Preschool, Cohort Studies, Confidence Intervals, Disease Progression, Female, Follow-Up Studies, Humans, Infant, Infant, Newborn, Kaplan-Meier Estimate, Logistic Models, Male, Odds Ratio, Patient Selection, Radioisotope Renography, Retrospective Studies, Risk Assessment, Time Factors, Treatment Outcome, Ureter pathology, Ureteral Obstruction complications, Ureteral Obstruction surgery, Urogenital Abnormalities diagnosis, Vesico-Ureteral Reflux, Remission, Spontaneous, Ureter abnormalities, Ureteral Obstruction therapy, Urogenital Abnormalities therapy
- Abstract
Purpose: We evaluated outcomes of nonoperative management of primary nonrefluxing megaureter at long-term followup to identify clinical predictors of spontaneous resolution., Materials and Methods: A total of 75 patients (88 primary megaureters) were diagnosed between 1990 and 2005 and followed for more than 6 months. Of the patients 63 (74 primary megaureters) were included in the main study population. Indications for surgery were obstructive hydroureteronephrosis, functional impairment and persistent symptoms., Results: Of the 74 primary megaureters 20 (27%) required surgery up to 7 years after diagnosis. Surgery was not indicated in 82% of primary megaureters with grade I or II hydronephrosis vs 62.9% of those with grade III or higher hydronephrosis (difference not significant), nor in 76.5% of types I and II primary megaureters vs 33.3% of type III primary megaureters (p = 0.040), 78.7% of renal units with differential function 40% or greater vs 0% with differential function less than 40% (p = 0.027), 80% of primary megaureters with a nonobstructive washout pattern vs 44.4% with an intermediate/obstructive pattern (p = 0.032), 67.9% of patients with perinatal presentation vs 25% with postneonatal presentation (p = 0.008) or 63.2% of patients presenting with symptoms vs 76.4% of those who were asymptomatic (difference not significant). On multivariate analysis age at presentation and washout pattern were significant predictors of spontaneous resolution., Conclusions: Most cases of primary megaureter resolve spontaneously or improve without loss of function or development of symptoms. Careful observation allows surgery to be delayed beyond the neonatal period in most patients. Long-term followup is recommended because symptoms can develop years later. Washout pattern and age at presentation are statistically significant predictors of spontaneous resolution., (Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
23. Early [¹⁸F]fluorodeoxyglucose positron emission tomography-based response evaluation after treatment with gemcitabine and vinorelbine for refractory Hodgkin disease: a children's oncology group report.
- Author
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Cole PD, McCarten KM, Drachtman RA, Alarcon Pd, Chen L, Trippett TM, and Schwartz CL
- Subjects
- Deoxycytidine therapeutic use, Hodgkin Disease prevention & control, Humans, Recurrence, Research Report, Retrospective Studies, Survival Analysis, Vinblastine therapeutic use, Vinorelbine, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Deoxycytidine analogs & derivatives, Fluorodeoxyglucose F18, Hodgkin Disease diagnostic imaging, Hodgkin Disease drug therapy, Positron-Emission Tomography, Vinblastine analogs & derivatives
- Abstract
The International Harmonization Project defined complete response (CR) after treatment for Hodgkin disease (HD) by absence of fluorodeoxyglucose avidity, regardless of the size of residual masses. Residual avidity after initial treatment is known to predict inferior survival. In the setting of retrieval therapy, early positron emission tomography (PET) scans may improve assessment of treatment efficacy. Retrospective analysis after 2 cycles of gemcitabine and vinorelbine for refractory HD revealed 6 CR among 13 patients by PET and 1 CR in 13 by computed tomography (CT). No relationship between PET response and event-free or overall survival could be discerned, presumably because of the heterogeneity of subsequent therapies.
- Published
- 2010
- Full Text
- View/download PDF
24. Quality of radiotherapy reporting in randomized controlled trials of Hodgkin's lymphoma and non-Hodgkin's lymphoma: in regard to Bekelman and Yahalom (Int J Radiat Oncol Biol Phys 2009;73:492-498).
