Publications by authors named "Shulkin B"

Background: Adult survivors of unilateral, nonmetastatic, non-syndromic Wilms tumor (WT) treated with whole abdomen radiation therapy (WART) are at risk for impaired kidney function. The impact of bias and accuracy on estimated glomerular filtration rate (eGFR) among adult survivors of WT has not been well documented.

Procedure: We clinically evaluated male and female WT survivors with creatinine and cystatin C, calculated eGFR using the Chronic Kidney Disease-Epidemiology equations with and without cystatin C, and measured Tc diethylenetriamine pentaacetic acid (DTPA) plasma clearance.

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  • * A group of experts from several medical societies reviewed existing research on the use of nuclear imaging in FUO cases to create guidelines on how to appropriately utilize these imaging methods.
  • * The established criteria aim to help healthcare providers make informed decisions when ordering diagnostic imaging for FUO, while also highlighting the need for more thorough future research in this area.
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Background: The Children's Oncology Group defines intermediate-risk rhabdomyosarcoma as unresected FOXO1 fusion-negative disease arising at an unfavourable site or non-metastatic FOXO1 fusion-positive disease. Temsirolimus in combination with chemotherapy has shown promising activity in patients with relapsed or refractory rhabdomyosarcoma. We aimed to compare event-free survival in patients with intermediate-risk rhabdomyosarcoma treated with vincristine, actinomycin, and cyclophosphamide alternating with vincristine and irinotecan (VAC/VI) combined with temsirolimus followed by maintenance therapy versus VAC/VI alone with maintenance therapy.

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  • - The study explored the effectiveness of [C]-Methionine PET imaging in diagnosing pediatric low-grade gliomas (pLGGs), revealing its high sensitivity (93%) for both newly diagnosed and previously treated cases.
  • - Researchers assessed tumor-to-brain uptake ratios (TBR) and metabolic tumor volumes in 44 patients, finding that TBR significantly decreased after treatment, indicating a response to therapy.
  • - The results suggest that [C]-MET-PET is a useful tool for evaluating pLGGs, with potential variances in imaging characteristics among different tumor types and genetic markers, although statistical analyses were limited by small sample sizes.
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Purpose: To assess the prognostic and therapeutic significance of sentinel lymph node biopsy (SLNB) and completion lymph node dissection (CLND) in pediatric conventional melanoma (CM), while evaluating potential predictive factors for outcomes.

Methods: We conducted a retrospective analysis of medical records spanning 2009-2020, focusing on patients aged 18 or younger with localized cutaneous conventional melanoma.

Results: Among the 33 patients, SLNB detected metastasis in 57.

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Fever of unknown origin (FUO) is a clinical conundrum for patients and clinicians alike, and imaging studies are often performed as part of the diagnostic workup of these patients. Recently, the Society of Nuclear Medicine and Molecular Imaging convened and approved a guideline on the use of nuclear medicine tools for FUO. The guidelines support the use of 2-18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in adults and children with FUO.

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  • Soft tissue sarcomas make up 6%-8% of cancers in children, with rhabdomyosarcoma being the most common type at 3% of pediatric cancers, known for its high-grade nature and tendency to spread.
  • Treatment for rhabdomyosarcomas involves a risk-adapted, multimodal approach that includes surgery, radiotherapy, and chemotherapy, while other soft tissue sarcomas, which account for 3%-4% of cases, vary in grade and often require similar treatments.
  • The article focuses on staging, risk assessment, and imaging related to soft tissue sarcomas, mainly within the context of the Children's Oncology Group trials, while also integrating insights from international research collaborations.
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  • Scientists are studying different types of imaging to see how well they can find and assess neuroblastoma in kids, especially comparing a method called mIBG with new PET scans.!
  • They looked at 10 studies involving 181 patients and found that the PET scans could detect more tumors than the mIBG method in many cases.!
  • Although PET scans seem to work better, doctors are still figuring out if this will really change how they treat patients in the future.!
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Background: Pleuropulmonary blastoma (PPB) is the most common primary lung neoplasm of infancy and early childhood. Given the rarity of PPB, the role of positron emission tomography (PET) and bone scintigraphy (bone scans) in diagnostic evaluation and surveillance has not been documented to date. Available PET and bone scan data are presented in this study.

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Rhabdomyosarcoma is the most common soft-tissue neoplasm in the pediatric population. The survival of children with rhabdomyosarcoma has only marginally improved over the past 25 years and remains poor for those with metastatic disease. A significant challenge to advances in treatment of rhabdomyosarcoma is the relative rarity of this disease, necessitating years to complete clinical trials.

