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  1. Article ; Online: Central Nervous System Metastases in Pediatric Patients With Ewing Sarcoma.

    Slatnick, Leonora R / Cost, Carrye / Garrington, Timothy / Donaldson, Nathan / Macy, Margaret E

    Journal of pediatric hematology/oncology

    2024  Volume 46, Issue 2, Page(s) e180–e183

    Abstract: Metastatic central nervous system (CNS) involvement is rare in pediatric primary extracranial Ewing sarcoma (ES). We describe the incidence and course of 6 patients with extracranial ES who developed metastatic CNS lesions treated at a single institution. ...

    Abstract Metastatic central nervous system (CNS) involvement is rare in pediatric primary extracranial Ewing sarcoma (ES). We describe the incidence and course of 6 patients with extracranial ES who developed metastatic CNS lesions treated at a single institution. The median time to CNS disease detection was 16.3 months (10.0-28.3 months). Event-free and overall survival after CNS disease detection were 1.9 months (0.4 to 10.3 months) and 4.6 months (1.1 to 50.9 months), respectively. One patient was alive at the time of analysis. Clinical status and ability to obtain disease control should be considered when making decisions regarding aggressive interventions in these patients with poor prognosis.
    MeSH term(s) Child ; Humans ; Sarcoma, Ewing/pathology ; Central Nervous System Neoplasms/therapy ; Central Nervous System Neoplasms/secondary ; Incidence ; Neoplasms, Second Primary ; Retrospective Studies ; Central Nervous System Diseases ; Central Nervous System/pathology
    Language English
    Publishing date 2024-02-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1231152-2
    ISSN 1536-3678 ; 1077-4114 ; 0192-8562
    ISSN (online) 1536-3678
    ISSN 1077-4114 ; 0192-8562
    DOI 10.1097/MPH.0000000000002825
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  2. Article ; Online: Investigating the Impact of Tumor Biology and Social Determinants on Time to Diagnosis and Stage at Presentation of Wilms Tumor.

    Collins, Adele / Molina Kuna, Elizabeth / Anderson-Mellies, Amy / Cost, Carrye / Green, Adam L

    Journal of pediatric hematology/oncology

    2024  Volume 46, Issue 3, Page(s) 147–153

    Abstract: Delays in diagnosis and time to diagnosis generally are used interchangeably in cancer disparity research, but these terms may have important differences. Although these terms are related, we hypothesize that time to diagnosis is determined by the ... ...

    Abstract Delays in diagnosis and time to diagnosis generally are used interchangeably in cancer disparity research, but these terms may have important differences. Although these terms are related, we hypothesize that time to diagnosis is determined by the aggressiveness of the tumor based on intrinsic factors such as tumor biology, whereas delays in diagnosis are caused by extrinsic factors such as socioeconomic status, leading to presentation at higher stage of disease due to barriers of care. We conducted a retrospective study of 306 patients diagnosed with Wilms tumor at Children's Hospital Colorado between 1971 and 2016 identifying patient barriers as extrinsic markers and using unfavorable histology and loss of heterozygosity as markers of aggressive tumor biology. Multivariable logistic regression was performed. Patients with Medicaid were more likely to present greater than 4 days after initial symptoms compared to those with private insurance, and those with housing concerns were more likely to be diagnosed greater than 9 days from initial symptoms. Tumor biology was noted to be associated with higher stage at diagnosis, but patient barriers were not. These findings suggest the interplay between tumor biology, patient barriers, diagnostic timing, and stage at diagnosis is more complex, multifactorial, and in need of further study.
    MeSH term(s) Child ; United States ; Humans ; Retrospective Studies ; Social Determinants of Health ; Wilms Tumor/diagnosis ; Kidney Neoplasms/diagnosis ; Biology
    Language English
    Publishing date 2024-03-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1231152-2
    ISSN 1536-3678 ; 1077-4114 ; 0192-8562
    ISSN (online) 1536-3678
    ISSN 1077-4114 ; 0192-8562
    DOI 10.1097/MPH.0000000000002846
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    Zs.A 1537: Show issues Location:
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  3. Article ; Online: Osteosarcoma/Ewing Sarcoma.

