Second primary osteosarcomas in patients with retinoblastoma

OBJECTIVE

Second primary malignancies have become the leading cause of death in retinoblastoma survivors. Although osteosarcoma is the most common second malignancy, little is known about its clinical and therapeutic features.

METHODS

We retrospectively reviewed a database of patients with retinoblastoma and osteosarcoma occurring as a second malignancy between 1964 and 2010 at the National Cancer Center Hospital of Japan.

RESULTS

Among 857 patients with retinoblastoma registered in the database, 10 (1.1%) developed osteosarcoma as a second malignancy. The median age at the onset of retinoblastoma was 3 months, being bilateral in nine patients and unilateral in one. Systemic chemoreduction was performed in three patients and intra-arterial chemotherapy in six; all patients received external beam radiotherapy. The median age at the onset of second primary osteosarcoma was 11.2 years; four were radiation-related and six were located in an extremity. Among five patients treated at our institute, four patients with tumors on an extremity were treated by wide resection with neoadjuvant and adjuvant chemotherapy. Three of these four patients (75%) were good responders to high-dose methotrexate-based multi-agent chemotherapy and survived with no evidence of disease (median follow-up period, 17.3 years). One patient whose temporal bone was affected underwent radiotherapy with chemotherapy but died after local recurrence.

CONCLUSIONS

The clinical outcomes of second primary osteosarcoma in an extremity occurring in retinoblastoma survivors may be more favorable than those of conventional osteosarcoma. Early diagnosis of radiation-related osteosarcoma arising in the craniofacial region should be made at a stage where complete resection is possible.

Abstract 1794: Preclinical evaluation of radiotherapy in combination with radio-sensitizing telomerase-specific oncolytic virus for human bone and soft tissue sarcomas

Background: Despite major advances in the treatment of bone and soft tissue sarcomas, including surgery, chemotherapy, and radiation, some sarcoma patients show poor prognosis due to resistance to conventional therapy. Therefore, the development of a novel therapeutic strategy for sarcoma patients is needed. We recently revealed that a telomerase-specific, replication-competent oncolytic adenovirus OBP-301 efficiently killed human sarcoma cells. Moreover, combination therapy with OBP-301 and radiation has been confirmed to show synergistic antitumor effect in epithelial malignant tumor cells; however, its effect in human sarcoma cells remains elusive. In this study, we investigated the antitumor effect of OBP-301 in combination with radiation against human sarcoma cells.

Methods: We used five human sarcoma cell lines, SK-ES-1 (Ewing sarcoma), RD-ES (Ewing sarcoma) SYO-1 (synovial sarcoma), U2OS (osteosarcoma) and HOS (osteosarcoma). Cells were irradiated 24 h after infection with OBP-301, and cell viability was assessed by XTT assay 4 days after irradiation. Combined effect of radiation with OBP-301 was analyzed with the CalcuSyn software (BioSoft). These cells were analyzed for apoptosis using western blot analysis. To analyze the effect of OBP-301 in DNA repair process, immunofluorescence staining was performed after treatment of irradiation with or without OBP-301 infection on SK-ES-1 cell. We further investigated the in vivo combined effect of OBP-301 and radiation. The SK-ES-1 tumor-bearing mice were irradiated at a dosage of 1 Gy/tumor once per week for three cycles, and OBP-301 (1 × 108 plaque-forming units per tumor), or PBS was injected into the tumor 3 times per week for three cycles.

Results: Combination treatment with OBP-301 and radiation showed synergistic or additive antitumor effect in all human sarcoma cells. Western blot analysis showed that combination treatment increased the expression of cleaved-PARP, and prolonged the level of γH2AX protein than radiation treatment. Combination therapy of OBP-301 with radiation showed antitumor effect more significantly than monotherapy in SK-ES-1 xenograft tumor model.

Conclusions: These results suggest that combination therapy of OBP-301 with radiation is a promising antitumor strategy for bone and soft tissue sarcomas.

