Publications by authors named "Richard D Glick"
Article Synopsis
- Pediatric breast masses in children and adolescents are mostly benign, but rare malignant cases require quick identification and treatment to protect developing breast tissue.
- Evaluation starts with a detailed history and physical exam, followed by ultrasound for further characterization, and in some cases, observation is adequate instead of surgery.
- Pediatric surgeons play a key role in managing these cases, and an established algorithm recommends careful diagnosis and treatment, with a multidisciplinary approach for malignant lesions.
Purpose: Research has demonstrated negative environmental impacts from in-person conferences. Nonetheless, there are benefits to in-person meetings. The 2023 American Pediatric Surgical Association (APSA) meeting was mostly attended in-person.
View Article and Find Full Text PDFPediatric renal tumors are among the most common pediatric solid malignancies. Surgical resection is a key component in the multidisciplinary therapy for children with kidney tumors. Therefore, it is imperative that surgeons caring for children with renal tumors fully understand the current standards of care in order to provide appropriate surgical expertise within this multimodal framework.
View Article and Find Full Text PDFPurpose: Our objectives were to compare overall survival (OS) and pulmonary relapse between patients with metastatic Ewing sarcoma (EWS) at diagnosis who achieve rapid complete response (RCR) and those with residual pulmonary nodules after induction chemotherapy (non-RCR).
Patients And Methods: This retrospective cohort study included children under 20 years with metastatic EWS treated from 2007 to 2020 at 19 institutions in the Pediatric Surgical Oncology Research Collaborative. Chi-square tests were conducted for differences among groups.
Article Synopsis
- Tunneled central venous catheters (CVCs) are crucial in cancer treatment for children, but there are few guidelines for their management, prompting the need for best practices.
- The study aimed to investigate how catheter material affects complications, the risks associated with low platelet and neutrophil counts during catheter placement, and management strategies for central line associated bloodstream infections (CLABSI).
- The findings indicate no major differences in complications based on catheter composition, suggest a slight risk increase with very low platelet counts, and recommend removing the catheter in case of complicated infections, although high-quality evidence is lacking across all areas.
Introduction: Cervical lymphadenopathy in children is typically self-limited; however, the management of persistent lymphadenopathy remains unclear. This study aimed to evaluate the management and outcomes of patients with persistent cervical lymphadenopathy.
Methods: Single-institution, retrospective review of children <18 years undergoing ultrasound (US) for cervical lymphadenopathy from 2013 to 2021 was performed.
Background: Undifferentiated embryonal sarcoma of the liver (UESL) is a rare tumor for which there are few evidence-based guidelines. The aim of this study was to define current management strategies and outcomes for these patients using a multi-institutional dataset curated by the Pediatric Surgical Oncology Research Collaborative.
Methods: Data were collected retrospectively for patients with UESL treated across 17 children's hospitals in North America from 1989 to 2019.
Background: To review race and ethnic group enrollment and outcomes for Wilms tumor (WT) across all 4 risk-assigned therapeutic trials from the current era Children's Oncology Group Renal Tumor Biology and Risk Stratification Protocol, AREN03B2.
Study Design: For patients with WT enrolled in AREN03B2 (2006 to 2019), disease and biologic features, therapeutic study-specific enrollment, and event-free (EFS) and overall (OS) 4-year survival were compared between institutionally reported race and ethnic groups.
Results: Among 5,146 patients with WT, no statistically significant differences were detected between race and ethnic groups regarding subsequent risk-assigned therapeutic study enrollment, disease stage, histology, biologic factors, or overall EFS or OS, except the following variables: Black children were older and had larger tumors at enrollment, whereas Hispanic children had lower rates of diffuse anaplasia WT and loss of heterozygosity at 1p.
Background: Patients with stage IV favorable histology Wilms tumor (FHWT) with extrapulmonary metastases (EPM) constitute a small subset of patients with FHWT. Because of their rarity and heterogeneity, optimal FHWT treatment is not well understood. Children's Oncology Group protocol AREN0533 assigned patients with FHWT and EPM to intensified chemotherapy, regimen M, after initial DD-4A chemotherapy.
View Article and Find Full Text PDFBackground: Nephrogenic rests (NR) may represent precursor lesions for Wilms tumor (WT), but their clinical course is not fully understood and no guidelines for treatment exist. This study sought to evaluate the outcomes of pediatric patients with NRs related to traditional chemotherapy and surgery.
Methods: A PRISMA-P-compliant literature search was conducted in MEDLINE, Embase, CINAHL, Web of Science, COCHRANE, and SCOPUS from inception to June 2021.
Although survival for many pediatric cancers has improved with advances in conventional chemotherapeutic regimens and surgical techniques in the last several decades, it remains a leading cause of disease-related death in children. Outcomes in patients with recurrent, refractory, or metastatic disease are especially poor. Recently, the advent of alternative classes of therapies, including immunotherapies, have revolutionized systemic treatment for pediatric malignancies.
