When cancer recurs in a child's marrow, bones, lungs, brain, liver, soft tissues and other sites, treatment at Mayo Clinic in Rochester will involve multispecialty evaluation and coordination of care by pediatric hematologists, oncologists and other experts. Examples of coordination for different diseases include:

• Leukemia or recurrent lymphoma
  Transplant specialists review the feasibility of bone marrow and stem cell transplant strategies. They will determine if healthy bone marrow can be removed and preserved for reintroduction after radiation treatments (autologous transplantation); or whether a healthy donor match can be made from a sibling or other genetically similar donor (allogeneic hematopoietic transplantation).
• Bone metastases
  Orthopedic surgeons, radiologists, radiofrequency ablation specialists, and other pediatric oncology consultants will work together to determine the best means of local and systemic control of the disease.
• Lung lesions
  When appropriate, surgeons at Mayo Clinic operate on both sides of the chest during the same procedure (called bilateral simultaneous thoracotomy) instead of performing two operations at different times.
• Aerosol cytokine therapy
  This drug therapy may be considered for selected cases after removal of all cancerous lung lesions.
• Brain lesions
  Pediatric neurosurgery, radiation oncology and pediatric oncology physicians determine the best treatment, such as surgical removal of tumor versus use of gamma knife and/or chemotherapy.
• Hepatic and/or soft tissue metastases
  Pediatric surgery, radiofrequency ablation and pediatric oncology work as a team to determine the best means of control at the tumor site and additional therapy.

Innovative therapies and resources available for pediatric oncology and hematology patients at Mayo Clinic in Rochester include:

• Radiofrequency ablation can be used for certain tumors.
• Mayo Clinic is a nationally recognized site for unrelated donor, bone marrow and stem cell transplants.
• Inhalation treatment with GMCSF for patients with recurring cancer in the lungs. Mayo Clinic specialists are pioneers in this treatment.
• A unique radiation therapy called intensity-modulated radiation therapy (IMRT) better targets tumors and limits side effects.
• Surgeons can perform bilateral simultaneous thoracotomies to treat metastatic lung disease. In this procedure surgeons remove cancerous nodules from the lungs through entry points on both sides of the chest. More traditional methods require two surgeries or an entry point at the center of the chest making certain nodules hard to locate.
• Special air filtration rooms are available to help keep patients undergoing intensive chemotherapy healthy when their blood counts are low.
• Patients at Mayo Clinic can often participate in clinical trials.

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