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Frisch S, Libuschewski H, Peters S, Gerß J, von Hoff K, Kortmann RD, Nemes K, Rutkowski S, Hasselblatt M, Pietsch T, Frühwald MC, Timmermann B. Radiation Therapy Plays an Important Role in the Treatment of Atypical Teratoid/Rhabdoid Tumors: Analysis of the EU-RHAB Cohorts and Their Precursors. Int J Radiat Oncol Biol Phys 2024; 119:1147-1157. [PMID: 38246248 DOI: 10.1016/j.ijrobp.2024.01.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE Atypical teratoid/rhabdoid tumor (AT/RT) is a rare malignancy of the central nervous system in young children with a dismal prognosis. Prognostic markers have been extensively investigated but have not been validated. The role of radiation therapy (RT) remains controversial. We evaluated the impact of RT as part of multimodality treatment by analyzing data of a European AT/RT cohort. METHODS AND MATERIALS We retrospectively analyzed data of the European Registry for Rhabdoid Tumors and its precursors. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Potential impact of prognostic factors was analyzed using univariable and multivariable Cox regression analyses with RT as a time-dependent factor. RESULTS Data of 186 children (118 male, 68 female) treated from 1990 to 2016 were evaluable. The median age at diagnosis was 1.57 years (range, 0.01-26.70 years); 47% (87/186) of the patients were under the age of 18 months. Sixty-nine percent (128/186) received RT (focal RT, n = 93; craniospinal treatment with local boost, n = 34; spinal irradiation, n = 1). The median follow-up duration of the entire cohort was 1.73 years (range, 0.06-20.11 years). The estimated PFS and OS rates were 48% (95% CI, 41%-55%) and 72% (95% CI, 65%-78%) at 1 year and 33% (95% CI, 26%-40%) and 49% (95% CI, 41%-56%) at 2 years, respectively. On multivariable analysis, RT was an independent significant prognostic factor for PFS (hazard ratio, 0.45; 95% CI, 0.27-0.75; P = .002) and OS (hazard ratio, 0.54; 95% CI, 0.32-0.93; P = .025). CONCLUSIONS This analysis confirms the relevance of local therapies. RT was an independent prognostic factor for outcomes in children experiencing AT/RT. However, long-term sequelae have to be carefully evaluated and considered given the young age at time of RT.
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Affiliation(s)
- Sabine Frisch
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany
| | - Hanna Libuschewski
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany
| | - Sarah Peters
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Katja von Hoff
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Rolf-Dieter Kortmann
- Department of Radiation Therapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Karolina Nemes
- University Children's Hospital Augsburg, Swabian Childrens Cancer Center, Augsburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Centre, Bonn, Germany
| | - Michael C Frühwald
- University Children's Hospital Augsburg, Swabian Childrens Cancer Center, Augsburg, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany; German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany.
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Mironova E, Molinas S, Pozo VD, Bandyopadhyay AM, Lai Z, Kurmashev D, Schneider EL, Santi DV, Chen Y, Kurmasheva RT. Synergistic Antitumor Activity of Talazoparib and Temozolomide in Malignant Rhabdoid Tumors. Cancers (Basel) 2024; 16:2041. [PMID: 38893160 PMCID: PMC11171327 DOI: 10.3390/cancers16112041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Malignant rhabdoid tumors (MRTs) are among the most aggressive and treatment-resistant malignancies affecting infants, originating in the kidney, brain, liver, and soft tissues. The 5-year event-free survival rate for these cancers is a mere 20%. In nearly all cases of MRT, the SMARCB1 gene (occasionally SMARCA4)-a pivotal component of the SWI/SNF chromatin remodeling complex-is homozygously deleted, although the precise etiology of these tumors remains unknown. While young patients with localized MRT generally show improved outcomes, especially those who are older and have early-stage disease, the overall prognosis remains poor despite optimal standard treatments. This highlights the urgent need for more effective treatment strategies. We investigated the antitumor activity of a PARP1 inhibitor (talazoparib, TLZ) combined with a DNA alkylating agent (temozolomide, TMZ) in MRT xenograft models. PARP1 is a widely targeted molecule in cancer treatment and, beyond its role in DNA repair, it participates in transcriptional regulation by recruiting chromatin remodeling complexes to modulate DNA accessibility for RNA polymerases. To widen the therapeutic window of the drug combination, we employed PEGylated TLZ (PEG~TLZ), which has been reported to reduce systemic toxicity through slow drug release. Remarkably, our findings indicate that five out of six MRT xenografts exhibited an objective response to PEG~TLZ+TMZ therapy. Significantly, the loss of SMARCB1 was found to confer a protective effect, correlating with higher expression levels of DNA damage and repair proteins in SMARCB1-deficient MRT cells. Additionally, we identified MGMT as a potential biomarker indicative of in vivo MRT response to PEG~TLZ+TMZ therapy. Moreover, our analysis revealed alterations in signaling pathways associated with the observed antitumor efficacy. This study presents a novel and efficacious therapeutic approach for MRT, along with a promising candidate biomarker for predicting tumor response.
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Affiliation(s)
- Elena Mironova
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Sebastian Molinas
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Vanessa Del Pozo
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Abhik M. Bandyopadhyay
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Zhao Lai
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
- Department of Molecular Medicine, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Dias Kurmashev
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | | | | | - Yidong Chen
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
- Department of Population Health Sciences, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Raushan T. Kurmasheva
- Greehey Children’s Cancer Research Institute, University of Texas Health Science Center, San Antonio, TX 78229, USA
- Department of Molecular Medicine, University of Texas Health Science Center, San Antonio, TX 78229, USA
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3
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Li Z, Wang Y, Zhao L, Li Y. Epidemiology, Characteristics, and Prognostic Factors of Primary Atypical Teratoid/Rhabdoid Tumors in the Spinal Canal: A Systematic Review. Neurospine 2024; 21:182-203. [PMID: 38317556 PMCID: PMC10992646 DOI: 10.14245/ns.2347096.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024] Open
Abstract
Primary atypical teratoid/rhabdoid tumors (AT/RTs) in the spinal canal are rare central nervous system (CNS) neoplasms that are challenging to diagnose and treat. To date, there has been no standard treatment regimen for these challenging malignant tumors. Thus, we conducted this research to explore potential prognostic factors and feasible treatment modalities for improving the prognosis of these tumors. Articles were retrieved from the PubMed, MEDLINE, and Embase databases, using the keywords "atypical teratoid/rhabdoid tumor," "rhabdoid tumor," "spine," "spinal," "spinal neoplasm", and "spinal cord neoplasm." All eligible cases demonstrated SMARCB1-deficient expression validated by pathological examination. We collected and analyzed data related to clinical presentation, radiological features, pathological characteristics, treatment modalities and prognosis via Kaplan-Meier and Cox regression analyses. Thirty-six articles comprising 58 spinal AT/RT patients were included in the study. The median progression-free survival (PFS) and overall survival (OS) were 18 and 22 months, respectively. Kaplan-Meier analysis demonstrated significant survival improvements for OS in the nonmetastasis, male, radiotherapy and intrathecal chemotherapy groups as well as for PFS in the chemotherapy and radiotherapy groups. Multivariate analysis revealed that chemotherapy and radiotherapy were prognostic factors for improved PFS, and that intrathecal chemotherapy reduced the risk of mortality. Spinal AT/RTs are uncommon malignant entities with a dismal survival rate. Although our review is limited by variability between cases, there is some evidence revealing potential risk factors and the importance of systematic chemotherapy, intrathecal chemotherapy and radiotherapy in spinal AT/RT treatment modalities.
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Affiliation(s)
- Zhibin Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Liyan Zhao
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun, China
| | - Yunqian Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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4
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Gupta NK, Godbole N, Sanmugananthan P, Gunda S, Kasula V, Baggett M, Gajjar A, Kouam RW, D'Amico R, Rodgers S. Management of Atypical Teratoid/Rhabdoid Tumors in the Pediatric Population: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 181:e504-e515. [PMID: 37871692 DOI: 10.1016/j.wneu.2023.10.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumors are rare and aggressive tumors that mainly affect children <3 years of age. Despite aggressive treatment, the overall survival rate for pediatric atypical teratoid/rhabdoid tumors remains poor. Due to their rarity, little is known regarding prognostic factors, and there is no official standard of treatment. METHODS A comprehensive database search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms included "atypical teratoid rhabdoid tumor" and "atypical (teratoid OR rhabdoid) tumor." Variables of interest included, but were not limited to, age, sex, tumor location, treatment modality, extent of resection, and overall survival. RESULTS The study included 294 articles and 936 patients. The median age of patients was 22 months. There was a significant difference in survival among patients receiving surgery compared with patients receiving nonoperative treatment (50.3 months vs. 28 months; P < 0.005). Extent of resection did not significantly improve survival (P = 0.832 for gross total resection, P = 0.650 for partial resection). Combination therapy with surgical resection, radiotherapy, and chemotherapy demonstrated the largest median overall survival (54.9 months) and significantly improved survival on multivariate analysis (hazard ratio, 0.48; 95% confidence interval, 0.23-0.97; P = 0.042). CONCLUSIONS The results of this study indicate that while surgery is a crucial treatment modality for pediatric atypical teratoid/rhabdoid tumors, the effect of extent of resection is unclear. Multimodal therapy including surgery, radiotherapy, and chemotherapy is effective in improving overall survival. Future studies should focus on using larger datasets to efficiently account for confounding factors and biases.
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Affiliation(s)
- Nithin K Gupta
- Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA.
| | - Nikhil Godbole
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Praveen Sanmugananthan
- Department of Neurosurgery, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri, USA
| | - Saket Gunda
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, Louisiana, USA
| | - Varun Kasula
- Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Mia Baggett
- Tulane Brain Institute, Tulane University, New Orleans, Louisiana, USA; School of Science and Engineering, New Orleans, Louisiana, USA
| | - Avi Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Romaric Waguia Kouam
- Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Randy D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital, New York, New York, USA
| | - Shaun Rodgers
- Department of Neurological Surgery, Cohen Children's Medical Center, New Hyde Park, New York, USA
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5
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Syed H, Teferi N, Hanson A, Challa M, Eschbacher K, Hitchon P. Clinical diagnostic and radiographic features of primary spinal atypical teratoid rhabdoid tumors tumor in a pediatric patient: A case report and review of the literature. J Cent Nerv Syst Dis 2023; 15:11795735231209199. [PMID: 37876767 PMCID: PMC10591496 DOI: 10.1177/11795735231209199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
Atypical teratoid rhabdoid tumors (ATRTs) are rare embryonal tumors comprising 1-2% of all pediatric CNS neoplasms. Spinal ATRTs are even more uncommon, accounting for 2% of all reported ATRT cases. Despite their rarity, ATRTs affect young children disproportionately and are characterized by a high malignant potential due to a heterogeneous cellular composition and inactivating mutations in the SMARCB1 (90%) and SMARCA4 (10%) genes. A 15-month-old female presented with a 2-week history of decreased lower extremity movement and new-onset need for assistance with ambulation. MRI lumbar spine revealed a contrast-enhancing intradural mass at the L3-L4 level with iso-intensity on T1 and T2 sequences. The patient subsequently underwent subtotal tumor resection (∼80%) given concerns for maintaining neurological function. Final pathology was consistent with spinal ATRT, and she later underwent adjuvant chemoradiation therapy per ACNS0333 protocol. She has since remained in remission with age-appropriate developmental milestones over the past 2 years. ATRTs should be considered in the differential diagnosis of intradural spinal lesions, especially in the pediatric patient population. Clinical course, presentation, and diagnosis is often delayed due to the rarity of these tumors, but contrasted craniospinal MRI is key for diagnosis and histopathology with IHC staining showing loss of INI is confirmatory. While gross total resection is the goal, maximal safe tumor resection should be prioritized in order to preserve neurological function. Adjuvant chemoradiation following gross total/subtotal resection has been shown to significantly improve overall survival.
