title: Emergent/urgent therapeutic irradiation in pediatric oncology: patterns of presentation, treatment, and outcome.
abstract: OBJECTIVE
  We reviewed all pediatric cases referred for emergent/urgent therapy (requiring treatment within 48 hours) to identify frequency, patterns of presentation, and efficacy of therapy. We defined five categories of emergent/urgent therapy based on irradiated site and/or signs: Group I, spinal cord compression; Group II, respiratory compromise; Group III, infradiaphagmatic distress; Group IV, intracranial signs; Group V, pain.
  
  
  METHODS
  From 2/1/88-3/1/ 94, 104 children with 115 problems were referred by specialists at the Children's Hospital of Philadelphia. Diagnosis, nature of the emergency, and response were examined. Responses were categorized as complete resolution, improvement or stabilization, and progression.
  
  
  RESULTS
  The 104 children represented 12% of referrals during the study period. The most common tumors were CNS PNET and gliomas (20%); and neuroblastoma (20%). Forty-five problems occurred with newly diagnosed tumors and 70 after progression. Ninety-one episodes were managed with radiation therapy and 24 with other modalities. Patients with spinal cord/cauda equina (n = 33) compression improved (55%) or stabilized (30%). Patients with respiratory compromise from thoracic (n = 14) or abdominal (n = 5) disease had a response rate of 72%. Eight patients in group III had a 66% response. In Group IV (n = 16), 63% had complete responses and 19% had stabilization. Group V (n = 15) patients had a complete or partial response of 93%.
  
  
  CONCLUSIONS
  Approximately 10% of children referred for radiation therapy required emergent/urgent treatment. Eighty percent of patients achieved stabilization or showed improvement in signs and symptoms, indicating that radiotherapy is a valuable and reliable component of multimodal care in such situations.
authors.affiliation: Department of Radiation Oncology, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
authors.forename: H
authors.initials: H
authors.lastname: Bertsch
authors.forename: S
authors.initials: S
authors.lastname: Rudoler
authors.forename: M N
authors.initials: MN
authors.lastname: Needle
authors.forename: P
authors.initials: P
authors.lastname: Malloy
authors.forename: L
authors.initials: L
authors.lastname: Sutton
authors.forename: J
authors.initials: J
authors.lastname: Belasco
authors.forename: A
authors.initials: A
authors.lastname: Meadows
authors.forename: J
authors.initials: J
authors.lastname: Goldwein
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008477:Mediastinal Diseases / Q000532:radiotherapy; D009369:Neoplasms / Q000532:radiotherapy*; D013117:Spinal Cord Compression / Q000532:radiotherapy