Pediatric and Adolescent Oncology
What this domain tests
Pediatric items test protocol-driven, risk-adapted multimodality therapy in a growing child, where dose is calculated per kilogram or per square metre, late effects and fertility matter, and the tolerance of normal tissue differs from adults.
Core rules
- Common entities and their pillars: acute lymphoblastic leukemia (risk-stratified multiagent chemotherapy with intrathecal therapy; CAR-T and blinatumomab for relapsed disease), Wilms tumor (nephrectomy plus risk-adapted chemotherapy ± flank radiotherapy), neuroblastoma (MYCN amplification, INRG risk grouping, MIBG imaging), medulloblastoma (molecular groups WNT, SHH, group 3, group 4; craniospinal irradiation plus chemotherapy), retinoblastoma (HER2-independent, RB1-driven; intra-arterial chemotherapy or enucleation), osteosarcoma and Ewing sarcoma (neoadjuvant chemotherapy with surgery ± radiotherapy), rhabdomyosarcoma (fusion status and group determine radiotherapy).
- Dose calculation uses body surface area for most agents and weight-based dosing for infants, with specific maximum caps (vincristine 2 mg, doxorubicin cumulative limits lower than in adults).
- Radiotherapy is avoided or delayed in very young children where possible; proton therapy is used to reduce integral dose and late effects; craniospinal irradiation carries growth, neurocognitive and endocrine consequences.
- Survivorship: monitor for cardiomyopathy after anthracyclines, ototoxicity after cisplatin, pulmonary toxicity after bleomycin, secondary malignancy after radiotherapy and alkylators, and infertility after alkylating agents and pelvic irradiation. Offer gamete cryopreservation where feasible.
- Oncologic emergencies in children include tumor lysis syndrome (Burkitt, high-count ALL), febrile neutropenia, superior vena cava syndrome and spinal cord compression.
Worked example
A 4-year-old with a large left renal mass undergoes nephrectomy showing stage III favorable-histology Wilms tumor (positive margin, no rupture). Treatment is combination chemotherapy with vincristine, actinomycin-D and doxorubicin, followed by flank radiotherapy to the tumor bed. Stage and histology, not tumor size alone, drive the radiotherapy decision, and the radiotherapy plan must account for the child's remaining growth.
Traps
- Switching to adult mg/m² dosing without observing pediatric caps and infant dose reductions.
- Giving aspirin to a febrile child (Reye syndrome risk) - use paracetamol.
- Giving radiotherapy to an infant at adult doses without considering growth and second malignancy.
- Forgetting baseline audiology and echocardiography before and after ototoxic and cardiotoxic therapy.