    Self, Chelsea / MacQuarrie, Kyle L / Cost, Carrye R

    Pediatrics in review

    2022  Volume 43, Issue 5, Page(s) 256–265

    MeSH term(s) Bone Neoplasms/diagnosis ; Bone Neoplasms/therapy ; Humans ; Osteosarcoma/diagnosis ; Osteosarcoma/therapy ; Sarcoma, Ewing
    Language English
    Publishing date 2022-03-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 774515-1
    ISSN 1526-3347 ; 0191-9601
    ISSN (online) 1526-3347
    ISSN 0191-9601
    DOI 10.1542/pir.2021-005065
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  4. Article ; Online: Aggressive Multimodality Therapy for a Urachal Rhabdomyosarcoma.

    Halstead, N Valeska / Mikkilineni, Nina / Cost, Carrye R / Cost, Nicholas G

    Urology

    2022  Volume 165, Page(s) e20–e24

    Abstract: Urachal rhabdomyosarcoma is a rare entity with a remarkably poor prognosis. Here we report on a 2-year-old male who presented with abdominal pain, fatigue, and urinary frequency. Imaging and subsequent surgical pathology confirmed urachal primary ... ...

    Abstract Urachal rhabdomyosarcoma is a rare entity with a remarkably poor prognosis. Here we report on a 2-year-old male who presented with abdominal pain, fatigue, and urinary frequency. Imaging and subsequent surgical pathology confirmed urachal primary embryonal rhabdomyosarcoma. Our patient underwent upfront surgical resection with adjuvant chemoradiation per Children's Oncology Group protocol D9803. He is doing well 15 months after diagnosis.
    MeSH term(s) Child ; Child, Preschool ; Combined Modality Therapy ; Humans ; Male ; Rhabdomyosarcoma/diagnosis ; Rhabdomyosarcoma/pathology ; Rhabdomyosarcoma/therapy ; Rhabdomyosarcoma, Embryonal/diagnosis ; Rhabdomyosarcoma, Embryonal/pathology ; Rhabdomyosarcoma, Embryonal/therapy
    Language English
    Publishing date 2022-04-22
    Publishing country United States
    Document type Case Reports
    ZDB-ID 192062-5
    ISSN 1527-9995 ; 0090-4295
    ISSN (online) 1527-9995
    ISSN 0090-4295
    DOI 10.1016/j.urology.2022.04.009
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  5. Article ; Online: Equivocal end-of-therapy imaging findings do not predict a higher risk of local relapse after definitive radiotherapy in pediatric Ewing sarcoma and rhabdomyosarcoma.

    McLean-Thomas, Lorna / Gao, Dexiang / Trenbeath, Zachary / Cost, Carrye R / Milgrom, Sarah A

    Pediatric blood & cancer

    2023  Volume 70, Issue 5, Page(s) e29989

    Abstract: Background: Posttherapy imaging studies can provide reassurance or induce anxiety regarding risk of recurrence for patients and their families. In some cases, it is difficult to determine if imaging findings represent posttreatment changes or residual ... ...

    Abstract Background: Posttherapy imaging studies can provide reassurance or induce anxiety regarding risk of recurrence for patients and their families. In some cases, it is difficult to determine if imaging findings represent posttreatment changes or residual disease. Equivocal radiographic findings can occur due to therapy-related inflammation or residual, inactive soft tissue masses, but it is unknown if such findings indicate an increased likelihood of local recurrence. The aim of this study was to assess the value of initial posttherapy scans for predicting local relapse in patients with Ewing sarcoma (EWS) or rhabdomyosarcoma (RMS) who received radiotherapy (RT) for local control. These findings are critical to inform clinicians' surveillance recommendations and ability to accurately counsel patients and their families.
    Procedure: The primary endpoint was time to local progression (LP). Patients were classified as having posttherapy scans that were "positive" (residual disease within the RT field), "negative" (no evidence of residual disease within the RT field), or "equivocal" (no determination could be made). The value of initial posttreatment scans for predicting LP was assessed using positive predictive value (PPV) and negative predictive value (NPV).
    Results: Negative imaging findings (n = 51) had an NPV of 88%, and positive imaging findings (n = 1) had a PPV of 100%. When equivocal findings (n = 16) were categorized with negative results (i.e., positive vs. equivocal/negative), the NPV was 90%. When equivocal findings were categorized with positive results (equivocal/positive vs. negative), the PPV was 12%.
    Conclusion: Equivocal findings within the RT field on end-of-therapy imaging studies indicate no higher risk of local recurrence than negative findings. These results may contribute to appropriate surveillance schedules and accurate counseling of patients with RMS and EWS who have received RT for local control.
    MeSH term(s) Child ; Humans ; Sarcoma, Ewing/diagnostic imaging ; Sarcoma, Ewing/radiotherapy ; Neoplasm Recurrence, Local/diagnostic imaging ; Sarcoma ; Rhabdomyosarcoma/diagnostic imaging ; Rhabdomyosarcoma/radiotherapy ; Anxiety ; Leukemia, Myeloid, Acute ; Retrospective Studies
    Language English
    Publishing date 2023-02-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2131448-2
    ISSN 1545-5017 ; 1545-5009
    ISSN (online) 1545-5017
    ISSN 1545-5009
    DOI 10.1002/pbc.29989
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    Zs.A 1131: Show issues Location:
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  6. Article ; Online: Provider Documentation of Tinnitus in Childhood Cancer Survivors.