Citation Format: Toshinori Omori, Yasuaki Yamakawa, Joe Hasei, Hiroshi Tazawa, Shuhei Osaki, Tusyoshi Sasaki, Kazuhisa Sugiu, Tomohiro Fujiwara, Toshiyuki Kunisada, Yasuo Urata, Toshifumi Ozaki, Toshiyoshi Fujiwara. Preclinical evaluation of radiotherapy in combination with radio-sensitizing telomerase-specific oncolytic virus for human bone and soft tissue sarcomas. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1794. doi:10.1158/1538-7445.AM2015-1794

Development and external validation of nomograms predicting distant metastases and overall survival after neoadjuvant chemotherapy and surgery for patients with nonmetastatic osteosarcoma: A multi-institutional study

BACKGROUND

In this era of individualized cancer treatment, data that could be applied to predicting the survival of patients with osteosarcoma are still limited because of the rarity of the disease and the difficulty in accumulating a sufficient number of patients. Therefore, a multi‐institutional collaboration was implemented to develop and externally validate nomograms that would predict metastasis‐free survival (MFS) and overall survival (OAS) for patients with nonmetastatic osteosarcoma.

METHODS

This study retrospectively examined 1070 patients treated with neoadjuvant chemotherapy and surgery for nonmetastatic osteosarcoma. Data from Japanese patients (n = 557) were used to develop multivariate nomograms based on Cox regression. Six clinical and pathologic variables were built into nomograms estimating the probability of MFS and OAS 3 and 5 years after diagnosis. The model was internally validated for discrimination and calibration with bootstrap resampling and was externally validated with an independent patient cohort from Korea (n = 513).

RESULTS

A patient's age, tumor site, and histologic response were found to have a stronger influence on MFS and OAS in the model than sex, tumor size, or pathologic fracture. The nomograms and calibration plots based on these results well predicted the probability of MFS (concordance index, 0.631) and OAS (concordance index, 0.679). The concordance indices for external validation were 0.682 for MFS and 0.665 for OAS.

CONCLUSIONS

The nomograms were externally validated and verified to be useful for the prediction of MFS and OAS and for the assessment of the postoperative prognosis. They can be used for counseling patients and for establishing appropriate surveillance strategies after surgery. Cancer 2015;121:3844–3852. © 2015 American Cancer Society.

Prognostic nomograms for osteosarcoma have been developed and externally validated through multi‐institutional collaboration. These prognostic nomograms are the first to be developed and externally validated for osteosarcoma.

Diagnostic value of Thallium-201 scintigraphy in differentiating malignant bone tumors from benign bone lesions

OBJECTIVE

This retrospective study aims to evaluate the diagnostic capacity of thallium-201 (201Tl) scintigraphy for differentiating malignant bone tumors from benign bone lesions.

METHODS

Between January 2006 and December 2012, 279 patients with bone lesions (51 malignant and 228 benign) underwent 201Tl scintigraphy before treatment. To evaluate 201Tl uptake, we investigated tumor-to-background contrast (TBC) as well as TBC washout rate (WR). The differences of TBC on early and delayed images and WR were estimated by the Mann-Whitney U test. Receiver operating characteristic (ROC) analyses were used to determine the cut-off TBC values for differentiating malignant bone tumors from benign bone lesions.

RESULTS

There were statistically significant differences in median TBC between malignant tumors and benign lesions. These differences occurred for early imaging (1.57 vs. 0.09, p < 0.001) as well as for delayed imaging (0.83 vs. 0.07, p < 0.001). However, there was no statistical difference in WR between malignant tumors and benign lesions (44 vs. 43 %, NS). The chosen TBC cut-off value was 0.68 for early imaging and 0.38 for delayed imaging. Using these cut-off values, the prediction of malignancy had a 77 % sensitivity, 74 % specificity, and 75 % accuracy for early imaging and an 80 % sensitivity, 76 % specificity, and 77 % accuracy for delayed imaging.

CONCLUSIONS

201Tl scintigraphy may have the ability to distinguish malignant bone tumors from benign bone lesions.

The global economic crisis, household income and pre-adolescent overweight and underweight: a nationwide birth cohort study in Japan

Background:

We hypothesized that children from lower income households and in households experiencing a negative income change in connection to the global economic crisis in 2008 would be at increased risk of adverse weight status during the subsequent years of economic downturn.

Methods:

Data were obtained from a nationwide longitudinal survey comprising all children born during 2 weeks of 2001. For 16,403 boys and 15,206 girls, information about anthropometric measurements and household characteristics was collected from 2001 to 2011 on multiple occasions. Interactions between the crisis onset (September 2008) and household income group, as well as the crisis onset and a >30% negative income change in connection to the crisis, were assessed with respect to risk of childhood over- and underweight.