- Author
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Fitzgerald TJ, Bishop-Jodoin M, Cicchetti MG, Hanusik R, Kessel S, Laurie F, McCarten KM, Moni J, Pieters RS, Rosen N, Ulin K, Urie M, Chauvenet AR, Constine LS, Deye J, Vikram B, Friedman D, Marcus RB Jr, Mendenhall NP, Williams JL, Purdy J, Saltz J, Schwartz CL, White KS, and Wolden S
- Subjects
- Child, Guideline Adherence, Hodgkin Disease drug therapy, Humans, Clinical Protocols standards, Hodgkin Disease radiotherapy, Quality Assurance, Health Care standards, Radiation Oncology standards
- Published
- 2010
- Full Text
- View/download PDF
25. Disease progression in Hutchinson-Gilford progeria syndrome: impact on growth and development.
- Author
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Gordon LB, McCarten KM, Giobbie-Hurder A, Machan JT, Campbell SE, Berns SD, and Kieran MW
- Subjects
- Adolescent, Body Weight, Bone Demineralization, Pathologic genetics, Bone Resorption genetics, Bone and Bones abnormalities, Child, Child, Preschool, Contracture genetics, Female, Femur Head Necrosis genetics, Humans, Incisor abnormalities, Infant, Infant, Newborn, Joint Diseases genetics, Longitudinal Studies, Male, Prospective Studies, Retrospective Studies, Tooth Eruption, Bone Diseases, Developmental genetics, Developmental Disabilities genetics, Disease Progression, Progeria genetics
- Abstract
Objectives: Hutchinson-Gilford progeria syndrome is a rare and uniformly fatal segmental "premature aging" disease that affects a variety of organ systems. We sought to more clearly define the bone and weight abnormalities in patients with progeria as potential outcome parameters for prospective clinical trials., Patients and Methods: We collected and analyzed longitudinal medical information, both retrospectively and prospectively, from a total of 41 children with Hutchinson-Gilford progeria syndrome spanning 14 countries, from the Progeria Research Foundation Medical and Research Database at the Brown University Center for Gerontology., Results: In addition to a number of previously well-defined phenotypic findings in children with progeria, this study identified abnormalities in the eruption of secondary incisors lingually and palatally in the mandible and maxilla, respectively. Although bony structures appeared normal in early infancy, clavicular resorption, coxa valga, avascular necrosis of the femoral head, modeling abnormalities of long bones with slender diaphyses, flared metaphyses, and overgrown epiphyses developed. Long bones showed normal cortical thickness centrally and progressive focal demineralization peripherally. The most striking finding identified in the retrospective data set of 35 children was an average weight increase of only 0.44 kg/year, beginning at approximately 24 months of age and persisting through life, with remarkable intrapatient linearity. This rate is >2 SD below normal weight gain for any corresponding age and sharply contrasts with the parabolic growth pattern for normal age- and gender-matched children. This finding was also confirmed prospectively., Conclusions: Our analysis shows evidence of a newly identified abnormal growth pattern for children with Hutchinson-Gilford progeria syndrome. The skeletal and dental findings are suggestive of a developmental dysplasia rather than a classical aging process. The presence of decreased and linear weight gain, maintained in all of the patients after the age of 2 years, provides the ideal parameter on which altered disease status can be assessed in clinical trials.
- Published
- 2007
- Full Text
- View/download PDF
26. Pediatric splenic injuries with a contrast blush: successful nonoperative management without angiography and embolization.