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Affiliation(s)
- Hashim Syed
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Alec Hanson
- University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Meron Challa
- University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Kathryn Eschbacher
- Department of Pathology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Patrick Hitchon
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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6
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Tran S, Plant-Fox AS, Chi SN, Narendran A. Current advances in immunotherapy for atypical teratoid rhabdoid tumor (ATRT). Neurooncol Pract 2023; 10:322-334. [PMID: 37457224 PMCID: PMC10346396 DOI: 10.1093/nop/npad005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Abstract
Atypical teratoid rhabdoid tumors (ATRT) are rare and aggressive embryonal tumors of central nervous system that typically affect children younger than 3 years of age. Given the generally poor outcomes of patients with ATRT and the significant toxicities associated with conventional multi-modal therapies, there is an urgent need for more novel approaches to treat ATRT, one such approach being immunotherapy. The recent rise of large-scale, multicenter interdisciplinary studies has delineated several molecular and genetic characteristics unique to ATRT. This review aims to describe currently available data on the tumor immune microenvironment of ATRT and its specific subtypes and to summarize the emerging clinical and preclinical results of immunotherapy-based approaches. It will also highlight the evolving knowledge of epigenetics on immunomodulation in this epigenetically influenced tumor, which may help guide the development of effective immunotherapeutic approaches in the future.
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Affiliation(s)
- Son Tran
- Departments of Oncology and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ashley S Plant-Fox
- Division of Hematology, Stem Cell Transplant, and Neuro-Oncology, Ann & Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Susan N Chi
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
| | - Aru Narendran
- Departments of Oncology and Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Liu J, Mi T, Zhang Z, Jin L, Li M, Zhanghuang C, Li M, Wang J, Wu X, Wang Z, Tan X, Wang Z, He D. BKM120 inhibits malignant rhabdoid tumor of the kidney through induction of apoptosis and G0/G1 phase arrest. Eur J Pharmacol 2023; 951:175747. [PMID: 37142086 DOI: 10.1016/j.ejphar.2023.175747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Abstract
Malignant rhabdomyosarcoma of the kidney (MRTK) has an inferior prognosis and is insensitive to radiotherapy and chemotherapy. Search for novel, potent medicinal agents is urgent. Herein, data on the gene expression and clinical characteristics of malignant rhabdoid tumors (MRT) were retrieved from the TARGET database. Prognosis-related genes were identified by differential analysis and one-way cox regression analysis, and prognosis-related signalling pathways were identified by enrichment analysis. The prognosis-related genes were imported into the Connectivity Map database for query, and BKM120 was predicted and screened as a potential therapeutic agent for MRTK. A combination of high-throughput RNA sequencing and Western blot verified that the PI3K/Akt signaling pathway is associated with MRTK prognosis and is overactivated in MRTK. Our results outlined that BKM120 inhibited the proliferation, migration, and invasion ability of G401 cells and induced apoptosis and cell cycle G0/G1 phase arrest. In vivo, BKM120 inhibited tumor growth and had no significant toxic side effects. Western blot and immunofluorescence results confirmed that BKM120 could reduce the expression of PI3K and p-AKT, critical proteins of the PI3K/Akt signaling pathway. BKM120 inhibits MRTK by inhibiting PI3K/Akt signalling pathway to induce apoptosis and cell cycle G0/G1 phase arrest, which is anticipated to give the clinical treatment of MRTK a new direction.
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Affiliation(s)
- Jiayan Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Tao Mi
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Zhaoxia Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Liming Jin
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Maoxian Li
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Chenghao Zhanghuang
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Mujie Li
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Jinkui Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Xin Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Zhaoying Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Xiaojun Tan
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Zhang Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China
| | - Dawei He
- Department of Urology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, International Science and Technology Cooperation base of Child Development and Critical Disorders, Chongqing, 400014, PR China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, PR China.
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8
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Wang XQ, Tessier-Cloutier B, Saunders J, Harvey M, Armstrong L, Ng T, Dunham C, Bush JW. Characterization of Switch/Sucrose Nonfermenting Complex Proteins and Nestin Expression in a Cohort of Pediatric Central Nervous System Tumors. Appl Immunohistochem Mol Morphol 2023; 31:304-310. [PMID: 37036408 DOI: 10.1097/pai.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/09/2023] [Indexed: 04/11/2023]
Abstract
Tumors of the central nervous system (CNS) in pediatric patients have undergone significant diagnostic refinement through the use of immunohistochemistry (IHC) and molecular techniques. The utility of these novel IHC antibodies has been demonstrated with the inactivation of the switch/sucrose nonfermenting (SWI/SNF) chromatin-remodeling complex in the diagnosis of atypical teratoid/rhabdoid tumors, predominantly through the loss of integrase interactor 1 (INI1; SMARCB1 ). Alternatively, these tumors may have inactivation of brahma-related gene 1 (BRG1; SMARCA4 ) in a subset of cases. The role of other SWI/SNF component proteins and their expression in pediatric brain tumors is not well established. Nestin, an intermediate filament, has been shown to be present in some pediatric CNS tumors, but of uncertain diagnostic and prognostic significance. We sought to explore the immunohistochemical expression profile for common SWI/SNF subunits and nestin in a pediatric CNS tumor cohort. Using a 118-sample tissue microarray, we performed IHC for INI1, BRG1, brahma (BRM), ARID1A, ARID1B, polybromo 1, and nestin. In 19 cases, INI1 was lost and BRG1 was lost in 2 cases. Interestingly, 6 cases originally diagnosed as primitive neuroectodermal tumors showed isolated loss of BRM. Other SWI/SNF proteins did not provide further diagnostic resolution. Nestin was positive in 76.2% of INI1/BRG1-deficient tumors, compared with 29.1% in INI1/BRG1-intact tumors yielding a sensitivity of 76.2%, specificity of 68.0%, and a P value of <0.001, but nestin positivity did not correlate specifically with poor outcomes. In conclusion, we confirm the utility of BRG1 IHC in the workup of pediatric CNS tumors, which may facilitate a difficult diagnosis when conventional markers are inconclusive, or as a first-line marker in cases where intraoperative smears are suggestive of atypical teratoid/rhabdoid tumor. Although nestin expression was associated with SWI/SNF inactivation, it did not yield statistically significant diagnostic or prognostic information in our study. Interestingly, we identified 6 tumors with isolated BRM IHC loss, the significance of which is uncertain but warrants further investigation.
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Affiliation(s)
| | - Basile Tessier-Cloutier
- Department of Pathology and Laboratory Medicine
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital
| | - Jessica Saunders
- Department of Pathology and Laboratory Medicine
- Division of Anatomical Pathology, British Columbia Children's Hospital and Women's Health Center, Vancouver, BC, Canada
| | - Melissa Harvey
- Division of Pediatric Hematology/Oncology/BMT, British Columbia Children's Hospital, and Department of Pediatrics
| | - Linlea Armstrong
- Provincial Medical Genetics Program, British Columbia Children's Hospital and Women's Health Center, and Department of Medical Genetics, University of British Columbia
| | - Tony Ng
- Department of Pathology and Laboratory Medicine
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital
| | - Christopher Dunham
- Department of Pathology and Laboratory Medicine
- Division of Anatomical Pathology, British Columbia Children's Hospital and Women's Health Center, Vancouver, BC, Canada
| | - Jonathan W Bush
- Department of Pathology and Laboratory Medicine
- Division of Anatomical Pathology, British Columbia Children's Hospital and Women's Health Center, Vancouver, BC, Canada
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9
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Paassen I, Williams J, Ríos Arceo C, Ringnalda F, Mercer KS, Buhl JL, Moreno N, Federico A, Franke NE, Kranendonk M, Upadhyaya SA, Kerl K, van de Wetering M, Clevers H, Kool M, Hoving EW, Roussel MF, Drost J. Atypical teratoid/rhabdoid tumoroids reveal subgroup-specific drug vulnerabilities. Oncogene 2023; 42:1661-1671. [PMID: 37020038 PMCID: PMC10181938 DOI: 10.1038/s41388-023-02681-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/07/2023]
Abstract
Atypical teratoid/rhabdoid tumors (ATRTs) represent a rare, but aggressive pediatric brain tumor entity. They are genetically defined by alterations in the SWI/SNF chromatin remodeling complex members SMARCB1 or SMARCA4. ATRTs can be further classified in different molecular subgroups based on their epigenetic profiles. Although recent studies suggest that the different subgroups have distinct clinical features, subgroup-specific treatment regimens have not been developed thus far. This is hampered by the lack of pre-clinical in vitro models representative of the different molecular subgroups. Here, we describe the establishment of ATRT tumoroid models from the ATRT-MYC and ATRT-SHH subgroups. We demonstrate that ATRT tumoroids retain subgroup-specific epigenetic and gene expression profiles. High throughput drug screens on our ATRT tumoroids revealed distinct drug sensitivities between and within ATRT-MYC and ATRT-SHH subgroups. Whereas ATRT-MYC universally displayed high sensitivity to multi-targeted tyrosine kinase inhibitors, ATRT-SHH showed a more heterogeneous response with a subset showing high sensitivity to NOTCH inhibitors, which corresponded to high expression of NOTCH receptors. Our ATRT tumoroids represent the first pediatric brain tumor organoid model, providing a representative pre-clinical model which enables the development of subgroup-specific therapies.
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Affiliation(s)
- Irene Paassen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- Oncode Institute, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - Justin Williams
- Department of Tumor Cell Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Carla Ríos Arceo
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- Oncode Institute, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - Femke Ringnalda
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- Oncode Institute, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - Kimberly Shea Mercer
- Department of Tumor Cell Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Juliane L Buhl
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- Oncode Institute, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - Natalia Moreno
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Aniello Federico
- Hopp Children's Cancer Center (KiTZ), 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center DKFZ and German Cancer Consortium DKTK, 69120, Heidelberg, Germany
| | - Niels E Franke
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - Mariette Kranendonk
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | | | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Marc van de Wetering
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- Oncode Institute, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - Hans Clevers
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- Oncode Institute, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences and University Medical Center, 3584 CT, Utrecht, the Netherlands
- Pharma, Research and Early Development (pRED) of F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Marcel Kool
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
- Hopp Children's Cancer Center (KiTZ), 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center DKFZ and German Cancer Consortium DKTK, 69120, Heidelberg, Germany
| | - Eelco W Hoving
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - Martine F Roussel
- Department of Tumor Cell Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
- Oncode Institute, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
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Atypical teratoid rhabdoid tumours (ATRTs)-a 21-year institutional experience. Childs Nerv Syst 2023; 39:1509-1518. [PMID: 36790496 DOI: 10.1007/s00381-023-05828-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/05/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Atypical teratoid/rhabdoid tumours (ATRTs) are malignant embryonal tumours of childhood that affect the central nervous system (CNS). We aim to determine which factors, including patient age, extent of resection (EOR), presence of distal metastasis and use of adjuvant therapies, affect overall survival in children with atypical teratoid/rhabdoid tumours (ATRTs) treated at this single centre. METHODS Retrospective cohort review of patients with histological diagnosis of ATRT treated over 21 years (1999-2020) was conducted. Data on demographics, tumour location, presence of metastasis, use of adjuvant therapy, extent of resection (EOR), complications, neurological outcome post-surgery, and overall survival were collected. Kaplan-Meier survival analysis was performed. RESULTS A total of 45 children (mean age 2 years) underwent 64 operations. 25 patients were <1 year of age. Gross-total resection (GTR) pre-adjuvant therapy was achieved in 15, near-total resection (NTR) in 15, subtotal resection (STR) in 9, and biopsy in 6 children. Most children had good neurological outcomes post-operatively (28/45 with GOS 5). Fourteen patients survived longer than 4 years. Survival analysis showed a significant difference in median survival in favour of GTR and localised disease. There was no significant difference in median survival between patients <1 year vs >1 year of age (p=0.84). CONCLUSION We find that presence of metastasis was an important factor in poor survival in patients with ATRT. GTR, where possible, may confer significant survival benefit in ATRT. Children aged <1 year appear to have performed as well as those >1 year and therefore should still be considered for radical surgery.