    Macaruso, Natalie / Campbell, Kristen / Cost, Carrye / Sopfe, Jenna

    Journal of pediatric hematology/oncology

    2020  Volume 43, Issue 5, Page(s) e642–e647

    Abstract: Tinnitus is a known complication of treatment for childhood cancer and potentially reduces the quality of life for childhood cancer survivors (CCS). Although current guidelines recommend annual surveillance in CCS at risk for tinnitus, current screening ... ...

    Abstract Tinnitus is a known complication of treatment for childhood cancer and potentially reduces the quality of life for childhood cancer survivors (CCS). Although current guidelines recommend annual surveillance in CCS at risk for tinnitus, current screening practices among pediatric oncology survivorship providers are unknown. The authors performed a retrospective cohort study to assess the adequacy of current tinnitus screening in survivorship care. The 5.6% prevalence of tinnitus reported by the Childhood Cancer Survivorship Study, the largest ongoing follow-up cohort of CCS, served as the baseline for comparison for our rate of documented positive screening for tinnitus. Survivorship providers identified tinnitus in 3 of 624 (0.48%) eligible CCS, which was significantly lower than the prevalence in the Childhood Cancer Survivorship Study (P<0.0001). Survivorship providers documented any screening for tinnitus (positive or negative) in 15 of 624 (2.4%) CCS. Screening practices significantly differed by ototoxic exposure history and age at follow-up. This study demonstrates that screening and detection of tinnitus are underdocumented by survivorship providers, raising concern for inadequate screening practices. Improved screening may facilitate the recognition and treatment of this late effect, improving the quality of life for CCS.
    MeSH term(s) Adolescent ; Adult ; Cancer Survivors ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Prevalence ; Retrospective Studies ; Tinnitus/diagnosis ; Tinnitus/epidemiology ; Young Adult
    Language English
    Publishing date 2020-10-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1231152-2
    ISSN 1536-3678 ; 1077-4114 ; 0192-8562
    ISSN (online) 1536-3678
    ISSN 1077-4114 ; 0192-8562
    DOI 10.1097/MPH.0000000000001966
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  7. Article ; Online: Incidence and Risk Factors for Brown Adipose Tissue Uptake in PET Imaging in Pediatric Patients.

    Smolik, Suzanne / Miller, Angie L / Mong, David A / Trenbeath, Zachary / Miller, Kristen R / Cost, Carrye / Demedis, Jenna

    Journal of pediatric hematology/oncology

    2023  Volume 46, Issue 1, Page(s) e60–e64

    Abstract: Background: Positron emission tomography (PET) scans are used in disease diagnosis and evaluation for pediatric oncology patients. Brown adipose tissue (BAT) 18 F-fluorodeoxyglucose-PET uptake is reported in 35% to 47% of pediatric patients. Several ... ...

