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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although malignant tumours are rare in the paediatric population&#44; with an incidence of 15 new cases per 100&#8239;000 children under 14 years per year&#44; they are the second leading cause of death overall and the leading cause of death due to disease in this age group&#46; While diagnosis of a malignancy is rare in children&#44; it is even less common in the first years of life&#46; The current issue of <span class="elsevierStyleSmallCaps">Anales de Pediatr&#237;a</span> includes an interesting review of the cases of 72 patients aged less than 18 months with malignant tumours managed in a single Spanish hospital in the past 12 years that analysed the differential features of cancer at this young age&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In agreement with the records of other childhood cancer registers in different countries&#44; and based on data corresponding to the past 5 years in the Spanish Register of Childhood Tumours of the Sociedad Espa&#241;ola de Hematolog&#237;a y Oncolog&#237;a Pedi&#225;tricas &#40;RETI-SEHOP&#41;&#44; patients aged less than 18 months account for 15&#37; of all malignant tumours diagnosed in children under 14 years &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<span class="elsevierStyleSup">2</span> While the most frequent malignant tumours in children are leukaemias &#40;30&#37;&#41;&#44; central nervous system &#40;CNS&#41; tumours &#40;20&#37;&#41;&#44; lymphomas &#40;15&#37;&#41; and tumours of the neural crest &#40;10&#37;&#41;&#44; in the group aged less than 18 months leukaemias are the third most frequent type of tumour&#44; with a frequency below that of embryonal tumours&#44; such as tumours of the neural crest &#40;29&#37;&#41;&#44; CNS tumours &#40;17&#46;4&#37;&#41; or retinoblastoma &#40;11&#37;&#41;&#46;<span class="elsevierStyleSup">2</span> In fact&#44; up to 50&#37; of neural crest tumour&#44; nearly 60&#37; of retinoblastomas&#44; more than 30&#37; of hepatoblastomas and more than 20&#37; of childhood renal tumours are diagnosed in the first 18 months of life &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Between 5&#37; and 10&#37; of childhood cancers are hereditary&#46; This hereditary nature is particularly relevant in the first years of life in patients with retinoblastoma&#44; Wilms tumour or neuroectodermal syndromes &#40;such as neurofibromatosis or tuberous sclerosis&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Early diagnosis allows detection of the disease in early stages&#44; when the probability of cure is greater&#46; Taking into account that the presenting symptoms of malignant tumours may overlap with those of other milder diseases in childhood&#44; recognising warning symptoms and signs may be particularly challenging in the youngest patients&#46; Thus&#44; it is important to pay particular attention to signs and symptoms such as prolonged fever&#44; faltering growth&#44; irritability&#44; pallor&#44; ecchymosis&#44; macrocephaly&#44; leukocoria&#44; abdominal distension&#44; hepatomegaly&#44; splenomegaly&#44; focal neurologic signs&#44; diarrhoea&#44; constipation&#44; persistent lymphadenopathy or skin lesions&#44; among others&#46; It is the severity of these manifestations&#44; their persistence or progression or their poor outcome despite treatment that should be considered red flags&#46; Leukocoria is clearly one of the few warning signs the presence of which warrants immediate referral for ophthalmological evaluation&#46; For this reason&#44; assessment of the pupillary light reflex at birth and in successive routine check-up visits in healthy children is essential for the early diagnosis of retinoblastoma&#44; which would allow visual and ocular preservation&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">As is the case of cancers in adults and older children&#44; at present the treatment of malignant tumours in young children is based on 4 tools&#58; surgery&#44; chemotherapy&#44; radiation and immunotherapy&#46; The most suitable approach is determined based on location and cancer subtype&#46; In recent years&#44; most patients have been treated in the context of clinical trials or in adherence with established international guidelines&#46; One of the biggest challenges in the treatment of the youngest children is determining the appropriate dosage of cytostatic agents&#46; Despite the lack of data&#44; empirical adjustment of the dosage is the norm in infants and young children based on observed improvements in the safety and tolerability of treatments&#46; The impact of such heterogeneous dosage in infants and young children on the toxicity and efficacy of different cytostatic agents has not been studied in depth&#46; Most protocols include dose adjustments of commonly used cytostatic agents based on age&#44; weight or body surface area using mathematical formulas &#40;for example&#44; the 30&#8239;kg&#8239;&#61;&#8239;1 m<span class="elsevierStyleSup">2</span> rule&#41;&#44; but once the patient exceeds the given threshold &#40;such as age &#62; 12 months&#41;&#44; treatment continues with the standard dose based on body surface area&#44; which entails a substantial increase in the administered dose&#46; Pending the establishment of a more objective method for dosing&#44; some groups are working on developing dosage tables based on body surface area to better fine-tune dose adjustments that take into account markers of clearance for different drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In very young children&#44; supportive