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Shinohara H, Sawado R, Nakagawa M, Hattori A, Yamagata K, Tauchi K, Ito J, Kuwahara Y, Okuda T, Ogawa C, Kitabayashi I. Dual targeting of EZH1 and EZH2 for the treatment of malignant rhabdoid tumors. Mol Ther Oncolytics 2022; 27:14-25. [PMID: 36212776 PMCID: PMC9529991 DOI: 10.1016/j.omto.2022.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/14/2022] [Indexed: 11/19/2022] Open
Abstract
Malignant rhabdoid tumors (MRTs) are rare and highly aggressive pediatric cancers with no standard of care. MRTs are characterized by loss of SMARCB1, which results in upregulated expression of enhancer of zeste homolog 2 (EZH2), which is responsible for the methylation of lysine 27 of histone H3 (H3K27me3), leading to the repression of gene expression. Although previous reports suggest EZH2 as an effective therapeutic target, the functions of EZH1, the other homolog of EZH, in MRT remain unknown. Here, we show that EZH1, as well as EZH2, contributes to MRT cell growth and H3K27 methylation. Depletion or selective inhibition of EZH2 led to a compensatory increase in EZH1 expression, and depletion of EZH1 enhanced the effect of EZH2 inhibition. EZH1/2 dual inhibitors suppressed MRT cell growth markedly, reflecting the reduction of H3K27me3 accumulation at one of the EZH1/2 targets, the CDKN2A locus. Dual inhibition of EZH1/2 in vivo suppressed tumor growth completely, with no significant adverse effects. These findings indicate that both EZH1 and EZH2 are potential targets for MRT therapy, and that EZH1/2 dual inhibitors may be promising therapeutic strategies for MRT.
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Affiliation(s)
- Haruka Shinohara
- Division of Hematological Malignancy, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
| | - Rie Sawado
- Division of Hematological Malignancy, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
| | - Makoto Nakagawa
- Division of Hematological Malignancy, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ayuna Hattori
- Division of Hematological Malignancy, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
- Department of Biosystems Science, Institute for Frontier Life and Medical Sciences, Kyoto University, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kazutsune Yamagata
- Division of Hematological Malignancy, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
| | - Kimiharu Tauchi
- Division of Hematological Malignancy, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
| | - Jumpei Ito
- Division of Hematological Malignancy, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
- Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, 160-8582 Tokyo, Japan
| | - Yasumichi Kuwahara
- Department of Biochemistry and Molecular Biology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tsukasa Okuda
- Department of Biochemistry and Molecular Biology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Chitose Ogawa
- Department of Pediatric Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
| | - Issay Kitabayashi
- Division of Hematological Malignancy, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
- Corresponding author Issay Kitabayashi, Division of Hematological Malignancy, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan.
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12
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Ding AS, Huq S, Casaos J, Raj D, Morales M, Zhao T, Kim T, Srivastava S, Pant A, Serra R, Gorelick NL, Brem H, Tyler B. Targeting of cyclin-dependent kinases in atypical teratoid rhabdoid tumors with multikinase inhibitor TG02. J Neurosurg Pediatr 2021; 28:734-743. [PMID: 34479190 DOI: 10.3171/2021.5.peds20920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/21/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Atypical teratoid rhabdoid tumors (ATRTs) are aggressive pediatric brain tumors with no current standard of care and an estimated median patient survival of 12 to 18 months. Previous genetic analyses have implicated cyclin D1 and enhancer of zeste homolog 2 (EZH2), a histone methyltransferase that is implicated in many cancers, as key drivers of tumorigenicity in ATRTs. Since the effects of EZH2 and cyclin D1 are facilitated by a host of cyclin-dependent kinases (CDKs), the authors sought to investigate the potential therapeutic effects of targeting CDKs in ATRTs with the multi-CDK inhibitor, TG02. METHODS Human ATRT cell lines BT12, BT37, CHLA05, and CHLA06 were selected for investigation. The effects of TG02 on cell viability, proliferation, clonogenicity, and apoptosis were assessed via Cell Counting Kit-8 assays, cell counting, clonogenic assays, and flow cytometry, respectively. Similar methods were used to determine the effects of TG02 combined with radiation therapy (RT) or cisplatin. Synergism indices for TG02-cisplatin combination therapy were calculated using CompuSyn software. RESULTS TG02 was observed to significantly impair ATRT cell growth in vitro by limiting cell proliferation and clonogenicity, and by inducing apoptosis. TG02 inhibited ATRT cell proliferation and decreased cell viability in a dose-dependent manner with nanomolar half maximal effective concentration (EC50) values (BT12, 207.0 nM; BT37, 127.8 nM; CHLA05, 29.7 nM; CHLA06, 18.7 nM). TG02 (150 nM) dramatically increased the proportion of apoptotic ATRT cells 72 hours posttreatment (TG02 8.50% vs control 1.52% apoptotic cells in BT12, p < 0.0001; TG02 70.07% vs control 15.36%, p < 0.0001). Combination therapy studies revealed that TG02 acted as a potent radiosensitizer in ATRT cells (BT12 surviving fraction, RT 51.2% vs RT + TG02 21.7%). Finally, CompuSyn analysis demonstrated that TG02 acted synergistically with cisplatin against ATRT cells at virtually all therapeutic doses. These findings were consistent in cell lines that cover all three molecular subgroups of ATRTs. CONCLUSIONS The results of this investigation have established that TG02 is an effective therapeutic against ATRTs in vitro. Given the lack of standard therapy for ATRTs, these findings help fill an unmet need and support further study of TG02 as a potential therapeutic option for patients with this deadly disease.
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Maternal embryonal leucine zipper kinase immunoreactivity in atypical teratoid/rhabdoid tumors: a study of 50 cases. Childs Nerv Syst 2021; 37:3769-3775. [PMID: 34611764 DOI: 10.1007/s00381-021-05335-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
Atypical teratoid/rhabdoid tumors (AT/RTs) are aggressive embryonal neoplasms of the central nervous system that correspond to WHO grade IV and have a dismal prognosis. The latest Central Brain Tumor Registry of the United States data shows that AT/RT constitutes 16.6% of all embryonal tumors in children. The molecular hallmark of this tumor is pathogenic SMARCB1 genetic alterations resulting in the loss of INI-1 immunopositivity, with fewer tumors harboring SMARCA4 (BRG1) variants. Maternal embryonal leucine zipper kinase (MELK) is a member of the Snf1/AMPK family of serine/threonine-protein kinases involved in various processes such as cell cycle regulation, self-renewal of stem cells, apoptosis, and splicing regulation. Recent studies have highlighted the involvement of MELK in AT/RT and its possible therapeutic role. The purpose of this study was to review the histological and immunohistochemical profile of AT/RT with special reference to MELK staining. In this retrospective study conducted over 6 years, all diagnosed cases of AT/RT, defined by loss of INI-1 immunopositivity, were retrieved and studied. Demographic details of patients and microscopic findings were analyzed, with special attention to histological patterns and immunohistochemistry profile including MELK immunoreactivity. There were 50 cases of AT/RT diagnosed in the specified period. Of the cases operated at our institute during this period, embryonal tumors constituted 20.6% of all pediatric brain tumors with AT/RT representing 12.6% of this subset. The median age at presentation was 3.5 years (range: 8 months-22 years) and there were three adult cases. Males outnumbered females by a ratio of 1.94:1. Tumor location was distributed equally between the supratentorial and infratentorial compartments. Characteristic rhabdoid cells were identified in 70% of cases. Areas with epithelial, mesenchymal, and undifferentiated tumor cells were seen in 8%, 20%, and 52% of cases, respectively. Cells with vacuolated cytoplasm were noted in 28% of cases. Immunohistochemistry (IHC) showed a polyimmunophenotypic profile with immunopositivity for GFAP in 70%, Vimentin in 100%, SMA in 68%, and EMA in 88% of cases, indicating the remarkable heterogeneity of the tumor cells. MELK immunopositivity was noted in 83.33% of cases. Thus, atypical teratoid/rhabdoid tumors are rare neoplasms. In line with other studies, we show that these tumors occur predominantly in very young children and display marked variability on histology and IHC with loss of INI-1. MELK is presumed to be an important molecule involved in cell cycle regulation, proliferation, and other critical functions. High expression of MELK in AT/RT may suggest its plausible role in neoplastic transformation of embryonic and postnatal multipotent neural progenitors which in turn could explain the diverse morphological and immunohistochemical characteristics observed in these tumors.
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Meng L, Wang L, Shao G. Relapsing cerebral atypical teratoid/rhabdoid tumor after trimodality therapy: A case report. Medicine (Baltimore) 2021; 100:e27986. [PMID: 34964793 PMCID: PMC8615398 DOI: 10.1097/md.0000000000027986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Atypical teratoid rhabdoid tumor (AT/RT) is a high-grade embryonal malignant neoplasm of the central nervous system. It is rare and most often diagnosed in children <4 years of age. The biological manifestations of AT/RTs are highly malignant and have a very poor prognosis. Here, we present the case of a 16-year-old boy with AT/RT in the right parietal lobe and with a dismal outcome. PATIENT CONCERNS A 16-year-old male boy presented with a headache after waking up for 1 year without obvious cause. The pain was persistent and dull, mainly in the right orbital, and was slightly relieved after pressing the orbital. Occasionally, nausea and vomiting occurred, and the vomiting was gastric contents. Examination and head computed tomography performed at a local hospital revealed a space-occupying lesion in the right parietal lobe. The patient was then transferred to our hospital for further diagnosis and treatment. DIAGNOSIS The patient underwent craniotomy and gross total excision of the tumor. Further histologic examination of the tumor was identified (space-occupying lesion in the right parietal lobe) AT/RT, World Health Organization grade IV. INTERVENTIONS The patient was transferred to the oncology department for radiotherapy and chemotherapy after surgery recovery. OUTCOMES The patient did not comply with the advice for adjuvant chemotherapy regularly and the tumor recurred rapidly. Finally, the patient died after 18 months after the definitive surgery. CONCLUSION In conclusion, in the presence of a tumor with peripheral cystic components or hemorrhage in young children, a diagnosis of AT/RT must always be considered. Patients must follow the doctor's advice for active treatment. All relevant data are within the paper and its Supporting Information files.