    Abstract Background: Positron emission tomography (PET) scans are used in disease diagnosis and evaluation for pediatric oncology patients. Brown adipose tissue (BAT) 18 F-fluorodeoxyglucose-PET uptake is reported in 35% to 47% of pediatric patients. Several risk factors may be associated with BAT uptake.
    Objective: The aim was to determine the incidence and risk factors for BAT in pediatric patients using a consensus-based system and a novel grading scale.
    Methods: A total of 285 PET scans in 154 patients were retrospectively reviewed for the presence of BAT from September 2015 through December 2016. A consensus review was done by 2 radiologists, who graded BAT on a 0 to 3 scale and assessed its impact on PET interpretation.
    Results: The presence of moderate to severe BAT occurred in 11% of PET scans, and 6% of PETs had limited interpretation. Hodgkin lymphoma (n=53) patients had a 3.62-fold increased odds of moderate or severe BAT and a 6.59-fold increased odds of limited interpretation on PET imaging.
    Conclusion: The incidence of BAT was low but impacted radiologic interpretation when present. Further studies with a larger group of Hodgkin lymphoma patients are needed to explore the risk factors associated with moderate or severe BAT.
    MeSH term(s) Humans ; Child ; Hodgkin Disease ; Fluorodeoxyglucose F18 ; Adipose Tissue, Brown/diagnostic imaging ; Retrospective Studies ; Incidence ; Positron-Emission Tomography/methods ; Risk Factors
    Chemical Substances Fluorodeoxyglucose F18 (0Z5B2CJX4D)
    Language English
    Publishing date 2023-10-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1231152-2
    ISSN 1536-3678 ; 1077-4114 ; 0192-8562
    ISSN (online) 1536-3678
    ISSN 1077-4114 ; 0192-8562
    DOI 10.1097/MPH.0000000000002778
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  8. Article ; Online: Brachytherapy in children, adolescents, and young adults: An underutilized modality in the United States?

    Zakem, Sara J / Cost, Carrye R / Cost, Nicholas G / Robin, Tyler P / Milgrom, Sarah A

    Pediatric blood & cancer

    2021  Volume 69, Issue 3, Page(s) e29412

    Abstract: Background: Brachytherapy (BT) delivers highly conformal radiation and spares surrounding tissues, which may limit late effects in pediatric, adolescent, and young adult (AYA) patients. We aimed to characterize trends in BT use for this population in ... ...

    Abstract Background: Brachytherapy (BT) delivers highly conformal radiation and spares surrounding tissues, which may limit late effects in pediatric, adolescent, and young adult (AYA) patients. We aimed to characterize trends in BT use for this population in the United States, focusing on patients with rhabdomyosarcoma (RMS).
    Methods: The National Cancer Database was queried to identify patients ≤ 21 who were treated for solid tumor malignancies in the United States from 2004 to 2016. We obtained disease, treatment, and outcome data for patients treated with BT, in particular for RMS.
    Results: 99 506 pediatric and AYA patients met study inclusion. Of these, 22 586 (23%) received radiation therapy (external beam radiation therapy [EBRT] and/or BT) and 240 (0.2%) received BT. Among patients treated with BT, 139 (58%) underwent surgery and 58 (24%) received EBRT. A total of 3836 patients were treated for RMS during this period. Of these, 2531 (66%) received any radiation and 37 (1%) received BT (EBRT + BT in 3, BT in 34). Of patients treated with BT for RMS, 28 (76%) underwent surgery + BT. Survival data were available for 31 patients treated with BT for RMS. With a median follow-up of 63 months, overall survival was 100% for patients with RMS of a favorable site treated with BT.
    Conclusions: BT is rarely used to treat pediatric and AYA patients in the United States. Patients treated with BT for RMS experienced favorable survival, suggesting that this approach may not compromise oncologic outcomes and warrants further study as a therapeutic option in pediatric and AYA patients, specifically in RMS.
    MeSH term(s) Adolescent ; Brachytherapy/adverse effects ; Child ; Humans ; Retrospective Studies ; United States/epidemiology ; Young Adult
    Language English
    Publishing date 2021-10-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2131448-2
    ISSN 1545-5017 ; 1545-5009
    ISSN (online) 1545-5017
    ISSN 1545-5009
    DOI 10.1002/pbc.29412
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  9. Article ; Online: Extrarenal, Soft Tissue Malignant Rhabdoid Tumor Arising in the Mons Pubis.

