Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.
Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee.
Pediatr Blood Cancer. 2018 Dec;65(12):e27412. doi: 10.1002/pbc.27412. Epub 2018 Aug 19.
Optimal imaging for children with pediatric malignant melanoma (MM) is unknown.
We reviewed clinical and imaging findings of patients with American Joint Commission on Cancer (AJCC) stage IIC-IV MM treated on our institutional MEL06 trial. All patients had baseline brain magnetic resonance imaging/computed tomography (MRI/CT), positron emission tomography/computed tomography (PET/CT), CT chest, abdomen, and pelvis (CTCAP). Patients on stratum A (PEG-interferon, where PEG is pegylated; AJCC IIC, IIIA, IIIB; n = 16) had imaging every 6 months; stratum B1 (PEG-interferon and temozolomide; unresectable measurable disease, metastatic, or recurrent; n = 2) had PET/CT scans every 2 months and brain imaging studies every 4 months; stratum B2 patients (PEG-interferon and temozolomide; unresectable nonmeasurable, metastatic, or recurrent, n = 3) had imaging every 4 months. Off-therapy imaging was done every 6 months for 3 years.
There were 21 patients (11 females, 11 spitzoid, median age 14 years, head/neck [6], trunk [7], extremities [8]). Patients with spitzoid melanoma underwent 236 imaging studies in total (86 PET/CT, 81 CTCAP, 11 CT chest, 10 CT brain, 48 MRI brain) at a median cost per patient of $32,718. Thirteen studies (5.8%) had findings that led to two biopsies (one positive). For conventional MM, 162 studies (61 PET/CT, 57 CTCAP, 8 CT chest, 7 CT brain, and 29 MRI brain) were performed with a median cost per patient of $23,420. Twenty (14%) had findings leading to six biopsies (four positive). At 6.3 years (range 0.4-9.2), 17 patients remain disease-free.
Children with spitzoid melanoma require minimal imaging at diagnosis and follow-up. Patients with conventional MM should be imaged according to adult guidelines.
儿童恶性黑色素瘤（MM）的最佳影像学检查方法尚不清楚。
我们回顾了在我们机构的 MEL06 试验中接受治疗的 AJCC 分期 IIC-IV 期 MM 患儿的临床和影像学检查结果。所有患者均行基线脑部磁共振成像/计算机断层扫描（MRI/CT）、正电子发射断层扫描/计算机断层扫描（PET/CT）、胸部 CT、腹部和骨盆 CT（CTCAP）检查。A 层患者（PEG-干扰素，PEG 是聚乙二醇化的；AJCC IIC、IIIA、IIIB；n=16）每 6 个月进行一次影像学检查；B1 层患者（PEG-干扰素和替莫唑胺；不可切除的可测量疾病、转移性或复发性；n=2）每 2 个月进行一次 PET/CT 扫描，每 4 个月进行一次脑部影像学检查；B2 层患者（PEG-干扰素和替莫唑胺；不可切除的不可测量疾病、转移性或复发性，n=3）每 4 个月进行一次影像学检查。治疗结束后，每 6 个月进行一次为期 3 年的影像学检查。
共纳入 21 例患儿（11 例女性，11 例 Spitz 样黑色素瘤，中位年龄 14 岁，头颈部[6]，躯干[7]，四肢[8]）。Spitz 样黑色素瘤患儿共进行了 236 次影像学检查（86 次 PET/CT，81 次 CTCAP，11 次胸部 CT，10 次脑部 CT，48 次脑部 MRI），每位患儿的中位费用为 32718 美元。13 项检查（5.8%）的结果导致两次活检（均为阳性）。对于常规 MM，对 162 例患儿（61 次 PET/CT，57 次 CTCAP，8 次胸部 CT，7 次脑部 CT，29 次脑部 MRI）进行了影像学检查，每位患儿的中位费用为 23420 美元。其中 20 项检查（14%）的结果导致了 6 次活检（4 次阳性）。截至 6.3 年（范围 0.4-9.2 年），17 例患儿无疾病存活。
Spitz 样黑色素瘤患儿在诊断和随访时仅需进行最低限度的影像学检查。常规 MM 患儿应根据成人指南进行影像学检查。