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Andrianteranagna M, Cyrta J, Masliah-Planchon J, Nemes K, Corsia A, Leruste A, Holdhof D, Kordes U, Orbach D, Corradini N, Entz-Werle N, Pierron G, Castex MP, Brouchet A, Weingertner N, Ranchère D, Fréneaux P, Delattre O, Bush J, Leary A, Frühwald MC, Schüller U, Servant N, Bourdeaut F. SMARCA4-deficient rhabdoid tumours show intermediate molecular features between SMARCB1-deficient rhabdoid tumours and small cell carcinomas of the ovary, hypercalcaemic type. J Pathol 2021; 255:1-15. [PMID: 33999421 DOI: 10.1002/path.5705] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 11/11/2022]
Abstract
Extracranial rhabdoid tumours (ECRTs) are an aggressive malignancy of infancy and early childhood. The vast majority of cases demonstrate inactivation of SMARCB1 (ECRTSMARCB1 ) on a background of a remarkably stable genome, a low mutational burden, and no other recurrent mutations. Rarely, ECRTs can harbour the alternative inactivation of SMARCA4 (ECRTSMARCA4 ) instead of SMARCB1. However, very few ECRTSMARCA4 cases have been published to date, and a systematic characterization of ECRTSMARCA4 is missing from the literature. In this study, we report the clinical, pathological, and genomic features of additional cases of ECRTSMARCA4 and show that they are comparable to those of ECRTSMARCB1. We also assess whether ECRTSMARCB1 , ECRTSMARCA4 , and small cell carcinomas of the ovary, hypercalcaemic type (SCCOHT) represent distinct or overlapping entities at a molecular level. Using DNA methylation and transcriptomics-based tumour classification approaches, we demonstrate that ECRTSMARCA4 display molecular features intermediate between SCCOHT and ECRTSMARCB1 ; however, ECRTSMARCA4 appear to be more closely related to SCCOHT by DNA methylation. Conversely, both transcriptomics and DNA methylation show a larger gap between SCCOHT and ECRTSMARCB1 , potentially supporting their continuous separate classification. Lastly, we show that ECRTSMARCA4 display concomitant lack of SMARCA4 (BRG1) and SMARCA2 (BRM) expression at the protein level, similar to what is seen in SCCOHT. Overall, these results expand our knowledge on this rare tumour type and explore the similarities and differences among entities from the 'rhabdoid tumour' spectrum. © 2021 The Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Mamy Andrianteranagna
- INSERM, U830, Pediatric Translational Research, PSL Research University, Institut Curie, Paris, France
- INSERM, U900, Paris, France
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, Paris, France
| | - Joanna Cyrta
- Department of Pathology, Institut Curie, PSL Research University, Paris, France
| | - Julien Masliah-Planchon
- Genetics Unit, Department of Tumor Biology, Institut Curie, PSL Research University, Paris, France
| | - Karolina Nemes
- Paediatrics and Adolescent Medicine, Swabian Children's Cancer Center, University Medical Center Augsburg, Augsburg, Germany
| | - Alice Corsia
- INSERM, U830, Pediatric Translational Research, PSL Research University, Institut Curie, Paris, France
| | - Amaury Leruste
- INSERM, U830, Pediatric Translational Research, PSL Research University, Institut Curie, Paris, France
| | - Dörthe Holdhof
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Nadège Corradini
- Centre Léon Bérard, Institut d'Hématologie et d'Oncologie pédiatrique, Lyon, France
| | - Natacha Entz-Werle
- Pediatric and Adolescent Oncology, IHOP, Centre Léon Bérard, Lyon, France
| | - Gaëlle Pierron
- Genetics Unit, Department of Tumor Biology, Institut Curie, PSL Research University, Paris, France
| | - Marie-Pierre Castex
- Department of Pediatric and Adolescent Unity Oncology, Toulouse University Hospital, Toulouse, France
| | - Anne Brouchet
- Department of Pathology, Insititut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Noëlle Weingertner
- Department of Pathology, Strasbourg University Hospital, Strasbourg, France
| | | | - Paul Fréneaux
- Department of Pathology, Institut Curie, PSL Research University, Paris, France
| | - Olivier Delattre
- Genetics Unit, Department of Tumor Biology, Institut Curie, PSL Research University, Paris, France
| | - Jonathan Bush
- Division of Anatomical Pathology, British Columbia Children's Hospital and Women's Hospital and Health Center, Vancouver, BC, Canada
| | - Alexandra Leary
- Gynecological Cancer Unit, Department of Medicine, Gustave Roussy, Villejuif, France
- INSERM U981, Gustave Roussy, Villejuif, France
| | - Michael C Frühwald
- Paediatrics and Adolescent Medicine, Swabian Children's Cancer Center, University Medical Center Augsburg, Augsburg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Nicolas Servant
- INSERM, U900, Paris, France
- MINES ParisTech, PSL Research University, CBIO-Centre for Computational Biology, Paris, France
- Institut Curie, PSL Research University, Paris, France
| | - Franck Bourdeaut
- INSERM, U830, Pediatric Translational Research, PSL Research University, Institut Curie, Paris, France
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
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Zhang M, Wong SW, Lummus S, Han M, Radmanesh A, Ahmadian SS, Prolo LM, Lai H, Eghbal A, Oztekin O, Cheshier SH, Fisher PG, Ho CY, Vogel H, Vitanza NA, Lober RM, Grant GA, Jaju A, Yeom KW. Radiomic Phenotypes Distinguish Atypical Teratoid/Rhabdoid Tumors from Medulloblastoma. AJNR Am J Neuroradiol 2021; 42:1702-1708. [PMID: 34266866 DOI: 10.3174/ajnr.a7200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Atypical teratoid/rhabdoid tumors and medulloblastomas have similar imaging and histologic features but distinctly different outcomes. We hypothesized that they could be distinguished by MR imaging-based radiomic phenotypes. MATERIALS AND METHODS We retrospectively assembled T2-weighted and gadolinium-enhanced T1-weighted images of 48 posterior fossa atypical teratoid/rhabdoid tumors and 96 match-paired medulloblastomas from 7 institutions. Using a holdout test set, we measured the performance of 6 candidate classifier models using 6 imaging features derived by sparse regression of 900 T2WI and 900 T1WI Imaging Biomarker Standardization Initiative-based radiomics features. RESULTS From the originally extracted 1800 total Imaging Biomarker Standardization Initiative-based features, sparse regression consistently reduced the feature set to 1 from T1WI and 5 from T2WI. Among classifier models, logistic regression performed with the highest AUC of 0.86, with sensitivity, specificity, accuracy, and F1 scores of 0.80, 0.82, 0.81, and 0.85, respectively. The top 3 important Imaging Biomarker Standardization Initiative features, by decreasing order of relative contribution, included voxel intensity at the 90th percentile, inverse difference moment normalized, and kurtosis-all from T2WI. CONCLUSIONS Six quantitative signatures of image intensity, texture, and morphology distinguish atypical teratoid/rhabdoid tumors from medulloblastomas with high prediction performance across different machine learning strategies. Use of this technique for preoperative diagnosis of atypical teratoid/rhabdoid tumors could significantly inform therapeutic strategies and patient care discussions.
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Affiliation(s)
- M Zhang
- From the Departments of Neurosurgery (M.Z.)
| | - S W Wong
- Department of Statistics (S.W.W.), Stanford University, Stanford, California
| | - S Lummus
- Department of Physiology and Nutrition (S.L.), University of Colorado, Colorado Springs, Colorado
| | - M Han
- Department of Pediatrics (M.H.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Radmanesh
- Department of Radiology (A.R.), New York University Grossman School of Medicine, New York, New York
| | - S S Ahmadian
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - L M Prolo
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - H Lai
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - A Eghbal
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - O Oztekin
- Department of Neuroradiology (O.O.), Cigli Education and Research Hospital, Bakircay University, Izmir, Turkey.,Department of Neuroradiology (O.O.), Tepecik Education and Research Hospital, Health Science University, Izmir, Turkey
| | - S H Cheshier
- Division of Pediatric Neurosurgery (S.H.C.), Department of Neurosurgery, Huntsman Cancer Institute, Intermountain Healthcare Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - H Vogel
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - R M Lober
- Division of Neurosurgery (R.M.L.), Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio
| | - G A Grant
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - A Jaju
- Department of Medical Imaging (A.J.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - K W Yeom
- Radiology (K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
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17
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Upadhyaya SA, Robinson GW, Onar-Thomas A, Orr BA, Johann P, Wu G, Billups CA, Tatevossian RG, Dhanda SK, Srinivasan A, Broniscer A, Qaddoumi I, Vinitsky A, Armstrong GT, Bendel AE, Hassall T, Partap S, Fisher PG, Crawford JR, Chintagumpala M, Bouffet E, Gururangan S, Mostafavi R, Sanders RP, Klimo P, Patay Z, Indelicato DJ, Nichols KE, Boop FA, Merchant TE, Kool M, Ellison DW, Gajjar A. Relevance of Molecular Groups in Children with Newly Diagnosed Atypical Teratoid Rhabdoid Tumor: Results from Prospective St. Jude Multi-institutional Trials. Clin Cancer Res 2021; 27:2879-2889. [PMID: 33737307 PMCID: PMC8127412 DOI: 10.1158/1078-0432.ccr-20-4731] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/08/2021] [Accepted: 03/11/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Report relevance of molecular groups to clinicopathologic features, germline SMARCB1/SMARCA4 alterations (GLA), and survival of children with atypical teratoid rhabdoid tumor (ATRT) treated in two multi-institutional clinical trials. MATERIALS AND METHODS Seventy-four participants with newly diagnosed ATRT were treated in two trials: infants (SJYC07: age < 3 years; n = 52) and children (SJMB03: age 3-21 years; n = 22), using surgery, conventional chemotherapy (infants), or dose-dense chemotherapy with autologous stem cell rescue (children), and age- and risk-adapted radiotherapy [focal (infants) and craniospinal (CSI; children)]. Molecular groups ATRT-MYC (MYC), ATRT-SHH (SHH), and ATRT-TYR (TYR) were determined from tumor DNA methylation profiles. RESULTS Twenty-four participants (32%) were alive at time of analysis at a median follow-up of 8.4 years (range, 3.1-14.1 years). Methylation profiling classified 64 ATRTs as TYR (n = 21), SHH (n = 30), and MYC (n = 13), SHH group being associated with metastatic disease. Among infants, TYR group had the best overall survival (OS; P = 0.02). However, outcomes did not differ by molecular groups among infants with nonmetastatic (M0) disease. Children with M0 disease and <1.5 cm2 residual tumor had a 5-year progression-free survival (PFS) of 72.7 ± 12.7% and OS of 81.8 ± 11%. Infants with M0 disease had a 5-year PFS of 39.1 ± 11.5% and OS of 51.8 ± 12%. Those with metastases fared poorly [5-year OS 25 ± 12.5% (children) and 0% (infants)]. SMARCB1 GLAs were not associated with PFS. CONCLUSIONS Among infants, those with ATRT-TYR had the best OS. ATRT-SHH was associated with metastases and consequently with inferior outcomes. Children with nonmetastatic ATRT benefit from postoperative CSI and adjuvant chemotherapy.
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Affiliation(s)
- Santhosh A Upadhyaya
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Giles W Robinson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Brent A Orr
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Pascal Johann
- Department of Pediatric Hematology and Oncology, Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neuro-Oncology, German Cancer Research Center (DKFZ) and German Cancer Research Consortium (DKTK), Heidelberg, Germany
| | - Gang Wu
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Catherine A Billups
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ruth G Tatevossian
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sandeep Kumar Dhanda
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ashok Srinivasan
- Department of Bone Marrow Transplant and Cell Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Alberto Broniscer
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ibrahim Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Anna Vinitsky
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Anne E Bendel
- Department of Hematology Oncology, Children's Minnesota, Minneapolis, Minnesota
| | - Tim Hassall
- Department of Medicine, Royal Children's Hospital Brisbane, Brisbane, Queensland, Australia
| | - Sonia Partap
- Department of Neurology, Division of Child Neurology, Stanford University, Palo Alto, California
| | - Paul G Fisher
- Department of Neurology, Division of Child Neurology, Stanford University, Palo Alto, California
| | - John R Crawford
- Department of Neurosciences and Pediatrics, University of California San Diego and Rady Children's Hospital, San Diego, California
| | - Murali Chintagumpala
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Eric Bouffet
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Sridharan Gururangan
- Department of Neurosurgery, Preston A. Wells Jr. Center for Brain Tumor Therapy, McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Roya Mostafavi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Paul Klimo
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zoltan Patay
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida Health, Jacksonville, Florida
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Frederick A Boop
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Marcel Kool
- Department of Pediatric Hematology and Oncology, Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neuro-Oncology, German Cancer Research Center (DKFZ) and German Cancer Research Consortium (DKTK), Heidelberg, Germany
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - David W Ellison
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
- Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
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18
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Frühwald MC, Hasselblatt M, Nemes K, Bens S, Steinbügl M, Johann PD, Kerl K, Hauser P, Quiroga E, Solano-Paez P, Biassoni V, Gil-da-Costa MJ, Perek-Polnik M, van de Wetering M, Sumerauer D, Pears J, Stabell N, Holm S, Hengartner H, Gerber NU, Grotzer M, Boos J, Ebinger M, Tippelt S, Paulus W, Furtwängler R, Hernáiz-Driever P, Reinhard H, Rutkowski S, Schlegel PG, Schmid I, Kortmann RD, Timmermann B, Warmuth-Metz M, Kordes U, Gerss J, Nysom K, Schneppenheim R, Siebert R, Kool M, Graf N. Age and DNA methylation subgroup as potential independent risk factors for treatment stratification in children with atypical teratoid/rhabdoid tumors. Neuro Oncol 2021; 22:1006-1017. [PMID: 31883020 DOI: 10.1093/neuonc/noz244] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Controversy exists as to what may be defined as standard of care (including markers for stratification) for patients with atypical teratoid/rhabdoid tumors (ATRTs). The European Rhabdoid Registry (EU-RHAB) recruits uniformly treated patients and offers standardized genetic and DNA methylation analyses. METHODS Clinical, genetic, and treatment data of 143 patients from 13 European countries were analyzed (2009-2017). Therapy consisted of surgery, anthracycline-based induction, and either radiotherapy or high dose chemotherapy following a consensus among European experts. Fluorescence in situ hybridization, multiplex ligation-dependent probe amplification, and sequencing were employed for assessment of somatic and germline mutations in SWItch/sucrose nonfermentable related, matrix associated, actin dependent regulator of chromatin, subfamily B (SMARCB1). Molecular subgroups (ATRT-SHH, ATRT-TYR, and ATRT-MYC) were determined using DNA methylation arrays, resulting in profiles of 84 tumors. RESULTS Median age at diagnosis of 67 girls and 76 boys was 29.5 months. Five-year overall survival (OS) and event-free survival (EFS) were 34.7 ± 4.5% and 30.5 ± 4.2%, respectively. Tumors displayed allelic partial/whole gene deletions (66%; 122/186 alleles) or single nucleotide variants (34%; 64/186 alleles) of SMARCB1. Germline mutations were detected in 26% of ATRTs (30/117). The patient cohort consisted of 47% ATRT-SHH (39/84), 33% ATRT-TYR (28/84), and 20% ATRT-MYC (17/84). Age <1 year, non-TYR signature (ATRT-SHH or -MYC), metastatic or synchronous tumors, germline mutation, incomplete remission, and omission of radiotherapy were negative prognostic factors in univariate analyses (P < 0.05). An adjusted multivariate model identified age <1 year and a non-TYR signature as independent negative predictors of OS: high risk (<1 y + non-TYR; 5-y OS = 0%), intermediate risk (<1 y + ATRT-TYR or ≥1 y + non-TYR; 5-y OS = 32.5 ± 8.7%), and standard risk (≥1 y + ATRT-TYR, 5-y OS = 71.5 ± 12.2%). CONCLUSIONS Age and molecular subgroup status are independent risk factors for survival in children with ATRT. Our model warrants validation within future clinical trials.