    Mikkilineni, Nina / Rodrigues Pessoa, Rodrigo / Cost, Carrye R / Doughty, Elizabeth / Treece, Amy L / Cost, Nicholas G

    Urology

    2022  Volume 168, Page(s) 205–207

    Abstract: Extrarenal, extracranial malignant rhabdoid tumors (MRT) are uncommon malignancies with poor prognoses that may be diagnostically challenging. Reports of soft tissue MRTs in children are rare. For this reason, there are no standard treatment protocols. ... ...

    Abstract Extrarenal, extracranial malignant rhabdoid tumors (MRT) are uncommon malignancies with poor prognoses that may be diagnostically challenging. Reports of soft tissue MRTs in children are rare. For this reason, there are no standard treatment protocols. Historically, an aggressive multimodal approach has been taken. Here, we present a case of metastatic superficial pelvic MRT in a 16-year-old girl who remains disease-free after aggressive multi-modal therapy.
    MeSH term(s) Humans ; Child ; Female ; Adolescent ; Rhabdoid Tumor/diagnosis ; Rhabdoid Tumor/therapy ; Rhabdoid Tumor/pathology ; Pubic Bone ; Sarcoma/pathology ; Disease-Free Survival
    Language English
    Publishing date 2022-05-01
    Publishing country United States
    Document type Case Reports
    ZDB-ID 192062-5
    ISSN 1527-9995 ; 0090-4295
    ISSN (online) 1527-9995
    ISSN 0090-4295
    DOI 10.1016/j.urology.2022.03.040
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  10. Article ; Online: A Multimodal Intervention to Reduce C. difficile Infections and Stool Testing.

    Cotter, Jillian M / Stokes, Claire L / Tong, Suhong / Birkholz, Meghan / Child, Jason / Cost, Carrye / Coughlin, Rebecca / Cox, Stephanie / Dolan, Susan A / Dorris, Kathleen / Hazleton, Keith Z / Lugo, Virginia / Norcross, Mikayla / Pearce, Kelly / Dominguez, Samuel R

    Pediatrics

    2024  Volume 153, Issue 3

    Abstract: Background and objectives: The introduction of multiplex gastrointestinal panels at our institution resulted in increased Clostridioides difficile (C. difficile) detection and stool test utilization. We aimed to reduce hospital-onset C. difficile ... ...

    Abstract Background and objectives: The introduction of multiplex gastrointestinal panels at our institution resulted in increased Clostridioides difficile (C. difficile) detection and stool test utilization. We aimed to reduce hospital-onset C. difficile infections (HO-CDIs), C. difficile detection, and overall stool testing by 20% within 1 year.
    Methods: We conducted a quality improvement project from 2018 to 2020 at a large children's hospital. Interventions included development of a C. difficile testing and treatment clinical care pathway, new options for gastrointestinal panel testing with or without C. difficile (results were suppressed if not ordered), clinical decision support tool to restrict testing, and targeted prevention efforts. Outcomes included the rate of HO-CDI (primary), C. difficile detection, and overall stool testing. All measures were evaluated monthly among hospitalized children per 10 000 patient-days (PDs) using statistical process-control charts. For balancing measures, we tracked suppressed C. difficile results that were released during real-time monitoring because of concern for true infection and C. difficile-related adverse events.
    Results: HO-CDI decreased by 55%, from 11 to 5 per 10 000 PDs. C. difficile detection decreased by 44%, from 18 to 10 per 10 000 PDs, and overall test utilization decreased by 29%, from 99 to 70 per 10 000 PDs. The decrease in stool tests resulted in annual savings of $55 649. Only 2.3% of initially suppressed positive C. difficile results were released, and no patients had adverse events.
    Conclusions: Diagnostic stewardship strategies, coupled with an evidence-based clinical care pathway, can be used to decrease C. difficile and improve overall test utilization.
    MeSH term(s) Child ; Humans ; Clostridioides difficile ; Child, Hospitalized ; Clostridium Infections/diagnosis ; Clostridium Infections/prevention & control ; Critical Pathways ; Hospitals, Pediatric
    Language English
    Publishing date 2024-02-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207677-9
    ISSN 1098-4275 ; 0031-4005
    ISSN (online) 1098-4275
    ISSN 0031-4005
    DOI 10.1542/peds.2023-061981
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