Results:

Adjusted for household and parental characteristics, boys and girls in the lower household income quartiles had a larger increase in risk of overweight after the crisis onset relative to their peers in the highest income group. (Odds ratio (95% confidence interval) for interaction term in boys=1.23 (1.02–1.24); girls=1.35 (1.23–1.49) comparing the lowest with the highest income group.) Among girls, an interaction between the crisis onset and a >30% negative change in household income with respect to risk of overweight was observed (odds ratio for interaction term=1.23 (1.09–1.38)). Girls from the highest income group had an increased risk of underweight after the crisis onset compared with girls from the lowest income group.

Conclusions:

Boys and girls from lower household income groups and girls from households experiencing a negative income change in connection to the global economic crisis in 2008, may be at increased risk of overweight. Vulnerability to economic uncertainty could increase risk of overweight in preadolescence.

Epidemiology of cataract--clinical evaluation with retro-illumination photography

Retro-illumination photography was utilized for epidemiological studies of cataract. Diagnosis of cataract was made by the existence of shadows on the photographs obtained. In the prevalence study, prevalence rate of cataract was 35.7% in all (30.2% in male and 45.1% female) 1,017 persons (643 males and 347 females). Prevalence rates were always higher in females than in males, and in diabetics as compared with non-diabetics, in all decades of life. The progression study in 338 persons (144 males and 194 females) revealed that maturing courses of cataract were most rapid in diabetic females in the fifth to seventh decades of life.

Sulfonamide antibiotic removal and nitrogen recovery from synthetic urine by the combination of rotating advanced oxidation contactor and methylene urea synthesis process

The combination of nitrogen recovery and pharmaceutical removal processes for livestock urine treatment were investigated to suppress the discharge of pollutants and recover nitrogen as resources. We combined methylene urea synthesis from urea and adsorption and photocatalytic decomposition of sulfonamide antibiotic using rotating advanced oxidation contactor (RAOC) contained for obtaining both safe fertilizer and reclaimed water. The methylene urea synthesis could recover urea in synthetic urine, however, almost all sulfonamide antibiotic was also incorporated, which is unfavorable from a safety aspect if the methylene urea is to be used as fertilizer. Conversely, RAOC could remove sulfonamide antibiotic without consuming urea. It was also confirmed that the methylene urea could be synthesized from synthetic urine treated by RAOC. Thus, we concluded that RAOC should be inserted prior to the nitrogen recovery process for effective treatment of urine and safe use of methylene urea as fertilizer.

Impact of recipient aging on kidney allograft in living donor transplantation

BACKGROUND

The aging of recipients is becoming increasingly important in organ transplantation.

PATIENTS AND METHODS

We analyzed outcomes in 215 consecutive adult kidney transplant recipients from living donors who underwent transplantation at our center between November 1988 and March 2012. The list of recipients was divided by age at transplantation into those aged 16 to 29 years (n = 61), 30 to 39 years (n = 69), 40 to 49 years (n = 33), 50 to 59 years (n = 29), and those 60 years or older (elderly group, n = 23). Cox proportional hazards analysis was used to calculate the relative risk (RR) of patient death and graft failure, with recipient age included as a continuous variable.

RESULTS

Univariate analysis showed that recipient age did not significantly affect the risk of graft failure, either uncensored (RR = 1.01, P = .312) or censored for death (RR = 0.993, P = .587). Multivariate analysis, however, showed that recipient age was an independent risk factor for patient death (RR = 1.053, P = .024). The patient survival rate was the poorest in elderly group (87.0%, P = .036), whereas the both death uncensored and censored graft survival rates of this group were 78.1% and 91.3%, respectively, comparable to those of other age groups (P = .567 and P = .696). Mean estimated glomerular filtration rate (eGFR) 1 year after transplantation was lower in elderly groups than in other groups (46.1 ± 13.0 mL/min/1.73 m(2), P = .014). However, mean δeGFR, defined as the difference between pretransplantation eGFR of the donor and eGFR of the recipient 1 year post-transplantation, did not differ significantly among age groups.

CONCLUSION

Recipient age did not affect allograft deterioration in living donor kidney transplantation, although it was an independent risk factor of recipient death.

MicroRNAs in soft tissue sarcomas: overview of the accumulating evidence and importance as novel biomarkers

Sarcomas are distinctly heterogeneous tumors and a variety of subtypes have been described. Although several diagnostic explorations in the past three decades, such as identification of chromosomal translocation, have greatly improved the diagnosis of soft tissue sarcomas, the unsolved issues, including the limited useful biomarkers, remain. Emerging reports on miRNAs in soft tissue sarcomas have provided clues to solving these problems. Evidence of circulating miRNAs in patients with soft tissue sarcomas and healthy individuals has been accumulated and is accelerating their potential to develop into clinical applications. Moreover, miRNAs that function as novel prognostic factors have been identified, thereby facilitating their use in miRNA-targeted therapy. In this review, we provide an overview of the current knowledge on miRNA deregulation in soft tissue sarcomas, and discuss their potential as novel biomarkers and therapeutics.