View Article and Find Full Text PDFArticle Synopsis
- This study aimed to analyze how children with Wilms tumor and inferior vena caval (IVC) thrombus are managed and the outcomes of those treatments in a modern cohort.
- The research involved reviewing data from 124 patients across 19 North American medical centers between 2009 and 2019, with findings showing that 81% of patients had favorable tumor histology and a high rate of successful outcomes after neoadjuvant chemotherapy.
- The results indicated that 93% of patients survived without significant events after two years, with neoadjuvant treatment reducing the need for cardiac surgery, and suggesting that complete removal of thrombus may not always be necessary for successful treatment.
Although general treatment approaches for Wilms tumor differ between Children's Oncology Group and Société Internationale d'Oncologie Pédiatrique-Renal Tumors Study Group protocols, complex tumors that may be candidates for nephron sparing surgery (NSS) and those with intravascular tumor extension represent a management challenge. In both of these scenarios, anatomic considerations are important in guiding management, making these areas of significant similarities in management between the international groups. This paper aims to explore the current approaches to NSS and intravascular tumor extension by both international groups, with attention to the evidence supporting these approaches and current knowledge gaps.
View Article and Find Full Text PDFBackground: Intraoperative nerve monitoring (IONM) is a technique used to decrease the possibility of nerve-associated morbidity and damage to nearby neural structures during complex surgical procedures. The use and potential benefits of IONM in pediatric surgical oncology are not well-described.
Methods: An overview of the current literature was performed to elucidate the various techniques that may be useful to pediatric surgeons for resection of solid tumors in children.
Introduction: This study evaluated North American pediatric surgeons' opinions and knowledge of business and economics in medicine and their perceptions of trends in their healthcare delivery environment.
Methods: We conducted an elective online survey of 1119 American Pediatric Surgical Association members. Over 8 mo, we iteratively developed the survey focused on four areas: opinion, knowledge, current practice environment, and trends in practice environment over the past 5 y.
Article Synopsis
- A study analyzed 1,259 children diagnosed with WT between 2009 and 2019, finding that 7.5% had pleural effusions, which were associated with older age and more advanced cancer stages.
- Despite the presence of pleural effusions, survival rates were still high (86.2% event-free, 91.5% overall), and the occurrence of malignant cells in the fluid was low, suggesting no need to change treatment approaches based on pleural effusion
Article Synopsis
- Inflammatory myofibroblastic tumor (IMT) is a type of intermediate malignancy, and this study involves a large cohort of patients (182) under the age of 39 to better understand the disease.
- The findings showed that the median age of patients is 11 years, with common symptoms including pain and respiratory issues, and a notable 53% of tumors displayed ALK overexpression.
- Surgery was frequently performed (91%), leading to a high 5-year survival rate of 95%, but certain factors like tumor size and respiratory symptoms were linked to recurrence risk, indicating that aggressive surgical approaches may not always be necessary.*
Article Synopsis
- Hepatocellular carcinoma (HCC) in children is rare and has various subtypes, making it challenging to manage and predict outcomes.
- A study involving 262 children identified three main HCC subtypes: conventional HCC (cHCC), fibrolamellar carcinoma (FLC), and hepatoblastoma with HCC features (HB-HCC), revealing significant differences in their clinical behaviors and mortality risk factors.
- The findings suggest that cHCC has a higher mortality risk compared to FLC, and factors such as elevated α-fetoprotein levels and tumor unresectability are associated with poorer outcomes, highlighting the need for tailored treatment strategies based on histological characteristics.
Background: Pulmonary nodules that are deep within lung parenchyma and/or small in size can be challenging to localize for biopsy. This study describes current trends in performance of image-guided localization techniques for pulmonary nodules in pediatric patients.
Methods: A retrospective review was performed on patients < 21 years of age undergoing localization of pulmonary nodules at 15 institutions.
Background/purpose: Cancer predisposition syndromes (CPS) are a heterogeneous group of inherited disorders that greatly increase the risk of developing malignancies. CPS are particularly relevant to pediatric surgeons since nearly 10% of cancer diagnoses are due to inherited genetic traits, and CPS often contribute to cancer development during childhood.
Materials/methods: The English language literature was searched for manuscripts, practice guidelines, and society statements on "cancer predisposition syndromes in children".
Background: Testicular germ cell tumors are uncommon tumors that are encountered by pediatric surgeons and urologists and require a knowledge of appropriate contemporary evaluation and surgical and medical management.
Method: A review of the recommended diagnostic evaluation and current surgical and medical management of children and adolescents with testicular germ cell tumors based upon recently completed clinical trials was performed and summarized in this article.
Results: In this summary of childhood and adolescent testicular germ cell tumors, we review the initial clinical evaluation, surgical and medical management, risk stratification, results from recent prospective cooperative group studies, and clinical outcomes.