- Author
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Cloutier DR, Baird TB, Gormley P, McCarten KM, Bussey JG, and Luks FI
- Subjects
- Adolescent, Angiography, Child, Child, Preschool, Embolization, Therapeutic, Emergencies, Female, Humans, Incidence, Infant, Male, Radiography, Interventional, Risk Factors, Single-Blind Method, Spleen blood supply, Spleen diagnostic imaging, Splenectomy, Splenic Rupture epidemiology, Splenic Rupture prevention & control, Treatment Outcome, Unnecessary Procedures, Wounds and Injuries diagnostic imaging, Arteries injuries, Contrast Media pharmacokinetics, Extravasation of Diagnostic and Therapeutic Materials, Hemorrhage diagnostic imaging, Spleen injuries, Tomography, X-Ray Computed
- Abstract
Background: The presence of a contrast blush on computed tomography (CT) in adult splenic trauma is a risk factor for failure of nonoperative management. Arterial embolization is believed to reduce this failure rate. The significance of a blush in pediatric trauma is unknown. The authors evaluated the outcome of children with blunt splenic trauma and contrast extravasation., Methods: The trauma registry was queried for all pediatric patients with blunt splenic injuries. Admission CT was reviewed for injury grade and presence of an arterial blush by a radiologist blinded to patient outcome. Hospital and office charts were reviewed for success of nonoperative management, late splenic rupture, and other complications., Results: One hundred seven children with blunt splenic trauma were identified over a 6-year period. Mean injury grade was 2.9. Six patients required emergency splenectomy. An additional 7 patients met hemodynamic criteria for surgical intervention (3 splenectomies, 4 splenorrhaphies). Admission CT was available in 63 patients. An arterial blush was identified in 5 (9.7%). Four remained stable and were treated conservatively. One underwent splenectomy for hemodynamic instability. There were no cases of delayed splenic rupture, failed nonoperative treatment, or long-term complications., Conclusions: Contrast blush in children with blunt splenic trauma is rare, and its presence alone does not appear to predict delayed rupture or failure of nonoperative treatment. Based on this limited series, splenic artery embolization does not have a place in the management of splenic injuries in children.
- Published
- 2004
- Full Text
- View/download PDF
27. Importance of radiology clerkships in teaching medical students life-threatening abnormalities on conventional chest radiographs.
- Author
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Scheiner JD, Noto RB, and McCarten KM
- Subjects
- Competency-Based Education, Humans, Radiography, Rhode Island, Students, Medical, Clinical Clerkship, Clinical Competence statistics & numerical data, Radiology education, Thoracic Diseases diagnostic imaging
- Abstract
Rationale and Objectives: The purpose of this study was to investigate the ability of medical students who had already completed medicine and surgery clerkships to identify life-threatening abnormalities on conventional chest radiographs., Materials and Methods: From May 2000 to August 2001, 72 consecutive 3rd- and 4th-year medical students enrolled in the radiology clerkship at Rhode Island Hospital completed examinations before and after the radiology clerkship. During the examination, they were asked to identify acute abnormalities on five conventional chest radiographs. Only students who had already completed both medicine and surgery clerkships were included in this prospective study., Results: Before the radiology clerkship, the frequency of correct diagnoses of pneumothorax, pneumoperitoneum, congestive heart failure, misplaced endotracheal tube, and misplaced feeding tube were 40%, 61%, 57%, 6%, and 6%, respectively. After the radiology clerkship, these findings were correctly identified more than 94% of the time (P < .001)., Conclusion: Learning to identify life-threatening abnormalities on conventional chest radiographs through medicine and surgery clerkships is insufficient. The radiology clerkship provides a unique educational experience that significantly improves these abilities.
- Published
- 2002
- Full Text
- View/download PDF
28. Level of in utero cocaine exposure and neonatal ultrasound findings.
- Author
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Frank DA, McCarten KM, Robson CD, Mirochnick M, Cabral H, Park H, and Zuckerman B
- Subjects
- Cocaine analogs & derivatives, Cocaine analysis, Dose-Response Relationship, Drug, Female, Fetus drug effects, Humans, Infant, Newborn, Intracranial Hemorrhages diagnostic imaging, Longitudinal Studies, Meconium chemistry, Odds Ratio, Pregnancy, Prospective Studies, Risk Factors, Cocaine-Related Disorders complications, Echoencephalography, Intracranial Hemorrhages chemically induced, Pregnancy Complications
- Abstract
Objective: To assess whether there is an association between the level of in utero cocaine exposure and findings on neonatal cranial ultrasound, controlling for potentially confounding variables., Study Design: In a prospective longitudinal study, three cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or of meconium benzoylecogonine concentration) or lighter cocaine exposure (all others). Neonatal ultrasounds from 241 well, term infants were read by a single radiologist who was masked to the exposure group., Results: Infants with lighter cocaine exposure did not differ from the unexposed infants on any ultrasound findings. After controlling for infant gender, gestational age, and birth weight z scores and for maternal parity, blood pressure in labor, ethnicity, and use of cigarettes, alcohol, and marijuana during pregnancy, the more heavily cocaine-exposed infants were more likely than the unexposed infants to show subependymal hemorrhage in the caudothalamic groove (covariate adjusted odds ratio: 3.88; 95% confidence interval: 1.45, 10.35)., Conclusions: This is the first study to demonstrate that ultrasound findings suggestive of vascular injury to the neonatal central nervous system are related to the level of prenatal cocaine exposure. Inconsistency in previous research in identifying an association between prenatal cocaine exposure and neonatal cranial ultrasound findings may reflect failure to consider dose effects.