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Affiliation(s)
- Michael C Frühwald
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Martin Hasselblatt
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Karolina Nemes
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany.,Department of Pediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Susanne Bens
- Institute of Human Genetics, University of Ulm & University Hospital of Ulm, Ulm, Germany
| | - Mona Steinbügl
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany
| | - Pascal D Johann
- Hopp Children's Cancer Center, German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Peter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Eduardo Quiroga
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Sevilla, Spain
| | - Palma Solano-Paez
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, Sevilla, Spain
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS National Tumor Institute, Milan, Italy
| | - Maria Joao Gil-da-Costa
- Pediatric Hematology and Oncology Division, University Hospital S João Alameda Hernani Monteiro, Porto, Portugal
| | - Martha Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - David Sumerauer
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - Jane Pears
- Department of Pediatric Haematology and Oncology Our Lady's Children's Hospital, Dublin, Ireland
| | - Niklas Stabell
- Pediatric Department, Oncology Unit, University Hospital of North Norway, Tromso, Norway
| | - Stefan Holm
- Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Joachim Boos
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Martin Ebinger
- Department of General Pediatrics, Hematology, and Oncology, Children's University Hospital Tübingen, Tübingen, Germany
| | - Stefan Tippelt
- Department of Pediatric Hematology/Oncology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, University of Saarland, Homburg, Germany
| | - Pablo Hernáiz-Driever
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, corporate member of the Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Harald Reinhard
- Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University of Würzburg, Würzburg, Germany
| | - Irene Schmid
- Department of Pediatric Hematology and Oncology, Ludwig-Maximilian-University, Munich, Germany
| | | | - Beate Timmermann
- Particle Therapy Clinics at West German Proton Therapy, University Hospital Essen, Essen, Germany
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Karsten Nysom
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg, Germany.,Department of Pediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Reinhard Schneppenheim
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reiner Siebert
- Institute of Human Genetics, University of Ulm & University Hospital of Ulm, Ulm, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center, German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
| | - Norbert Graf
- Hopp Children's Cancer Center, German Cancer Research Center and German Cancer Consortium, Heidelberg, Germany
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19
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Hoffman LM, Richardson EA, Ho B, Margol A, Reddy A, Lafay-Cousin L, Chi S, Slavc I, Judkins A, Hasselblatt M, Bourdeaut F, Frühwald MC, Vibhakar R, Bouffet E, Huang A. Advancing biology-based therapeutic approaches for atypical teratoid rhabdoid tumors. Neuro Oncol 2021; 22:944-954. [PMID: 32129445 DOI: 10.1093/neuonc/noaa046] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Atypical teratoid rhabdoid tumor (ATRT) is a rare, highly malignant central nervous system cancer arising in infants and younger children, historically considered to be homogeneous, monogenic, and incurable. Recent use of intensified therapies has modestly improved survival for ATRT; however, a majority of patients will still succumb to their disease. While ATRTs almost universally exhibit loss of SMARCB1 (BAF47/INI1/SNF5), recent whole genome, transcriptome, and epigenomic analyses of large cohorts reveal previously underappreciated molecular heterogeneity. These discoveries provide novel insights into how SMARCB1 loss drives oncogenesis and confer specific therapeutic vulnerabilities, raising exciting prospects for molecularly stratified treatment for patients with ATRT.
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Affiliation(s)
- Lindsey M Hoffman
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Elizabeth Anne Richardson
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ben Ho
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Cell Biology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Margol
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Alyssa Reddy
- Departments of Neurology and Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Lucie Lafay-Cousin
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Paediatrics and Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan Chi
- Pediatric Medical Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Alexander Judkins
- Center for Personalized Medicine, Children's Hospital of Los Angeles.,Pathology and Laboratory Medicine, Children's Hospital of Los Angeles.,Department of Pathology, Keck School of Medicine University of Southern California, Los Angeles, California, USA
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Franck Bourdeaut
- Curie Institute, Integrated Cancer Research Site, Paris, France.,Departments of Genetics and of Oncopediatry and Young Adults, Curie Institute, Paris, France.,INSERM U830, Laboratory of Translational Research in Pediatric Oncology, SIREDO Pediatric Oncology Center, Curie Institute, Paris, France
| | - Michael C Frühwald
- Swabian Children's Cancer Center, University Children's Hospital, University Hospital Augsburg, Augsburg, Germany.,Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, University of Münster, Münster, Germany.,EU-RHAB Registry Working Group, Augsburg, Germany
| | - Rajeev Vibhakar
- Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, USA.,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Neurosurgery, University of Colorado Denver, Aurora, Colorado, USA
| | - Eric Bouffet
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Annie Huang
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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20
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Abstract
Central nervous system (CNS) tumors, including brain and spinal cord tumors, are the most common solid tumors of childhood. Within the neonatal population, however, CNS tumors are relatively rare. These often carry a dismal prognosis in part due to the limited therapeutic options available for newborns and the unique biology of these tumors compared with those seen in older infants and children. This article reviews neonatal CNS tumors, specifically their clinical presentation, imaging findings, treatment, prognosis, and associated genetic syndromes. The unique psychosocial and emotional challenges facing clinicians and families are discussed as well.
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Affiliation(s)
- Shubin Shahab
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA; Emory University School of Medicine, 1760 Haygood Drive Northeast HSRB E397, Atlanta, GA 30322, USA.
| | - Jason Fangusaro
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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21
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Olkhova LV, Kushel YV, Kadyrov SU, Melikyan AG, Gorelyshev SK, Popov VE, Schultz EI, Ryzhova MV, Zheludkova OG. [Influence of resection quality on postoperative outcomes in children with atypical teratoid-rhabdoid tumor of the central nervous system]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:17-25. [PMID: 33864665 DOI: 10.17116/neiro20218502117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to assess the influence of resection quality on overall survival and disease-free survival in children with atypical teratoid-rhabdoid tumors (ATRT). The study included children younger than 18 years old for the period from 2008 to 2019. There were 134 interventions in 105 patients with ATRT including 11 redo resections («second-look» surgery) and 18 procedures for tumor recurrence. Age of patients ranged from 2 to 168 months (median 21 months). Patients with supratentorial tumors prevailed (50.5%), infratentorial neoplasms were diagnosed in 45.7% of patients, spinal cord lesion - 3.8% of cases. At the first stage, all patients underwent surgical treatment. Total resection was achieved in 34 (32.4%) patients, subtotal - 37 (35.2%) patients, partial resection - 30 (28.6%) patients. Biopsy was performed in 4 (3.8%) patients. Quality of resection and age at surgery significantly influenced overall and disease-free survival. Extended resection of tumor followed by adjuvant chemo- and radiotherapy are required to improve survival although ATRTs are high-grade neoplasms with poor prognosis.
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Affiliation(s)
- L V Olkhova
- Children's Clinical Hospital of the Pirogov Russian National Medical University, Moscow, Russia
| | - Yu V Kushel
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | - V E Popov
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - E I Schultz
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M V Ryzhova
- Burdenko Neurosurgical Center, Moscow, Russia
| | - O G Zheludkova
- Voino-Yasenetsky Research and Practical Center for Specialized Medical Care, Moscow, Russia
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22
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Alharbi OA, Almushayqih MH, Alqahtani A, Alsuhaibani MS. Perinatal atypical teratoid/rhabdoid tumor involving the deep ear structures and complicated by arterial infarction. Radiol Case Rep 2020; 15:2433-2439. [PMID: 33005281 PMCID: PMC7519276 DOI: 10.1016/j.radcr.2020.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/29/2022] Open
Abstract
Atypical teratoid/rhabdoid tumor is a malignant pediatric brain tumor. Unusual invasive behavior of the dura and bony involvement of the deep ear structures and rapid progression in size complicated by arterial infarction have not been described before. A newborn girl presented with increased intracranial pressure. Medical imaging revealed a large mass centered in the left cerebellopontine angle and left middle cranial fossa with large supra-tentorial components associated with destruction of the left petrous bone with involvement of the inner and middle ear structures. Shortly, the tumor rapidly progressed in size and complicated by left middle cerebral artery territory infarction. The patient passed away after a short hospital course. This case report illustrates how rapid and aggressive the natural history of atypical teratoid/thabdoid tumor can be with unusual skull base destruction and deep ear structures involvement.
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Affiliation(s)
- Omar Abdullah Alharbi
- Department of Radiology, King Faisal Specialist Hospital and Research center, Riyadh, Saudi Arabia
| | - Musab Hamoud Almushayqih
- Department of Radiology, King Faisal Specialist Hospital and Research center, Riyadh, Saudi Arabia
| | - Abdulmalik Alqahtani
- Department of Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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23
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Atypical teratoid rhabdoid tumor: molecular insights and translation to novel therapeutics. J Neurooncol 2020; 150:47-56. [PMID: 33021733 DOI: 10.1007/s11060-020-03639-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Atypical teratoid rhabdoid tumor (ATRT) is a rare, often lethal brain tumor of childhood characterized by a complex epigenetic landscape amongst a simple genetic background. Recent molecular studies have defined key biologic events that contribute to tumorigenesis and molecular subtypes of ATRT. METHODS Seminal studies on ATRT are reviewed with an emphasis on molecular pathogenesis and its relevance to novel therapeutics. RESULTS In this review, we summarize the key clinicopathologic and molecular features of ATRT, completed and ongoing clinical trials and outline the translational potential of novel insights into the molecular pathogenesis of this tumor. CONCLUSIONS SMARCB1 loss is the key genetic event in ATRT pathogenesis that leads to widespread epigenetic dysregulation and loss of lineage-specific enhancers. Current work is defining subtype-specific treatments that target underlying molecular derangements that drive tumorigenesis.
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24
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Patterson JD, Henson JC, Breese RO, Bielamowicz KJ, Rodriguez A. CAR T Cell Therapy for Pediatric Brain Tumors. Front Oncol 2020; 10:1582. [PMID: 32903405 PMCID: PMC7435009 DOI: 10.3389/fonc.2020.01582] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/22/2020] [Indexed: 12/31/2022] Open
Abstract
Chimeric Antigen Receptor (CAR) T cell therapy has recently begun to be used for solid tumors such as glioblastoma multiforme. Many children with pediatric malignant brain tumors develop extensive long-term morbidity of intensive multimodal curative treatment. Others with certain diagnoses and relapsed disease continue to have limited therapies and a dismal prognosis. Novel treatments such as CAR T cells could potentially improve outcomes and ameliorate the toxicity of current treatment. In this review, we discuss the potential of using CAR therapy for pediatric brain tumors. The emerging insights on the molecular subtypes and tumor microenvironment of these tumors provide avenues to devise strategies for CAR T cell therapy. Unique characteristics of these brain tumors, such as location and associated morbid treatment induced neuro-inflammation, are novel challenges not commonly encountered in adult brain tumors. Despite these considerations, CAR T cell therapy has the potential to be integrated into treatment schema for aggressive pediatric malignant brain tumors in the future.
