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Children's Cancer and Leukaemia Group/ Oncology interest Group


Paediatric Haem-Oncology is an important sub-speciality where Radiology plays a pivotal role in diagnosis, staging, management planning and follow up. Fast paced research activities and wide-ranging pathologies make it a challenge for a Paediatric Radiologist to keep abreast of the advances in this field. This interest group intends to bring together radiologists with an interest in Paediatric Haem-Oncology to share and disseminate their knowledge, views and experience.

The Children's Cancer and Leukaemia Group (CCLG),which is the national association of healthcare professionals involved in the treatment and care of children and younger teenagers with cancer has also undergone significant change in recent years. Its relationship and interaction with the radiologists has also been affected by these changes. This Paediatric Radiology interest group in the BSPR can play a pivotal role in representing the views of the association to the CCLG, especially in key areas like radiological investigation and follow up protocols in various cancers. Membership of CCLG, for which there is an annual fee, is open to all members of BSPR with an active interest in Paediatric Haem-Oncology.

Download CCLG membership Information here


Download Winter Meeting 2013/4 Information here


Useful Guidelines and Standards

International Neuroblastoma Staging System from NCI Neuroblastoma Homepage

The treatment section of this document is organized to correspond with the Children’s Oncology Group (COG) risk-based schema for the treatment of neuroblastoma. This schema is based on three factors: patient age at diagnosis, certain biological characteristics of the patient’s neuroblastoma tumor, and the stage of the tumor as defined by the International Neuroblastoma Staging System (INSS). The INSS has replaced the previously used Children’s Cancer Group (CCG) and Pediatric Oncology Group (POG) staging systems.

International Neuroblastoma Staging System


This protocol is printed in full as it lies in a password protected part of the CCLG website (A Maclennan).

It is essential that all new children’s brain tumour cases are imaged using a consistent and comprehensive protocol. This is to ensure that optimal diagnostic information can be obtained, consistency is maintained, studies are directly comparable and that all brain tumour cases can be recruited into national CCLG driven tumour studies. It is equally important that follow up imaging is undertaken in a consistent and timely manner. Lack of a consistent protocol has lead to very significant difficulties in analysing imaging of patients enrolled into CCLG tumour studies from different centres in the UK.

In future, lack of adherence to the national CCLG imaging protocol will exclude new cases being recruited to CCLG studies. The protocol given below is based upon the imaging protocol published in 20011 but reflects recent advances in imaging techniques (DTI, perfusion MRI, MRS). Not all centres can or will wish to use these newer techniques, and therefore these are given as optional sequences. Many centres will have their own preferred imaging sequences and this protocol is not intended to be proscriptive or to exclude other sequences and techniques, however it is essential that a standardised basic set of sequences is adopted nationally.



Standard sequences: Axial T1, T2; Coronal FLAIR; DTI and/or DWI (with ADC maps);

Post Gd Ax, Cor, Sag T1: at 1.5T; Post Gd Ax T1, Ax 3D T1 volume at 3T

Optional sequences (according to local capacity/availability or CCLG trial involvement)

Cor/SagT2 or FLAIR; Perfusion MRI (requires placement of blue or pink cannula);



Standard sequences: Sag T1 (post Gd); Ax T1 through any equivocal focal abnormality

Optional sequences: Sag T2



Standard sequences: Axial T1, T2; Coronal FLAIR; DTI and/or DWI (with ADC maps);

Post Gd Ax, Cor, Sag T1: at 1.5T; Post Gd Ax T1, Ax 3D T1 volume at 3T

SPINE (only if not obtained prior to surgery)

Standard sequences: Sag T1; Ax T1 through any equivocal focal abnormality



Standard sequences: Axial T1, T2; Coronal FLAIR; DTI and/or DWI (with ADC maps);

Post Gd Ax, Cor, Sag T1: at 1.5T; Post Gd Ax T1, Ax 3D T1 volume at 3T

Optionalsequences: (according to local preference or CCLG trial involvement)

Cor/Sag T2 or FLAIR; Perfusion MRI (requires placement of blue or pink cannula);

ASL; MRS if tumour size >1.0cm (and dependent on tumour type/protocol)

SPINE (dependent on tumour type/protocol)

Standard sequences: Sag T1 (post Gd); Ax T1 through any equivocal focal abnormality

Optional sequences: Sag T2


1. Thiesse P, Jaspan T, Couanet D, Bracard S, Neuenschwander S, Griffiths PD. Un protocole d’imagerie des tumeurs cerebrales de l’enfant (A protocol for imaging pediatric brain tumors). J Radiol 2001;82:11-16.

This protocol will be subject to review in January 2010.

TJ/CCLG January 2009

Download pdf of this guideline HERE



Full Imaging details: VIT-0910 Protocol Vn2.1 Vd04May2012, Section 11, Page 33


This sheet is for quick reference regarding imaging. The VIT-0910 protocol remains the official guide on imaging.

Primary Objective: To evaluate the efficacy of the combination of temozolomide with vincristine and irinotecan in children and adults with refractory or relapsed rhabdomyosarcoma as assessed by confirmed objective tumour response

Evaluation criteria: The primary efficacy endpoint is the objective response, defined as a documented complete or partial volume tumour response after two cycles of treatment in each treatment group.

Pertinent Inclusion Criteria: Patients must have measurable disease defined as lesions that can be measured in 3 dimensions by medical imaging techniques such as CT or MRI. Ascites, pleural fluid, bone marrow disease alone and lesions seen on Tc scintigraphy or PET scan only are not considered measurable for these patients

More than 3 weeks since prior radiation therapy to the site of any progressive lesion that will be identified as a target lesion to measure tumour response.


Objective Tumour Response and Progression

Measurements of all lesions should be recorded in metric units.

All baseline evaluations should be performed as closely as possible to the treatment start, within 14 days of the beginning of the treatment if possible, then after every 2 cycles and to confirm any response.

The same radiological modality and technique (same sequence) for assessing disease at study entry is to be used for reassessment so that a direct comparison can be made to accurately evaluate disease response.

This study will use volumetric measurements of the primary tumour using an elliptical model (0.52 times the product of the 3 largest perpendicular diameters in the axial, coronal and sagittal plane) to assess response to neo adjuvant therapy. The RECIST 1.1 (Response Evaluation Criteria in Solid Tumours; ref New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1) European Journal of Cancer 45 (2009) 228–247) criteria will be used for assessment of the size of measurable metastases, including nodal metastases.

Primary Tumour Response (Volumetric)

On the basis of previous reports showing that volumetric tumour measurements may be more accurate than bidirectional or unidirectional measurements for tumours measuring >35 cm3, we will obtain volumetric measurements of the primary tumour using the formula for an ellipsoid model: volume 0.52 (antero-posterior diameter x transverse diameter x length) [Sohaib 2000, Prasad 2002].

Tumour volume (V) calculation:

V = ��/6 x a x b x c = 0.52 x a x b x c in cm3

a =length (in cm)

b = width (in cm)

c = thickness (in cm)

It is planned to also measure the maximum uni-dimensional measurement as suggested by the RECIST 1.1 guidelines (European Journal of Cancer 2009; 45: 228-47) and later compare the volume with uni-dimensional measurements in terms of tumour response. The maximum lesion diameter in any plane should be recorded as the longest tumour diameter and measurements may be taken from CT or MRI, but the maximum tumour measurement must always be in the same plane (axial, coronal or sagittal) even if this results in measuring the lesion at a different slice level or in a different orientation or vector compared with the baseline study.

A clinical assessment should be done at each visit in order to detect tumour progression at any point during treatment. This should be supplemented by radiological examination as appropriate.


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