and holistic care delivered by a multidisciplinary team is necessary to minimise the incidence of acute and late complications associated with cancer&#44; with particular emphasis on the maintenance of permanent vascular access lines&#44; pain management and anaesthesia in diagnostic and therapeutic procedures&#44; nutritional support&#44; infection prevention and treatment and neurodevelopment&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In Spain&#44; the current 5-year survival for childhood cancer overall is currently 80&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> similar to survival in other developed countries&#44; and in this context&#44; the survival for some of the tumours diagnosed in the first years of life &#40;such as retinoblastoma&#44; nephroblastoma&#44; localized neuroblastoma&#41; exceeds 90&#37;&#46; Surgery&#44; radiotherapy&#44; chemotherapy&#44; immunotherapy&#44; recurrent use of anaesthesia for performance of diagnostic or therapeutic procedures and the acute complications of treatment may cause long-term sequelae&#44; especially when used in the first years of life&#46; For this reason&#44; the goals of treatment no longer focus exclusively on pursuing cure&#44; but also prioritize prevention&#44; diagnosis and monitoring of long term adverse effects&#46; To this end&#44; it is particularly important to understand and predict how cancer and its treatment may affect neurodevelopment in infancy and early childhood and schedule periodic evaluations by specialists to follow-up these patients and deliver appropriate interventions through early intervention units&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Meeting the psychosocial needs of young children with cancer poses a unique challenge&#44; as these patients experience abrupt changes in many developmental milestones&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Lastly&#44; we must not forget the psychological impact that diagnosis of cancer in infants or young children has on their families &#40;parents&#44; siblings&#44; grandparents&#44; caregivers&#41;&#44; and the importance of offering support and follow-up through mental health services&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Cancer in the first 18 months of life is a challenge that demands interdisciplinary care offering patients not only the highest chances of cure and close monitoring of possible adverse events of treatment&#44; but also facilitate the appropriate interventions to ensure the highest possible degree of social integration in subsequent stages of life&#46;</p></span>"
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Editorial
Cancer in the first 18 months of life
Cáncer en los primeros 18 meses de vida
Ana Fernández-Teijeiro Álvareza,b
a Chief of the Pediatric Onco-Hematology Unit, Hospital Universitario Virgen Macarena, Seville, Spain
b President of the Sociedad Española de Hematología y Oncología Pediátricas (SEHOP), Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Although malignant tumours are rare in the paediatric population&#44; with an incidence of 15 new cases per 100&#8239;000 children under 14 years per year&#44; they are the second leading cause of death overall and the leading cause of death due to disease in this age group&#46; While diagnosis of a malignancy is rare in children&#44; it is even less common in the first years of life&#46; The current issue of <span class="elsevierStyleSmallCaps">Anales de Pediatr&#237;a</span> includes an interesting review of the cases of 72 patients aged less than 18 months with malignant tumours managed in a single Spanish hospital in the past 12 years that analysed the differential features of cancer at this young age&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In agreement with the records of other childhood cancer registers in different countries&#44; and based on data corresponding to the past 5 years in the Spanish Register of Childhood Tumours of the Sociedad Espa&#241;ola de Hematolog&#237;a y Oncolog&#237;a Pedi&#225;tricas &#40;RETI-SEHOP&#41;&#44; patients aged less than 18 months account for 15&#37; of all malignant tumours diagnosed in children under 14 years &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;<span class="elsevierStyleSup">2</span> While the most frequent malignant tumours in children are leukaemias &#40;30&#37;&#41;&#44; central nervous system &#40;CNS&#41; tumours &#40;20&#37;&#41;&#44; lymphomas &#40;15&#37;&#41; and tumours of the neural crest &#40;10&#37;&#41;&#44; in the group aged less than 18 months leukaemias are the third most frequent type of tumour&#44; with a frequency below that of embryonal tumours&#44; such as tumours of the neural crest &#40;29&#37;&#41;&#44; CNS tumours &#40;17&#46;4&#37;&#41; or retinoblastoma &#40;11&#37;&#41;&#46;<span class="elsevierStyleSup">2</span> In fact&#44; up to 50&#37; of neural crest tumour&#44; nearly 60&#37; of retinoblastomas&#44; more than 30&#37; of hepatoblastomas and more than 20&#37; of childhood renal tumours are diagnosed in the first 18 months of life &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Between 5&#37; and 10&#37; of childhood cancers are hereditary&#46; This hereditary nature is particularly relevant in the first years of life in patients with retinoblastoma&#44; Wilms tumour or neuroectodermal syndromes &#40;such as neurofibromatosis or tuberous sclerosis&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Early diagnosis allows detection of the disease in early stages&#44; when the probability of cure is greater&#46; Taking into account that the presenting symptoms of malignant tumours may overlap