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Affiliation(s)
- John D Patterson
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jeffrey C Henson
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Rebecca O Breese
- Department of General Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States
| | - Kevin J Bielamowicz
- Division of Hematology/Oncology, Department of Pediatrics, Arkansas Children's Research Institute, Little Rock, AR, United States
| | - Analiz Rodriguez
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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25
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Mousa A, Al-Kofide A, Siddiqui K, Alhindi H, Alshaikh N, Alshail E. Atypical Teratoid Rhabdoid Tumors (ATRT): King Faisal Specialist Hospital and Research Centre experience. Int J Pediatr Adolesc Med 2020; 8:154-159. [PMID: 34350327 PMCID: PMC8319682 DOI: 10.1016/j.ijpam.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/29/2020] [Accepted: 06/28/2020] [Indexed: 11/29/2022]
Abstract
Background Atypical teratoid rhabdoid tumor is an uncommon aggressive central nervous system tumor. All retrospective series have shown a short mean overall survival rate. Considering the rarity of the disease, few prospective clinical trials addressed treatment recommendations for such aggressive tumors, and consequently no definitive treatment guidelines have been established. In this study, we are reviewing our experience in treating atypical teratoid rhabdoid tumor patients. Methods We reviewed the medical charts of 43 patients with atypical teratoid rhabdoid tumor who were treated in King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, between 1996 and 2013. We evaluated the overall survival rate and the influence of different clinical features and treatment protocols on survival. Results The median overall survival time was 16.9 months (95% Confidence Interval, 5.2–32.9 months) with an estimated 2- and 5-year overall survival of 41.9% ± 9.6 and 27.9% ± 9.2, respectively. Patients receiving trimodal treatment (surgery, chemotherapy, and radiotherapy) exhibited significantly better median overall survival time compared to their counterparts (P value < .001). Conclusions Atypical teratoid rhabdoid tumor is rare and aggressive central nervous system tumor. Despite the limitations of the study, our results support several of clinical practice development. Utilization of postoperative radiotherapy and the adoption of trimodal therapy are associated with significant improvement of median survival. Prompt management with aggressive trimodal therapy should be the standard for future treatment protocols.
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Affiliation(s)
- Amr Mousa
- Radiation Oncology section, Oncology Center, King Faisal Specialist Hospital and Research Centre, Al-Takhassussi street, Riyadh, Saudi Arabia.,Radiation Oncology department, National Cancer Institute, Cairo University, Kasr El-Aini street, Cairo, Egypt
| | - Amani Al-Kofide
- Department of Pediatric Hematology/Oncology King Faisal Specialist Hospital and Research Centre, Al-Takhassussi street, Riyadh, Saudi Arabia.,Faculty of medicine, Al-Faisal University, Al-Takhassussi street, Riyadh, Saudi Arabia
| | - Khawar Siddiqui
- Department of Pediatric Hematology/Oncology King Faisal Specialist Hospital and Research Centre, Al-Takhassussi street, Riyadh, Saudi Arabia
| | - Hindi Alhindi
- Department of Pathology, King Faisal Specialist Hospital & Research Centre, Al-Takhassussi street, Riyadh, Saudi Arabia
| | - Nada Alshaikh
- Department of Pediatric Hematology/Oncology King Faisal Specialist Hospital and Research Centre, Al-Takhassussi street, Riyadh, Saudi Arabia
| | - Essam Alshail
- Division of Neurosurgery, Department of Neurosciences, King Faisal Specialist Hospital and Research Centre Al-Takhassussi street, Riyadh, Saudi Arabia.,Faculty of medicine, Al-Faisal University, Al-Takhassussi street, Riyadh, Saudi Arabia
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26
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Underiner RM, Eltobgy M, Stanek JR, Finlay JL, AbdelBaki MS. Meta-Analysis of Treatment Modalities in Metastatic Atypical Teratoid/Rhabdoid Tumors in Children. Pediatr Neurol 2020; 108:106-112. [PMID: 32402552 DOI: 10.1016/j.pediatrneurol.2020.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/11/2020] [Accepted: 03/01/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Metastatic atypical teratoid/rhabdoid tumors (AT/RTs) are aggressive central nervous system tumors that present during infancy and are associated with dismal outcomes. Patients receive multimodal treatment including surgical resection, systemic chemotherapy, and one or more of intrathecal chemotherapy (IT), marrow-ablative chemotherapy with autologous hematopoietic cell rescue (AuHCR) and radiation therapy (XRT). While data regarding treatment modalities for AT/RT patients exist, no comprehensive data have been published regarding the metastatic patients. METHODS We performed a meta-analysis of 1578 articles published through September 2018, including 44 studies with a total of 123 subjects. In addition, seven patients were included through chart review of patients treated at Nationwide Children's Hospital. RESULTS Analysis of 130 patients revealed a 3-year overall survival (OS) of 25%. Age at diagnosis had a significant effect on survival (P = 0.0355); 3-year OS for infants less than 18 months was 21%, 18 to 36 months was 26%, and greater than 36 months was 36%. Location of the primary tumor, metastatic stage, and extent of surgical resection did not have a significant impact on OS. On univariate analysis, XRT (P < 0.0001), IT (P = 0.01), and AuHCR (P < 0.0001) were found to significantly improve survival. The most substantial effect was noted in patients who received AuHCR (3-year OS of 60% vs 9% in those who did not). On multivariable analysis, XRT (P = 0.0006), IT (P = 0.0124), and AuHCR (P < 0.0001) were independently associated with reduced risk of death. CONCLUSIONS Although more research is warranted to make generalizable conclusions, these results suggest that treatment regimens for patients with metastatic AT/RTs should include AuHCR, XRT, and IT.
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Affiliation(s)
| | - Mostafa Eltobgy
- Department of Microbial Infection and Immunity, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Joseph R Stanek
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | - Jonathan L Finlay
- The Ohio State University College of Medicine, Columbus, Ohio; Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | - Mohamed S AbdelBaki
- The Ohio State University College of Medicine, Columbus, Ohio; Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio.
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Bhimani AD, Ryoo JS, Reddy AK, Denyer S, McGuire LS, Alonso M, Mehta AI. Differentiation of Outcomes by Treatment Regimen and Histology in Central Nervous System Primary Embryonal Tumors. World Neurosurg 2020; 141:e289-e306. [PMID: 32434022 DOI: 10.1016/j.wneu.2020.05.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Central nervous system (CNS) embryonal tumors are malignant neoplasms of undifferentiated embryonic cells that typically occur in the pediatric population. They are further divided into many subgroups by distinct histologic and genetic profiles. We present the largest study to date to identify differential survival outcomes within each subgroup by treatment regimen. METHODS The SEER (Surveillance Epidemiology and End Results) database was queried from 1973 to 2015 for embryonal tumors of primary CNS origin (n = 3900). The effects of patient demographics, tumor characteristics, and treatment regimen were analyzed using a multivariate Cox proportional hazard model in CNS embryonal tumor subtypes divided into medulloblastoma, atypical teratoid/rhabdoid tumor, and primitive neuroectodermal tumor. RESULTS No significant patient demographic factors were found to be associated with increased mortality. In all 3 CNS embryonal tumor subtypes, most monotherapy and combinatorial treatment paradigms showed a higher hazard ratio compared with gross total resection with adjuvant chemoradiotherapy (hazard ratio, 1.72-22.94; P < 0.05 for all). In a subgroup analysis of patients with medulloblastoma ≤3 years of age, patients who did not receive radiation showed lower survival probabilities at 1, 5, and 10 years (odds ratio [OR], 0.37, P < 0.0001; OR, 0.39, P < 0.0001; OR, 0.34, P < 0.0001, respectively). Kaplan-Meier analysis of medulloblastoma histologic subtypes showed that use of radiation imparted a higher survival probability in the desmoplastic/nodular medulloblastoma and medulloblastoma not otherwise specified groups (P < 0.001 for both). CONCLUSIONS CNS embryonal tumors are highly malignant in all populations and the best survival is seen with aggressive combination therapies. Radiation therapy may have a role in prolonging survival in patients with medulloblastoma ≤3 years of age.
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Affiliation(s)
- Abhiraj D Bhimani
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James S Ryoo
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Abhinav K Reddy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Steven Denyer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Laura S McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Matthew Alonso
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
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28
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Meredith DM. Advances in Diagnostic Immunohistochemistry for Primary Tumors of the Central Nervous System. Adv Anat Pathol 2020; 27:206-219. [PMID: 30720470 DOI: 10.1097/pap.0000000000000225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As genomic characterization becomes increasingly necessary for accurate diagnosis of tumors of the central nervous system, identification of rapidly assessible biomarkers is equally important to avoid excessive cost and delay in initiation of therapy. This article reviews novel immunohistochemical markers that may be used to determine mutation status, activation of signaling pathways, druggable targets, and cell lineage in many diverse tumor types. In particular, recently added entities to the 2016 WHO classification of central nervous system tumors will be addressed, including IDH-mutant gliomas, diffuse midline glioma, epithelioid glioblastoma, angiocentric glioma, RELA-rearranged ependymoma, embryonal tumors (medulloblastoma, atypical teratoid/rhabdoid tumor, pineoblastoma, embryonal tumor with multilayered rosettes, and other genetically defined high-grade neuroepithelial tumors), and meningiomas associated with germline alterations.
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29
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Chen F, Mei W, Lu W, Zeng T, Kang D, Wu X, You H. Atypical Teratoid/Rhabdoid Tumor Originated From the Trigeminal Nerve in a Young Male Adult: Case Report and Review of the Literature. Front Neurol 2020; 11:265. [PMID: 32373048 PMCID: PMC7186469 DOI: 10.3389/fneur.2020.00265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is a highly malignant central nervous system neoplasm predominantly found in children under the age of 3 years, and is extremely rare in adults. There is no specific clinical presentations or radiological features in reported cases of AT/RT. Diagnosis of brain AT/RT is mainly dependent on the classical pathological characteristics. We report a rare case of AT/RT arising from the trigeminal nerve and leading to progressively multiple cranial nerve palsies in a 25-year-old male patient. Microsurgical resection of the tumor has been performed and confirmed the diagnosis by postoperative pathology. To our knowledge, this is the second case of adult-onset AT/RT originating from the trigeminal nerve.
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Affiliation(s)
- Fuxiang Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wenzhong Mei
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen Lu
- Department of Disease Prevention and Healthcare, Fujian Provincial Hospital, Fuzhou, China
| | - Tiefa Zeng
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiyue Wu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Honghai You
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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30
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Richards A, Ved R, Murphy C, Hennigan D, Kilday JP, Kamaly-Asl I, Mallucci C, Bhatti I, Patel C, Leach P. Outcomes with respect to extent of surgical resection for pediatric atypical teratoid rhabdoid tumors. Childs Nerv Syst 2020; 36:713-719. [PMID: 31889208 DOI: 10.1007/s00381-019-04478-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/16/2019] [Accepted: 12/17/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate overall survival for atypical teratoid rhabdoid tumors (ATRTs) in relation to extent of surgical resection. METHODS The neurosurgical tumor databases from three UK Pediatric centers (University Hospital of Wales, Alder Hey and Royal Manchester Children's Hospital) were analyzed. Patients with a diagnosis of ATRT were identified between 2000 and 2018. Data was collected regarding demographics, extent of resection, complications, and overall survival. RESULTS Twenty-four patients diagnosed with ATRT underwent thirty-eight operations. The age range was 20 days to 147 months (median 17.5 months). The most common location for the tumor was the posterior fossa (nine patients; 38%). Six patients (25%) underwent a complete total resection (CTR), seven (29%) underwent a near total resection (NTR), eight (33.3%) underwent a subtotal resection (STR), and three patients (12.5%) had biopsy only. Two-thirds of patients who underwent a CTR are still alive, as of March 2019, compared to 29% in the NTR and 12.5% in the STR groups. Out of the thirty-eight operations, there were a total of twenty-two complications, of which the most common was pseudomeningocele (27%). The extent of surgical resection (p = 0.021), age at surgery (p = 0.00015), and the presence of metastases at diagnosis (0.015) significantly affected overall survival. CONCLUSIONS Although these patients are a highly vulnerable group, maximal resection is recommended where possible, for the best chance of long-term survival. However, near total resections are likely beneficial when compared with subtotal resections and biopsy alone. Maximal surgical resection should be combined with adjuvant therapies for the best long-term outcomes.
