Treatments in children

Based on the results of the examinations, age of the child and their response to initial treatments, a treatment protocol is chosen.  The chosen protocol has, most of the time, been developed at international level.   Indeed, as childhood cancers remain a rare group of diseases in our small country, international consensuses guide doctors in the choice of treatments for your child.

This protocol specifies the frequency, intervals, doses and administration duration of the various different medications.  The duration, number of medications received or even the intensity of side effects are not directly related to the prognosis of the disease. We should therefore not compare the treatments between different children, but instead discus them with the doctor to understand the importance and role of each stage of treatment.

Chemotherapy

Chemotherapy drugs are medications that kill cancer cells throughout the whole body.  There are many different chemotherapy drugs.  Several different chemotherapy drugs are often combined to increase the efficacy of the treatment.

Sometimes they are used as the first line treatment and sometimes they are used as adjuvant to other treatments: surgery or radiotherapy for example.

Generally-speaking, chemotherapy drugs are always administered in several cycles to give the child’s healthy cells time to “recover” in between two cycles and to ensure that all of the persistent cancer cells are destroyed.  By analogy with a garden, the first cycles pull out all the weeds and the subsequent cycles kill the roots.

Most chemotherapy drugs attack cells that reproduce rapidly such as cancerous cells which divide more quickly than their normal counterparts.

Routes of administration

Chemotherapy is administered either during a stay in hospital, in a day unit, or at home. Chemotherapy can be administered via various different routes: intravenous, intramuscular, subcutaneous or by mouth.

Most chemotherapy drugs irritate the small veins and must be administered via a large blood vessel.  Different techniques are used to directly inject the drug into the blood vessel.

The central route

A long catheter is inserted through a vein in the neck or under the collarbone by the anesthetist.  This procedure is carried out under light anesthetic.  In contrast to the port, the central route is removed when the patient is discharged from hospital. 

Implanted Port (Port-A-Cath®)

This is a small disc attached to a catheter which is inserted into a large blood vessel.  This disc, which looks like the end of a stethoscope, is inserted under general anesthetic by the surgeon and placed just under the skin of the upper chest and sutured to the muscle.  It has a membrane which allows blood to be taken and medications to be administered.

To make puncturing the port less painful, it is advised numb the child’s skin over the port with Emla® (anesthetic cream) one hour before drip is set up. After the port has been used, the dressing applied by the nurses should be kept dry and clean for 48 hours.

If your child has to come back several days in a row and the port needle could not stay in place, a new tube of Emla should be used before each infusion to avoid the risk of infection.

If the period of time between two consultations is spaced out, the port should be flushed approximately every 3 months to ensure it works properly.

The port is removed at the end of treatment after discussion with the doctors.

Radiotherapy

Radiotherapy uses ionizing radiation to destroy rapidly multiplying cancerous cells.  This technique requires a number of calculations to ensure that the radiation beam only targets the cancerous cells and spares the health tissue around the tumor.

Before the first radiotherapy session, a “simulation” is organized in order to define the area to irradiate as accurately as possible.

Patients will then receive a timetable of sessions typically spread over a few weeks.  The procedure does not often take more than a few minutes. However, during the session it is essential that the child remains completely still.

For more information, please consult this link, concerning the Vladi project.

Surgery

Faced with tumors, surgery is often of great importance.  In certain situations, it is able to remove most of the tumor.  However, the majority of the time, even in the case of full surgical excision with the naked eye, treatment needs to be supplemented with radiotherapy or chemotherapy to ensure that the “roots” of the tumor have been destroyed. 

Surgery is also very useful for the diagnosis of a mass by means of a biopsy: a small fragment of the tumor is sampled and examined under a microscope.  For some tumors, other examinations performed on the fragments are used to determine the aggressiveness of the tumor and its response to different therapies.

Bone marrow transplant

In certain diseases, treatment with a bone marrow stem cell transplant may be required.  These stem cells produce the cells that make up the blood: red bloods cells, white blood cells and platelets.

They are taken from either a medullary sample (medullary stem cells), a peripheral sample (peripheral blood stem cells), or placental blood (cord blood stem cells).

Depending on the transplant indication, these cells are taken either from the child itself (autograft) or from a compatible third person: a brother or sister, an anonymous voluntary donor (allograft) or cord blood available in a cord blood bank.

Autografts are indicated following intensive treatments that have destroyed the stem cells in order to more quickly reconstitute the child’s bone marrow.  They are not generally used to treat leukemias and lymphomas. 

However, allografts are indicated in the case of leukemias and lymphomas.  The aim of the transplant is to replace the unhealthy stem cells of the recipient with those of the compatible donor. 

To do this, the child is given chemotherapy or radiotherapy in order to destroy all of the cancerous cells.  Then, the bag containing the donor’s stem cells is administered as a single infusion in order to recolonize the recipient’s bone narrow. 

The post-transplant period, during which the recipient’s bone marrow is destroyed and new bone marrow is then produced, is very precarious.  Indeed, the factory producing the blood completely shuts down for 2 to 3 weeks on average. This means that the child has no defense against infections.  That is why these transplants are performed in Unit 56, the sterile unit.  Medullary recovery is gradual and requires hospitalization for a total minimum period of 4 to 5 weeks.  After that period, very close medical follow-up with frequent immunoglobulin infusions is initiated.