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JCO ARST1321 was a phase II study designed to compare the near complete pathologic response rate after preoperative chemoradiation with/without pazopanib in children and adults with intermediate-/high-risk chemotherapy-sensitive body wall/extremity non-Rhabdomyosarcoma Soft Tissue Sarcoma (ClinicalTrials.gov identifier: NCT02180867). Enrollment was stopped early following a predetermined interim analysis that found the rate of near complete pathologic response to be significantly greater with the addition of pazopanib.

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Osteosarcoma is the most common type of primary malignant bone tumor. F-FDG PET/CT is useful for staging, detecting recurrence, monitoring response to neoadjuvant chemotherapy, and predicting prognosis. Here, we review the clinical aspects of osteosarcoma management and assess the role of F-FDG PET/CT, in particular with regard to pediatric and young adult patients.

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  • Diagnostic mIBG scans are essential for assessing treatment response in children with high-risk neuroblastoma, specifically analyzing the importance of Curie scores (CS) during tandem high-dose chemotherapy (HDC) and autologous hematopoietic cell transplant (AHCT) in the COG study ANBL0532.
  • A retrospective analysis found that the optimal CS cut points at diagnosis (CS = 12) and end-of-induction (CS = 0) significantly predicted better event-free survival (EFS), with respective survival rates of 74.2% and 72.9% for patients with lower scores compared to those above these cut-offs.
  • Ultimately, these findings suggest that monitoring CS at diagnosis and end-of-induction
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Infantile fibrosarcoma is the most common soft-tissue sarcoma in children under the age of 1 yr and is defined molecularly by fusion proteins. This tumor is known to be locally invasive; however, although rare, metastases can occur. The fusion acts as a driver for tumor formation, which can be targeted by first- and second-generation inhibitors.

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Background: In the Children's Oncology Group ANBL1221 phase 2 trial for patients with first relapse/first declaration of refractory high-risk neuroblastoma, irinotecan and temozolomide (I/T) combined with either temsirolimus (TEMS) or immunotherapy (the anti-GD2 antibody dinutuximab (DIN) and granulocyte macrophage colony stimulating factory (GM-CSF)) was administered. The response rate among patients treated with I/T/DIN/GM-CSF in the initial cohort (n=17) was 53%; additional patients were enrolled to permit further evaluation of this chemoimmunotherapy regimen. Potential associations between immune-related biomarkers and clinical outcomes including response and survival were evaluated.

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Adrenal neoplasms rarely occur in children. They can be diagnosed in the presence of endocrine, metabolic or neurological problems, an abdominal mass, more rarely an adrenal incidentaloma, or in the context of an adrenal mass discovered in the evaluation of childhood cancer including hematologic malignancy. According to standard medical practice, pediatric malignancies are almost always evaluated by F-fluorodeoxyglucose positron emission tomography with computed tomography ([F]FDG PET/CT).

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Childhood spinal tumors are rare. Tumors can involve the spinal cord, the meninges, bony spine, and the paraspinal tissue. Optimized imaging should be utilized to evaluate tumors arising from specific spinal compartments.

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Objective: Recent increased awareness and research studies reflect possible associations between opioid exposure and cancer outcomes. Children with neuroblastoma (NB) often require opioid treatment for pain. However, associations between tumor response to chemotherapy and opioid exposure have not been investigated in clinical settings.

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The most common indication for F-FDG PET/CT is tumor imaging, which may be performed for initial diagnosis, staging, therapeutic response monitoring, surveillance, or suspected recurrence. In the routine practice of pediatric nuclear medicine, most infectious, inflammatory, and autoimmune processes that are detected on F-FDG PET/CT imaging - except for imaging in fever or inflammation of unknown origin - are coincidental and not the main indication for image acquisition. However, interpreting these "coincidental" findings is of utmost importance to avoid erroneously attributing these findings to a neoplastic process.

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When pregnancy is discovered during or after a diagnostic examination, the physician or the patient may request an estimate of the radiation dose received by the fetus as per guidelines and standard operating procedures. This study provided the imaging community with dose estimates to the fetus from PET/CT with protocols that are adapted to University of Michigan low-dose protocols for patients known to be pregnant. There were 9 patients analyzed with data for the first, second, and third trimesters, the availability of which is quite rare.

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Adrenal tumors other than neuroblastoma are uncommon in children. The most frequently encountered are adrenocortical carcinoma and pheochromocytoma. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary adrenal malignancy other than neuroblastoma at diagnosis and during follow-up.

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