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Affiliation(s)
- Alexandra Richards
- Department of Pediatric Neurosurgery, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Ronak Ved
- Department of Pediatric Neurosurgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Christopher Murphy
- Department of Pediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK
| | - Dawn Hennigan
- Department of Pediatric Neurosurgery, Alder Hey Children's Hospital, Liverpool, L14 5AB, UK
| | - John-Paul Kilday
- Department of Pediatric Neuro-Oncology, Children's Brain Tumor Research Network, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK
| | - Ian Kamaly-Asl
- Department of Pediatric Neurosurgery, Royal Manchester Children's Hospital, Manchester, M13 9WL, UK
| | - Conor Mallucci
- Department of Pediatric Neurosurgery, Alder Hey Children's Hospital, Liverpool, L14 5AB, UK
| | - Imran Bhatti
- Department of Pediatric Neurosurgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Chirag Patel
- Department of Pediatric Neurosurgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Paul Leach
- Department of Pediatric Neurosurgery, University Hospital of Wales, Cardiff, CF14 4XW, UK
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Upregulation of Protein Synthesis and Proteasome Degradation Confers Sensitivity to Proteasome Inhibitor Bortezomib in Myc-Atypical Teratoid/Rhabdoid Tumors. Cancers (Basel) 2020; 12:cancers12030752. [PMID: 32235770 PMCID: PMC7140067 DOI: 10.3390/cancers12030752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
Atypical teratoid rhabdoid tumors (ATRTs) are among the most malignant brain tumors in early childhood and remain incurable. Myc-ATRT is driven by the Myc oncogene, which directly controls the intracellular protein synthesis rate. Proteasome inhibitor bortezomib (BTZ) was approved by the Food and Drug Administration as a primary treatment for multiple myeloma. This study aimed to determine whether the upregulation of protein synthesis and proteasome degradation in Myc-ATRTs increases tumor cell sensitivity to BTZ. We performed differential gene expression and gene set enrichment analysis on matched primary and recurrent patient-derived xenograft (PDX) samples from an infant with ATRT. Concomitant upregulation of the Myc pathway, protein synthesis and proteasome degradation were identified in recurrent ATRTs. Additionally, we found the proteasome-encoding genes were highly expressed in ATRTs compared with in normal brain tissues, correlated with the malignancy of tumor cells and were essential for tumor cell survival. BTZ inhibited proliferation and induced apoptosis through the accumulation of p53 in three human Myc-ATRT cell lines (PDX-derived tumor cell line Re1-P6, BT-12 and CHLA-266). Furthermore, BTZ inhibited tumor growth and prolonged survival in Myc-ATRT orthotopic xenograft mice. Our findings suggest that BTZ may be a promising targeted therapy for Myc-ATRTs.
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32
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Li BK, Al-Karmi S, Huang A, Bouffet E. Pediatric embryonal brain tumors in the molecular era. Expert Rev Mol Diagn 2020; 20:293-303. [PMID: 31917601 DOI: 10.1080/14737159.2020.1714439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Embryonal brain tumors (EBTs) are highly aggressive malignancies predominantly affecting children. They include medulloblastoma (MB), atypical rhabdoid/teratoid tumors (ATRT), pineoblastoma (PB), embryonal tumor multiple rosettes (ETMR)/C19MC-altered tumors, and newly recognized embryonal tumors with FOXR2 activation or BCOR alteration.Areas covered: This review will provide a comprehensive overview and updated of the literature on each of these EBTs. The evolution from location- and histopathology-based diagnosis to more specific and robust molecular-based classification schemes, as well as treatment modalities, will be discussed.Expert commentary: The subgrouping of EBTs with multi-omic profiling has had important implications for risk stratification and discovery of targetable driver pathways. However, these innovations are unlikely to significantly improve survival among high-risk patients until robust preclinical studies are conducted, followed by validation in biology-informed clinical trials.
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Affiliation(s)
- Bryan K Li
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Salma Al-Karmi
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada
| | - Annie Huang
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON, Canada.,Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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Benesch M, Nemes K, Neumayer P, Hasselblatt M, Timmermann B, Bison B, Ebetsberger-Dachs G, Bourdeaut F, Dufour C, Biassoni V, Morales La Madrid A, Entz-Werle N, Laithier V, Quehenberger F, Weis S, Sumerauer D, Siebert R, Bens S, Schneppenheim R, Kool M, Modena P, Fouyssac F, C Frühwald M. Spinal cord atypical teratoid/rhabdoid tumors in children: Clinical, genetic, and outcome characteristics in a representative European cohort. Pediatr Blood Cancer 2020; 67:e28022. [PMID: 31571386 DOI: 10.1002/pbc.28022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/25/2019] [Accepted: 09/13/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Case reports have portrayed spinal cord atypical teratoid/rhabdoid tumor (spATRT) as an aggressive form of ATRT. We conducted a retrospective European survey to collect data on clinical characteristics, molecular biology, treatment, and outcome of children with intramedullary spATRT. METHODS Scrutinizing a French national series and the European Rhabdoid Registry database, we identified 13 patients (median age 32 months; metastatic disease at diagnosis, n = 6). Systemic postoperative chemotherapy was administered to all patients; three received intrathecal therapy and six were irradiated (craniospinal, n = 3; local, n = 3). RESULTS Median observation time was 8 (range, 1-93) months. Progression-free and overall survival rates at 1 and (2 years) were 35.2% ± 13.9% (26.4% ± 12.9%) and 38.5% ± 13.5% (23.1% ± 11.7%). Four patients (ATRT-SHH, n = 2; ATRT-MYC, n = 1; DNA methylation subgroup not available, n = 1) achieved complete remission (CR); two of them are alive in CR 69 and 72 months from diagnosis. One patient relapsed after CR and is alive with progressive disease (PD) and one died of the disease. Three patients (ATRT-MYC, n = 2; subgroup not available, n = 1) died after 7 to 22 months due to PD after having achieved a partial remission (n = 1) or stabilization (n = 2). Five patients (ATRT-MYC, n = 2; subgroup not available, n = 3) developed early PD and died. One patient (ATRT-MYC) died of intracerebral hemorrhage prior to response evaluation. CONCLUSIONS Long-term survival is achievable in selected patients with spATRT using aggressive multimodality treatment. Larger case series and detailed molecular analyses are needed to understand differences between spATRT and their inracranial counterparts and the group of extradural malignant rhabdoid tumors.
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Affiliation(s)
- Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Karolina Nemes
- Swabian Children's Cancer Center, University Children's Hospital, University Hospital Augsburg, Augsburg, Germany
| | - Petra Neumayer
- Swabian Children's Cancer Center, University Children's Hospital, University Hospital Augsburg, Augsburg, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Beate Timmermann
- West German Proton Therapy Center Essen/Clinic for Particle Therapy, Essen University Hospital, Essen, Germany
| | - Brigitte Bison
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Georg Ebetsberger-Dachs
- Department of Pediatrics, Kepler University Hospital and School of Medicine, Johannes Kepler University, Linz, Austria
| | - Franck Bourdeaut
- PSL Research University, Institut Curie, Pediatric Care and Research Center, Paris, France
| | - Christelle Dufour
- Gustave Roussy, Grand Paris Cancer Campus, Department of Childhood and Adolescent Oncology, Villejuif, France
| | - Veronica Biassoni
- S.C. Pediatria, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrés Morales La Madrid
- Oncology Department at Hospital Sant Joan de Deu, Barcelona Children's Hospital, Barcelona, Spain
| | | | | | - Franz Quehenberger
- Institute for Medical Statistics, Medical University of Graz, Graz, Austria
| | - Serge Weis
- Division of Neuropathology, Department of Pathology and Neuropathology, Kepler University Hospital and School of Medicine, Johannes Kepler University, Linz, Austria
| | - David Sumerauer
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Susanne Bens
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Reinhard Schneppenheim
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcel Kool
- Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Piergiorgio Modena
- Laboratory of Genetics, Pathology Unit, S. Anna General Hospital, Como, Italy
| | - Fanny Fouyssac
- University Hospital of Nancy, Pediatric Hematology and Oncology, Nancy, France
| | - Michael C Frühwald
- Swabian Children's Cancer Center, University Children's Hospital, University Hospital Augsburg, Augsburg, Germany
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Fazlollahi L, Hsiao SJ, Kochhar M, Mansukhani MM, Yamashiro DJ, Remotti HE. Malignant Rhabdoid Tumor, an Aggressive Tumor Often Misclassified as Small Cell Variant of Hepatoblastoma. Cancers (Basel) 2019; 11:cancers11121992. [PMID: 31835848 PMCID: PMC6966472 DOI: 10.3390/cancers11121992] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
The clinical management of pediatric liver tumors involves stratification into risk groups. One previously defined, high-risk group of hepatoblastomas is the small cell undifferentiated variant. In light of molecular studies showing SMARCB1 deletion in these tumors, it is now recognized that most small cell, undifferentiated liver tumors represent an aggressive unrelated tumor—the malignant rhabdoid tumor (MRT). SMARCB1 is a member of the chromatin remodeling SWI/SNF complex and encodes the INI1 protein. The histologic diagnosis of MRT is currently based on INI1 negative immunoreactivity and the presence of rhabdoid morphology. INI1-negative small cell liver tumors lacking classic rhabdoid morphology are often misclassified as small cell undifferentiated hepatoblastomas (SCUD-HB), according to the current classification. Pediatric liver tumors diagnosed between 2003–2017 as SCUD-HB (four cases) or MRT (two cases) were identified from the Columbia University Pathology Department Archives. All tumors were associated with normal or low serum alpha fetoprotein levels, and showed an absence of immunohistochemical staining of hepatocellular markers (Hep-par1, Arginase) and loss of INI1 staining. Two cases were initially diagnosed as MRT, one with prominent rhabdoid morphology, the other with predominant small cell morphology. The remaining four cases with small cell morphology were classified as SCUD-HB. Ancillary molecular studies confirmed the loss of SMARCB1, supporting the diagnosis of MRT in all cases, proving morphology an unreliable criterion. It is critical to eliminate the term INI1-negative hepatoblastoma from the current classification scheme, and classify INI1-negative tumors as MRT, particularly since high-risk HB-chemotherapy regimens are not effective for treating MRT.
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Affiliation(s)
- Ladan Fazlollahi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY 10032, USA; (S.J.H.); (M.M.M.); (D.J.Y.); (H.E.R.)
- Correspondence: ; Tel.: +1-212-305-6719
| | - Susan J. Hsiao
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY 10032, USA; (S.J.H.); (M.M.M.); (D.J.Y.); (H.E.R.)
| | - Manpreet Kochhar
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, Stem Cell Transplantation, Columbia University Irving Medical Center; New York, NY 10032, USA;
| | - Mahesh M. Mansukhani
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY 10032, USA; (S.J.H.); (M.M.M.); (D.J.Y.); (H.E.R.)
| | - Darrell J. Yamashiro
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY 10032, USA; (S.J.H.); (M.M.M.); (D.J.Y.); (H.E.R.)
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, Stem Cell Transplantation, Columbia University Irving Medical Center; New York, NY 10032, USA;
| | - Helen E. Remotti
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY 10032, USA; (S.J.H.); (M.M.M.); (D.J.Y.); (H.E.R.)
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Nonviral polymeric nanoparticles for gene therapy in pediatric CNS malignancies. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2019; 23:102115. [PMID: 31655205 DOI: 10.1016/j.nano.2019.102115] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 12/15/2022]
Abstract
Together, medulloblastoma (MB) and atypical teratoid/rhabdoid tumors (AT/RT) represent two of the most prevalent pediatric brain malignancies. Current treatment involves radiation, which has high risks of developmental sequelae for patients under the age of three. New safer and more effective treatment modalities are needed. Cancer gene therapy is a promising alternative, but there are challenges with using viruses in pediatric patients. We developed a library of poly(beta-amino ester) (PBAE) nanoparticles and evaluated their efficacy for plasmid delivery of a suicide gene therapy to pediatric brain cancer models-specifically herpes simplex virus type I thymidine kinase (HSVtk), which results in controlled apoptosis of transfected cells. In vivo, PBAE-HSVtk treated groups had a greater median overall survival in mice implanted with AT/RT (P = 0.0083 vs. control) and MB (P < 0.0001 vs. control). Our data provide proof of principle for using biodegradable PBAE nanoparticles as a safe and effective nanomedicine for treating pediatric CNS malignancies.
