title: The use of zoledronic acid in pediatric cancer patients.
abstract: BACKGROUND
  The third generation bisphosphonate zoledronic acid has demonstrated efficacy in reducing skeletal-related events in adult patients with multiple cancer types that have skeletal disease. The use of zoledronic acid in pediatric oncology patients with bone metastases for the purpose of reducing pain, improving bone strength and altering the progression of metastatic disease has not been thoroughly evaluated.
  
  
  METHODS
  From October 2005 to December 2008, 19 patients at the Aflac Cancer Center received one or more doses of zoledronic acid as part of their therapy. A retrospective review of these patients was performed and information was collected including indication for treatment, toxicities, and outcomes.
  
  
  RESULTS
  Most patients (n = 15) received zoledronic acid following relapse of their malignancy with metastatic disease present in one or more bony sites. Hypocalcemia and hypophosphatemia were frequent, but did not result in clinical symptoms. More significant toxicities associated with zoledronic acid, including clinically apparent renal insufficiency and osteonecrosis of the jaw, were not seen. Overall, zoledronic acid was well tolerated in this population.
  
  
  CONCLUSIONS
  The benefits of zoledronic acid seen in randomized trials of adults with bone metastases have sparked interest in its use for children with metastatic cancer. The administration of zoledronic acid in pediatric oncology appears safe, and may result in improved bone strength and pain control. Further evaluation is warranted to prospectively evaluate its efficacy and long-term safety in pediatric patients with cancer and skeletal metastases.
authors.affiliation: Children's Mercy Hospital, Kansas City, Missouri 30342-1600, USA.
authors.forename: Keith J
authors.initials: KJ
authors.lastname: August
authors.forename: Amanda
authors.initials: A
authors.lastname: Dalton
authors.forename: Howard M
authors.initials: HM
authors.lastname: Katzenstein
authors.forename: Bradley
authors.initials: B
authors.lastname: George
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Olson
authors.forename: Karen
authors.initials: K
authors.lastname: Wasilewski-Masker
authors.forename: Louis B
authors.initials: LB
authors.lastname: Rapkin
mesh_terms: D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D012509:Sarcoma / Q000473:pathology; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid