Background: Pediatric cancer patients at home are usually hospitalized in their original cancer treatment facility when they need inpatient care. However, an adult palliative care unit specialized for pain relief could also be used. We conducted a survey to clarify which facility is desirable for such children.

Objective: We conducted a survey of adult palliative care units to clarify the age and medical care of children with cancer and their potential acceptability.

Method: In June 2016, we performed a questionnaire survey of 28 palliative care units in Tokyo, excluding our hospital. The questionnaire included items on the experience of pediatric cancer patients, treatable age, and details of supportive care.

Result: Valid answers were obtained from 18 (64%) hospitals. Only two institutions had encountered childhood cancer patients in the past. Forms of supportive care included radiation therapy (n=8, 44%), oral anticancer drugs (n=3, 17%), erythrocyte transfusion (n=8, 50%), platelet transfusion (n=7, 44%), and intravenous hyperalimentation. However, it was difficult to use children’s devices such as pediatric central venous ports (n=2, 11%) and pediatric feeding tubes (n=2, 11%). None of the hospitals reported cooperating with home clinics for children.

Conclusions: Considering the present circumstances, if pediatric cancer patients receiving medical care at home require hospitalization for pain relief, the original cancer treatment facility would be better. Promotion of palliative care, quality improvement, and regional collaboration are essential to improve the services offered in pediatric cancer treatment facilities.

A 6-month-old infant developed paraplegia at 4 months of age. Spinal magnetic resonance imaging (MRI) revealed an intramedullary tumor in Th7-L1. Partial excisional surgery was performed, and a diagnosis of anaplastic astrocytoma (grade III) was made. MRI revealed a large residual lesion (48 mm×10 mm) after resection. Radiotherapy with a total dose of 36 Gy in 24 fractions was performed, but the lesion remained with a size of 43 mm×5 mm, although paraplegia of both lower limbs improved. After 14 courses of oral administration of etoposide (25 mg/day for 11 days), no residual lesion was observed. No recurrence has been detected for 19 months from the disease onset. In anaplastic astrocytoma, complete resection and radiotherapy are the main treatments, whereas the significance of chemotherapy has not been established. Our patient showed that remission could be achieved by administering etoposide for anaplastic astrocytoma even after partial resection.

A 14-year-old boy was referred to our center for further treatment of a mediastinal mass with associated symptoms of fever and weight loss of two months’ duration. First, pneumonia was diagnosed but proved refractory to antimicrobial therapy. Computed tomography disclosed a large mediastinal mass compressing the left main bronchus with multiple bone metastases. Complete resection of the tumor was not feasible and a biopsy was performed by bronchoscopy. We detected the EWSR1-ATF1 fusion gene by RT-PCR and diagnosed the patient as having clear cell sarcoma. We initiated chemotherapy combined with local radiotherapy. Two weeks after the radiotherapy, the size of the primary tumor was reduced and the left main bronchus compression improved. We continued the chemotherapy and radiotherapy. However, the tumor increased in size two months after the completion of the radiotherapy, and the patient died of sepsis. In this case, radiotherapy was temporarily effective, but the development of a novel treatment is desirable.

We report the case of an 8-year-old girl with a mediastinal mature teratoma causing cardiac tamponade, who showed shoulder pain and hemosputum. She was transferred to our hospital and diagnosed as having mediastinal mature teratoma by computed tomography (CT). Her tumor marker levels were within the normal ranges. Tumor extirpation was planned, but general fatigue and fever elevation were recognized on admission. Tumor enlargement and pericardial effusion were detected by enhanced CT. Pericardial drainage was performed for cardiac tamponade induced by progressive pericardial effusion. Bloody fluid was recognized and the patient showed severe anemia requiring blood transfusion. Emergent tumor extirpation was performed through left thoracotomy. The histopathological findings showed a benign mature teratoma. The postoperative course was uneventful and her pericardial effusion gradually decreased after surgery. Mediastinal mature teratoma sometimes causes serious complications affecting surrounding organs due to tumor rupture. Careful follow-up is required for patients with mediastinal mature teratoma.

Patients with Diamond-Blackfan anemia (DBA), who respond poorly to steroids, and are dependent on transfusion, are candidates for hematopoietic cell transplantation (HCT); however, the optimal conditioning regimen remains to be established. Here, we report the case of a 3-year-old girl with DBA who was successfully treated by unrelated bone marrow transplantation (BMT) following reduced intensity conditioning (RIC) consisting of fludarabine (125 mg/m²), melphalan (140 mg/m²), rabbit antithymocyte globulin (5 mg/kg), and total body irradiation (3 Gy). Engraftment was achieved on day 30. She suffered from stage 2 acute graft-versus-host disease of the gut, which was resolved by increasing the dose of tacrolimus. At 11 months after BMT, she is independent of transfusions and maintains complete donor-type chimerism. RIC-HCT may be a promising option for DBA, although more cases are required to assess the efficacy and safety of RIC-HCT.