Results of a multicenter retrospective study of a combined medical and surgical approach to pulmonary aspergillosis in pediatric neutropenic patients.
BACKGROUND
Invasive aspergillosis (IA) is a serious problem in patients suffering from hematological malignancies. Surgical resection has been reported to improve disease control and patient survival. There are few reports describing the role of surgery in children with pulmonary IA.


METHODS
From October 1998 to September 2005, 21 patients fulfilled the inclusion criteria. Demographic and clinical data, as well as type and duration of antifungal therapy; surgery and related complications; time elapsing from surgery to resumption of chemotherapy were collected retrospectively through a specially designed form filled in by each investigator.


RESULTS
Eleven males and 10 females, aged between 2 and 17 years underwent one or more surgical lung resections for diagnostic and therapeutic purposes. Surgical complications were reported in three patients. Two patients, who underwent a wedge resection and a lobectomy, respectively, had no fungal lesions detected at surgery. Seventeen of 20 patients with malignancy resumed chemotherapy after a median of 19 days from surgery, range 7-81, and 11 of them underwent hematopoietic stem cell transplantation after a median time of 60 days from surgery, range 19-110. After a median follow-up of 1.7 years, 12 patients are alive while 9 patients have died from progression of their underlying disease.


CONCLUSIONS
This study suggests that the combination of medical antifungal therapy and early surgical excision is a feasible and an effective strategy in pediatric patients with IA. In order to avoid unnecessary surgical procedures, we advise checking the response to antifungal therapy by chest-computed tomography immediately before the date of surgery.
Cesaro
Simone
S
Clinic of Pediatric Hematology Oncology, Department of Pediatrics, University of Padua, Padua, Italy. simone.cesaro@unipd.it
Cecchetto
Giovanni
G
De Corti
Federica
F
Dodero
Paolo
P
Giacchino
Mareva
M
Caviglia
Ilaria
I
Fagioli
Franca
F
Livadiotti
Susanna
S
Salin
Federica
F
Caselli
Desireè
D
Castagnola
Elio
E
D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D008297:Male; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
D000935:Antifungal Agents