The prognosis of osteosarcoma occurring as second malignancy of childhood cancers may be favorable: experience of two cancer centers in Japan

BACKGROUND

Osteosarcoma as second malignancy of childhood cancers rarely occurs, and its clinical characteristics are unclear.

METHODS

Patients with osteosarcoma occurring as second malignancy of childhood cancers were retrospectively surveyed.

RESULTS

Of 323 patients with osteosarcoma registered in the database, 10 (3.1%) had a past history of childhood cancers. The mean age at the onset of the first childhood cancer was 2.7 years, and the diagnosis of the first childhood cancer was adrenocortical carcinoma, malignant teratoma, ovarian carcinoma, Ewing's sarcoma, and rhabdomyosarcoma in 1 patient each, and retinoblastoma in 5 patients. Osteosarcoma as second malignancy occurred 14.6 years after the first childhood cancer on average. Seven patients were alive and 3 died. In 1 patient, the cause of death was related to a complication of treatment for the first childhood cancer. Except for this patient, 7 (77.8%) of 9 patients survived with no disease (mean follow-up period: 10.9 years).

CONCLUSIONS

Attention should be paid to complications of treatment for the first childhood cancer in the treatment for osteosarcoma occurring as second malignancy. The prognosis of osteosarcoma as second malignancy of childhood cancers may be more favorable than that of conventional osteosarcoma.

Unique mutation portraits and frequent COL2A1 gene alteration in chondrosarcoma

Chondrosarcoma is the second most frequent malignant bone tumor. However, the etiological background of chondrosarcomagenesis remains largely unknown, along with details on molecular alterations and potential therapeutic targets. Massively parallel paired-end sequencing of whole genomes of 10 primary chondrosarcomas revealed that the process of accumulation of somatic mutations is homogeneous irrespective of the pathological subtype or the presence of IDH1 mutations, is unique among a range of cancer types, and shares significant commonalities with that of prostate cancer. Clusters of structural alterations localized within a single chromosome were observed in four cases. Combined with targeted resequencing of additional cartilaginous tumor cohorts, we identified somatic alterations of the COL2A1 gene, which encodes an essential extracellular matrix protein in chondroskeletal development, in 19.3% of chondrosarcoma and 31.7% of enchondroma cases. Epigenetic regulators (IDH1 and YEATS2) and an activin/BMP signal component (ACVR2A) were recurrently altered. Furthermore, a novel FN1-ACVR2A fusion transcript was observed in both chondrosarcoma and osteochondromatosis cases. With the characteristic accumulative process of somatic changes as a background, molecular defects in chondrogenesis and aberrant epigenetic control are primarily causative of both benign and malignant cartilaginous tumors.

Immediate soft-tissue reconstruction using a rectus abdominis myocutaneous flap following wide resection of malignant bone tumours of the pelvis

Resection of malignant bony tumours of the pelvis creates large bone and soft-tissue defects, and is frequently associated with complications such as wound dehiscence and deep infection. We present the results of six patients in whom a rectus abdominis myocutaneous (RAM) flap was used following resection of a malignant tumour of the pelvis. Bony reconstruction was performed using a constrained hip tumour prosthesis in three patients, vascularised fibular graft in two and frozen autograft in one. At a mean follow-up of 63 months (16 to 115), no patients had a problem with the wound.

Immediate reconstruction using a RAM flap may be used after resection of a malignant tumour of the pelvis to provide an adequate volume of tissue to eliminate the dead space, cover the exposed bone or implants with well-vascularised soft tissue and to reduce the risk of complications.

Cite this article: Bone Joint J 2014;96-B:270–3.

Prevalence and risk factors of soil-transmitted helminth infection in Nepal

BACKGROUND

The purpose of this study is to evaluate the prevalence and intensity and examine the risk factors of soil transmitted helminth (STH; i.e., roundworm [Ascaris lumbricoides], hookworms [Ancylostoma duodenale and Necator americanus], and whipworm [Trichuris trichiura]) infections in Nepal.

METHODS

Five hundred and ninety-four adults (256 men and 338 women) were selected via convenience sampling from five communities in Nepal. The Kato-Katz method was used to assess the prevalence and intensity of STH infection in this population.