with those of other milder diseases in childhood&#44; recognising warning symptoms and signs may be particularly challenging in the youngest patients&#46; Thus&#44; it is important to pay particular attention to signs and symptoms such as prolonged fever&#44; faltering growth&#44; irritability&#44; pallor&#44; ecchymosis&#44; macrocephaly&#44; leukocoria&#44; abdominal distension&#44; hepatomegaly&#44; splenomegaly&#44; focal neurologic signs&#44; diarrhoea&#44; constipation&#44; persistent lymphadenopathy or skin lesions&#44; among others&#46; It is the severity of these manifestations&#44; their persistence or progression or their poor outcome despite treatment that should be considered red flags&#46; Leukocoria is clearly one of the few warning signs the presence of which warrants immediate referral for ophthalmological evaluation&#46; For this reason&#44; assessment of the pupillary light reflex at birth and in successive routine check-up visits in healthy children is essential for the early diagnosis of retinoblastoma&#44; which would allow visual and ocular preservation&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">As is the case of cancers in adults and older children&#44; at present the treatment of malignant tumours in young children is based on 4 tools&#58; surgery&#44; chemotherapy&#44; radiation and immunotherapy&#46; The most suitable approach is determined based on location and cancer subtype&#46; In recent years&#44; most patients have been treated in the context of clinical trials or in adherence with established international guidelines&#46; One of the biggest challenges in the treatment of the youngest children is determining the appropriate dosage of cytostatic agents&#46; Despite the lack of data&#44; empirical adjustment of the dosage is the norm in infants and young children based on observed improvements in the safety and tolerability of treatments&#46; The impact of such heterogeneous dosage in infants and young children on the toxicity and efficacy of different cytostatic agents has not been studied in depth&#46; Most protocols include dose adjustments of commonly used cytostatic agents based on age&#44; weight or body surface area using mathematical formulas &#40;for example&#44; the 30&#8239;kg&#8239;&#61;&#8239;1 m<span class="elsevierStyleSup">2</span> rule&#41;&#44; but once the patient exceeds the given threshold &#40;such as age &#62; 12 months&#41;&#44; treatment continues with the standard dose based on body surface area&#44; which entails a substantial increase in the administered dose&#46; Pending the establishment of a more objective method for dosing&#44; some groups are working on developing dosage tables based on body surface area to better fine-tune dose adjustments that take into account markers of clearance for different drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In very young children&#44; supportive and holistic care delivered by a multidisciplinary team is necessary to minimise the incidence of acute and late complications associated with cancer&#44; with particular emphasis on the maintenance of permanent vascular access lines&#44; pain management and anaesthesia in diagnostic and therapeutic procedures&#44; nutritional support&#44; infection prevention and treatment and neurodevelopment&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In Spain&#44; the current 5-year survival for childhood cancer overall is currently 80&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> similar to survival in other developed countries&#44; and in this context&#44; the survival for some of the tumours diagnosed in the first years of life &#40;such as retinoblastoma&#44; nephroblastoma&#44; localized neuroblastoma&#41; exceeds 90&#37;&#46; Surgery&#44; radiotherapy&#44; chemotherapy&#44; immunotherapy&#44; recurrent use of anaesthesia for performance of diagnostic or therapeutic procedures and the acute complications of treatment may cause long-term sequelae&#44; especially when used in the first years of life&#46; For this reason&#44; the goals of treatment no longer focus exclusively on pursuing cure&#44; but also prioritize prevention&#44; diagnosis and monitoring of long term adverse effects&#46; To this end&#44; it is particularly important to understand and predict how cancer and its treatment may affect neurodevelopment in infancy and early childhood and schedule periodic evaluations by specialists to follow-up these patients and deliver appropriate interventions through early intervention units&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Meeting the psychosocial needs of young children with cancer poses a unique challenge&#44; as these patients experience abrupt changes in many developmental milestones&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Lastly&#44; we must not forget the psychological impact that diagnosis of cancer in infants or young children has on their families &#40;parents&#44; siblings&#44; grandparents&#44; caregivers&#41;&#44; and the importance of offering support and follow-up through mental health services&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Cancer in the first 18 months of life is a challenge that demands interdisciplinary care offering patients not only the highest chances of cure and close monitoring of possible adverse events of treatment&#44; but also facilitate the appropriate interventions to ensure the highest possible degree of social integration in subsequent stages of life&#46;</p></span>"
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ISSN: 23412879
Original language: English
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