- Published
- 1999
- Full Text
- View/download PDF
29. Commentary: atlantoaxial instability in Down syndrome: reassessment by the Committee on Sports Medicine and Fitness of the American Academy of Pediatrics.
- Author
-
O'Connor JF, Cranley WR, McCarten KM, and Feingold M
- Subjects
- Child, Humans, Joint Instability complications, Radiography, Spinal Cord Injuries prevention & control, Athletic Injuries prevention & control, Atlanto-Axial Joint diagnostic imaging, Down Syndrome complications, Joint Instability diagnostic imaging
- Published
- 1996
- Full Text
- View/download PDF
30. Imaging of musculoskeletal disorders in children.
- Author
-
O'Connor JF, Cranley WR, and McCarten KM
- Subjects
- Bone Lengthening, Child, Humans, Infant, Bone Diseases diagnosis, Diagnostic Imaging, Muscular Diseases diagnosis
- Abstract
A review of the year's literature on musculoskeletal disorders in infants and children includes many advances in imaging principles, especially MR imaging pulse sequences. We have not attempted to review these advances because the principles are essentially the same in children as in adults. We have confined this review to several topics including the importance of differentiating the findings in osteogenesis imperfecta from those in the abused child, limb-lengthening procedures in infants and children, the treatment of slipped upper femoral capital epiphysis, spinal anomalies, and skeletal abnormalities associated with cloacal exstrophy. A brief comment on cervical spine films in pediatric trauma patients is also included.
- Published
- 1991
31. Pediatric case of the day. Cardiac hemangioma.
- Author
-
Braverman RM, Lipshultz SE, McCarten KM, and Griscom NT
- Subjects
- Diagnostic Imaging, Heart Neoplasms pathology, Hemangioma pathology, Humans, Infant, Newborn, Heart Neoplasms congenital, Hemangioma congenital
- Published
- 1991
- Full Text
- View/download PDF
32. Radiographic manifestations of congenital anomalies of the spine.
- Author
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O'Connor JF, Cranley WR, McCarten KM, and Radkowski MA
- Subjects
- Humans, Radiography, Spine diagnostic imaging, Spine embryology, Syndrome, Spine abnormalities
- Abstract
Although the foregoing review of embryologic development and congenital anomalies of the spine in infants and children is necessarily brief, the most commonly encountered abnormalities have been reviewed, and when possible, an attempt has been made to cite the stage of embryologic development at which the various abnormalities originate. As noted, congenital abnormalities of the spine are relatively uncommon but may be of profound clinical significance. During the past decade, the most significant developments in the diagnosis and treatment of these abnormalities have been ultrasonography, CT scanning, and MR imaging. In the neonate, the spinal cord and neural outflow can be evaluated by ultrasonography until the osseous elements begin to fuse. Thereafter, MR imaging is the procedure of choice because it permits evaluation of the spine and spinal cord in all planes of imaging and provides detailed evaluation of the effect of osseous abnormalities on neural structures. Finally, plain radiographs of the spine for evaluation of neonates who have any of a spectrum of sacral dimples are rarely helpful, and in the presence of significant cutaneous or subcutaneous abnormalities, ultrasonography is the preferred modality for evaluation.
- Published
- 1991
33. Delayed appearance of right diaphragmatic hernia associated with group B streptococcal infection in newborns.
- Author
-
McCarten KM, Rosenberg HK, Borden S 4th, and Mandell GA
- Subjects
- Female, Gases, Hernia, Diaphragmatic etiology, Humans, Infant, Newborn, Intestines physiology, Male, Pleural Effusion diagnostic imaging, Pneumonia diagnostic imaging, Radiography, Streptococcus agalactiae, Time Factors, Hernia, Diaphragmatic diagnostic imaging, Infant, Newborn, Diseases diagnostic imaging, Streptococcal Infections complications, Streptococcal Infections diagnostic imaging
- Abstract
Right diaphragmatic hernia should be considered when an infant with Group B streptococcal infection shows deterioration. Although the diaphragm appears normal at first, increased density is seen in the right lower lobe shortly thereafter, indicating pneumonia and/or irregular aeration. Pleural effusion may develop over the next few days. Characteristically, the bowel gas on the right and the liver shadow gradually become elevated and the heart and mediastinal structures shift into the left hemithorax; loops of bowel may be seen in the right hemithorax as well. Static plain views should confirm hernia or eventration, necessitating immediate surgery.
- Published
- 1981
- Full Text
- View/download PDF
34. Renal ultrasonography in Beckwith-Wiedemann syndrome.
- Author
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McCarten KM, Cleveland RH, Simeone JF, and Aretz T
- Subjects
- Female, Humans, Infant, Newborn, Kidney Diseases diagnosis, Kidney Diseases pathology, Syndrome, Kidney Diseases congenital, Ultrasonography
- Published
- 1981
- Full Text
- View/download PDF
35. The area and volume of the sella turcica in childhood primary hypothyroidism.
- Author
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McCarten KM and Kuhns LR
- Subjects
- Adenoma diagnosis, Adolescent, Age Factors, Body Height, Bone Development, Child, Child, Preschool, Diagnosis, Differential, Humans, Hyperplasia diagnosis, Hypopituitarism diagnostic imaging, Hypothyroidism diagnosis, Infant, Pituitary Hormones, Anterior deficiency, Pituitary Neoplasms diagnosis, Radiography, Hypothyroidism diagnostic imaging, Sella Turcica diagnostic imaging
- Abstract
Sellar area and volume are compared to chronological age, stature, and osseous maturation (bone age) in a series of control children of short stature and in those with primary hypothyroidism and idoiopathic pituitary deficiencies. Sellar area is increased most significantly in relation to bone age in primary hypothyroidism; volume is less useful than area in the diagnosis of this disease.
- Published
- 1976
- Full Text
- View/download PDF
36. Enterocolonic fistula as a late complication of necrotizing enterocolitis.
- Author
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Paley RH, McCarten KM, and Cleveland RH
- Subjects
- Colonic Diseases diagnostic imaging, Colonic Diseases etiology, Enterocolitis, Pseudomembranous complications, Humans, Infant, Infant, Newborn, Intestinal Diseases diagnostic imaging, Intestinal Diseases etiology, Intestinal Fistula etiology, Intestinal Obstruction diagnostic imaging, Intestinal Obstruction etiology, Jejunum diagnostic imaging, Male, Radiography, Enterocolitis, Pseudomembranous diagnostic imaging, Intestinal Fistula diagnostic imaging
- Published
- 1979
- Full Text
- View/download PDF
37. The changing radiographic appearance of osteogenic sarcoma.
- Author
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McCarten KM, Jaffe N, and Kirkpatrick JA
- Subjects
- Adolescent, Adult, Bone Neoplasms secondary, Female, Humans, Lung Neoplasms diagnostic imaging, Lung Neoplasms secondary, Male, Osteosarcoma drug therapy, Prognosis, Radiography, Bone Neoplasms diagnostic imaging, Osteosarcoma diagnostic imaging
- Published
- 1980
38. Preduodenal portal vein: venography, ultrasonography, and review of the literature.
- Author
-
McCarten KM and Littlewood Teele R
- Subjects
- Adolescent, Duodenum, Humans, Male, Phlebography, Portal Vein diagnostic imaging, Pyloric Stenosis surgery, Ultrasonography, Portal Vein abnormalities
- Published
- 1978
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