RESULTS

Prevalence of STH infection ranged from 3.3% in Birendranagar in Chitwan, 3.5% in Kuleshor in Kathmandu, 11.7% in Kanyam in Ilam, 17.0% in Dhikurpokhari in Kaski and 51.4% in Khokana in Lalitpur District [corrected]. Multivariable regression analysis revealed that not using soap for hand-washing was significantly associated with the prevalence and infection intensity of roundworm, hookworms and whipworm. Similarly, not wearing sandals or shoes outside was significantly associated with the prevalence and infection intensity of roundworm and hookworms, but not with infection intensity of whipworm. Literacy, being underweight or overweight, anemia and occupation were not associated with prevalence and intensity of roundworm and hookworms infection, but there was an association between occupation and the prevalence of whipworm infection.

CONCLUSION

STH infection was associated with individual hygiene behavior, but not with nutritional status or socio-demographic characteristics. Health policy focusing on changing individual hygiene behaviors might be useful in addressing STH infection in Nepal.

Pharmacokinetics, safety, and monotherapy antiviral activity of GSK1265744, an HIV integrase strand transfer inhibitor

BACKGROUND

GSK1265744 is an HIV integrase strand transfer inhibitor selected for clinical development.

OBJECTIVE

This first-time-in-human and phase IIa investigation assessed GSK1265744 antiviral activity, pharmacokinetics, safety, and tolerability in healthy and HIV-1-infected subjects.

METHODS

This double-blind, placebo-controlled study consisted of a dose escalation of single (part A) and multiple (part B) oral doses in 48 healthy subjects and an oral dose (part C) in 11 HIV-1-infected subjects. In part A, 2 cohorts of 9 subjects received either 5 and 25 mg or 10 and 50 mg. In part B, 3 cohorts of 10 subjects received 5, 10, or 25 mg once daily for 14 days. In part C and the phase IIa study, subjects received 5 or 30 mg once daily for 10 days.

RESULTS

Dose-proportional increases in drug exposure were observed in healthy and HIV-1-infected subjects. In healthy subjects, pharmacokinetic variability was low following single or repeat dosing (coefficient of variation, 13%-34% and 15%-23%, respectively). Mean plasma half-life was 31.5 hours. GSK1265744 monotherapy significantly reduced plasma HIV-1 RNA from baseline to day 11 in HIV-1-infected subjects receiving 5 or 30 mg versus placebo (P < .001); mean decrease was 2.2 to 2.3 log10 copies/mL, respectively. Study drug was generally well tolerated with no clinically relevant trends in laboratory values, vital signs, or electrocardiograms.

CONCLUSIONS

GSK1265744 was well tolerated in healthy and HIV-1-infected subjects. Results demonstrate once-daily doses of 5 or 30 mg exceeded minimum target therapeutic concentrations and produced a significant reduction in plasma HIV-1 RNA viral load.

Kidney transplantation of living unrelated and ABO-incompatible donor-recipient combinations

INTRODUCTION

In Japan, ABO-incompatible (ABO-IC) living kidney transplantation (LKT) has been performed among more than 2000 patients between 1989 and 2010 seeking to compensate for the shortage of donor organs. In addition, many patients lack a genetically living related donor (LRD); therefore, volunteer spouses (unrelated, LURD) have been considered since about 1990.

PATIENTS AND METHODS

We performed 112 LKT between April 2003 and March 2011, including 44 (39%) spousal and two other LURD. The other 66 cases received LRD kidneys. We divided patients into two groups: 44 patients (group 1) received a kidney from a spouse (LURD) and 66 (group 2) from LRD. During the induction phase, tacrolimus or cyclosporine, mycophenolate mofetil, and methylprednisolone were prescribed for immunosuppression. Basiliximab was administered on postoperative days 0 and 4. For ABO-IC LKT, plasmapheresis was performed to remove anti-AB antibodies prior to LKT. Splenectomy was performed at the time of or before LKT. Since March 2010, rituximab administration was performed before transplantation instead of splenectomy.

RESULTS

Death-censored graft survival rates were 97.7% in group 1 and 98.5% in group 2, respectively. The incidences of acute rejection episodes were 31.8% and 24.2% in groups 1 and 2, respectively. There were three cases of antibody-mediated rejection in group 1. No patient experienced a lethal infectious complication.

CONCLUSIONS

Our results demonstrated that spousal LKT (LURD) was equivalent to LRD. In response to the shortage of deceased donors and genetically LRD, LKT between married couples or from ABO-IC donors will spread in Japan.