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Li D, Heiferman DM, Syed HR, Santos JG, Bowman RM, DiPatri AJ, Tomita T, Wadhwani NR, Alden TD. Pediatric primary spinal atypical teratoid rhabdoid tumor: a case series and review of the literature. J Neurosurg Pediatr 2019; 24:267-283. [PMID: 31299639 DOI: 10.3171/2019.4.peds19113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022]
Abstract
Atypical teratoid rhabdoid tumors (ATRTs) are rare malignant central nervous system tumors, commonly occurring before 3 years of age. Median overall survival (OS) of patients with these tumors is about 1 year, despite aggressive multimodal therapy. Pediatric primary spinal ATRTs are even more rare, with fewer than 50 cases reported. The authors present a series of four patients who were treated at Ann and Robert H. Lurie Children's Hospital of Chicago in the period from 1996 to 2017.These patients, with ages 2-11 years, presented with pain and a decline in motor functions. They were found to have lesions in the lumbar, thoracic, and/or cervical spine. One patient's tumor was intramedullary with exophytic components, while another patient's tumor had both intra- and extradural components. All patients underwent resection followed by chemotherapy (systemic and intrathecal). Two patients had fractionated radiation therapy and one had an autologous stem cell transplant. Three patients are known to be deceased (OS 8.5-45 months). The fourth patient was in remission 19 years after her initial diagnosis. To the authors' knowledge, this is the largest series of pediatric primary spinal ATRTs documented at a single institution. These cases illustrate a variety of presentations of spinal ATRT and add to the body of literature on this aggressive pathology.A systematic MEDLINE search was also conducted using the keywords "atypical teratoid rhabdoid tumor," "pediatric spinal rhabdoid tumor," and "malignant rhabdoid tumor spine." Reports were included for patients younger than 21 years, without evidence of intracranial or systemic disease at the time of diagnosis. Clinical characteristics and outcomes of the four institutional cases were compared to those in the literature. This review yielded an additional 48 cases of primary pediatric spinal ATRTs reported in the English-language literature. Patients (ages 2 months to 19 years) presented with symptoms of pain, regression of motor function, and spinal cord compression. The majority of tumors were intradural (14 extramedullary, 8 intramedullary, 1 both). Eleven cases in the literature described tumors limited to extradural structures, while 10 tumors involved the intra- and extradural spine. Four reports did not specify tumor location. Although rare, spinal ATRT should be considered in the differential diagnosis of pediatric patients presenting with a new spinal mass.
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Affiliation(s)
- Daphne Li
- 1Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Daniel M Heiferman
- 1Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Hasan R Syed
- 2Department of Neurological Surgery, Division of Pediatric Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - João Gustavo Santos
- 3Department of Neurological Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Robin M Bowman
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; and
- Departments of5Neurological Surgery and
| | - Arthur J DiPatri
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; and
- Departments of5Neurological Surgery and
| | - Tadanori Tomita
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; and
- Departments of5Neurological Surgery and
| | - Nitin R Wadhwani
- 6Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tord D Alden
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; and
- Departments of5Neurological Surgery and
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Asmaro K, Arshad M, Massie L, Griffith B, Lee I. Sellar Atypical Teratoid/Rhabdoid Tumor Presenting with Subarachnoid and Intraventricular Hemorrhage. World Neurosurg 2019; 123:e31-e38. [DOI: 10.1016/j.wneu.2018.10.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/12/2022]
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Shen Z, Wang N, Shi W, Zhang P, Weng J, Zeng H. Atypical teratoid rhabdoid tumor mimicking type II neurofibromatosis: A case report. Medicine (Baltimore) 2019; 98:e14308. [PMID: 30702605 PMCID: PMC6380747 DOI: 10.1097/md.0000000000014308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Brain magnetic resonance imaging (MRI) images of atypical teratoid rhabdoid tumor (ATRT) often present heterogeneous signals of various cells without remarkable features of the disease. We describe a unique case of atypical brain MRI images presenting as an type II neurofibromatosis and explore some diagnostic hints. PATIENT CONCERNS A 1-year-and-7-month-old boy admitted to our department with a 7-day history of drowsiness and 2-day history of emesis, and his presenting complaint was repeated vomit. On physical examination, he had drowsiness, positive sun set sign, slow light reflection, high muscular tension of limbs and 55 cm head circumference. MRI presented masses of bilateral auditory nerve distribution area, the fourth ventricle and right frontal lobe, obstructive hydrocephalus, and amplified cisterna magna. Particularly, dumbbell shape tumor in left cerebellopontine angle area and the fourth ventricle showed iso- or hypo-intensity on T1-weighted image and mix-intensity on T2-weighted image with irregular frontier, obvious mutual high and low signal on T2-weighted image, and growing along cerebrospinal fluid pathway. DIAGNOSIS The diagnosis of type II neurofibromatosis (NF-II) was considered pre-operatively. After surgery, postoperative histopathology confirmed the diagnosis of ATRT. INTERVENTIONS After ventriculo-peritoneal (VP) shunt, no evidence of tumor was inspected in cerebrospinal fluid, and enhancement MRI showed heterogeneous contrast signal on dumbbell shape tumor. We executed an incomplete microsurgery for dumbbell shape lesion in left auditory nerve distribution area and the fourth ventricle for differential diagnosis and facilitating further treatment. OUTCOMES The patient did not recover well postoperatively and suffered from severe pulmonary infection. Refusing further intervention in view of poor prognosis of ATRT, the patient was transferred to another hospital for rehabilitation care. The patient died from progressive tumor and respiratory failure after 2 months. LESSONS The diagnosis of ATRT can be challenging, in our case due to the disturbance of bilateral auditory nerve distribution area tumors. Under MRI, Irregular frontier, obvious mutual high and low signal on T2-weighted image, growing along cerebrospinal fluid pathway, and heterogeneous contrast enhancement should lead the clinician to strongly consider ATRT.
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Ma XJ, Li D, Wang L, Hao SY, Zhang LW, Zhang JT, Wu Z. Overall Survival of Primary Intracranial Atypical Teratoid Rhabdoid Tumor Following Multimodal Treatment: A Pooled Analysis of Individual Patient Data. Neurosurg Rev 2018; 43:281-292. [PMID: 30535934 DOI: 10.1007/s10143-018-1055-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/13/2018] [Indexed: 11/27/2022]
Abstract
No standard treatment protocol to guide the management of the primary central nervous system atypical teratoid rhabdoid tumors (ATRTs). To evaluate the efficacy of GTR (gross total resection), RT (radiotherapy), CCMT (conventional chemotherapy), or intensified chemotherapy (ICMT) and verify the optimal treatment strategy. A total of 501 cases (18 cases from our center and 483 cases from published literature) were eligible for analysis. Clinical characteristics were reviewed, and overall survival (OS) of each combined treatment modality was compared. These prior publication data were processed according to PRISMA guidelines. This study included 265 (52.9%) males and 216 (43.1%) females. The median age of the cohort was 2.2 years with 295 (58.9%) cases younger than 3 years. GTR was achieved in 217 (43.3%) patients. Initial adjuvant CCMT, CCMT plus intrathecal chemotherapy (ITCMT), CCMT plus high-dose chemotherapy (HDCMT), and CCMT plus ITCMT and HDCMT were administered in 228 (45.5%), 78 (15.6%), 55 (11.0%), and 24 (4.8%) patients, respectively. Radiotherapy (RT) was prescribed in 266 (53.1%) patients. Fewer patients younger than 3 years old received RT (21.9% vs 33.0%, p < 0.001, chi-square test). The OS of the entire cohort at 1, 3, and 5 years were 56.6, 35.9, and 30.8%, respectively. After adjusting for age and sex, GTR (HR 0.630; p < 0.001), RT (HR = 0.295; p < 0.001), CCMT (HR = 0.382; p < 0.001), and ICMT (HR = 0.209; p < 0.001) were independent prognostic factors. The 3-year OS of surgery alone, surgery plus CCMT, surgery plus RT, surgery plus ICMT, surgery plus CCMT and RT, and surgery plus ICMT and RT were 8.9, 13.4, 23.7, 37.4, 48.3, and 68.5%, respectively. When taking into consideration the extent of tumor resection (n = 462), GTR followed by RT, CCMT, intrathecal chemotherapy, and high-dose chemotherapy provided the best OS (5-year OS 88.2%). In younger children, adjuvant ICMT had a greater 3-year OS than adjuvant RT alone (34.0% vs 0%, p = .001). This study identified independent favorable predictors for OS of ATRTs and distinguished significantly different OS following various treatment modalities. If tolerable, intensive treatment with GTR followed by adjuvant RT and ICMT is recommended. Intensified CCMT could be an alternative to avoid radiological radiotoxicity for younger children CRD42018098841.
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Affiliation(s)
- Xiu-Jian Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing, People's Republic of China
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing, People's Republic of China.
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing, People's Republic of China
| | - Shu-Yu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing, People's Republic of China
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing, People's Republic of China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing, People's Republic of China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Dongcheng District, Beijing, People's Republic of China.
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Wu HY, Xu WB, Lu LW, Li HH, Tian JS, Li JM, Chen ZR. Imaging features of spinal atypical teratoid rhabdoid tumors in children. Medicine (Baltimore) 2018; 97:e13808. [PMID: 30593171 PMCID: PMC6314652 DOI: 10.1097/md.0000000000013808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aims to analyze and summarize the imaging features of spinal atypical teratoid/rhabdoid tumors (AT/RT) in children.Imaging features in 8 children with spinal AT/RT confirmed by surgical pathology were retrospectively analyzed. All patients had underwent total spine 3.0 T magnetic resonance imaging (MRI) and 64-slice spiral computed tomography (CT). Among these 8 patients, head MR non-enhanced and spinal enhanced scanning was applied to 5 patients, while CT examination was applied to 3 patients.All 8 patients were characterized by cauda equina syndrome. The lesions of 7 patients were in the thoracolumbar spinal junction, while the lesion of the remaining patient was in the lumbar spine. Furthermore, among these patients, the lesions of 5 patients were limited to the intraspinal canal (1 lesion in the epidural space, and 4 lesions in the subdural space), while the lesions of 3 patients invaded the paravertebra (2 lesions in the epidural space and 1 lesion in the subdural space). Three or more spinal segments were invaded by tumors in 7 patients, while sacral canal was affected in 5 patients. All 8 patients experienced bleeding in the tumors. Enhanced MRI revealed meningeal enhancement in 6 patients, and bilateral nerve root enhancement in 4 patients. The masses in 3 patients brought damages to the intervertebral foramen or sacral pore. The lesion of 1 patient was featured by skip growth. One patient had total spinal metastasis and 3 had hydrocephalus. The masses in 2 patients had a slightly low density when detected by CT, and enhanced scanning revealed a mild to moderate enhancement.Spinal AR/TR had the following characteristics: children were characterized by cauda equina syndrome; the mass that invaded the thoracolumbar spinal junction and the extramedullary space of multiple segments grew along the spinal longitudinal axis; bleeding mass was revealed in MRI imaging; meninges, nerve root, and sacral canal metastases occurred. The gold standard for the definite diagnosis of AT/RT is biopsy combined with immunohistochemistry.
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Affiliation(s)
| | | | | | | | | | | | - Zheng-Rong Chen
- Department of Pathology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
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41
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Nesvick CL, Nageswara Rao AA, Raghunathan A, Biegel JA, Daniels DJ. Case-based review: atypical teratoid/rhabdoid tumor. Neurooncol Pract 2018; 6:163-178. [PMID: 31386032 DOI: 10.1093/nop/npy037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is a rare CNS cancer that typically occurs in children younger than 3 years of age. Histologically, AT/RTs are embryonal tumors that contain a rhabdoid component as well as areas with primitive neuroectodermal, mesenchymal, and epithelial features. Compared to other CNS tumors of childhood, AT/RTs are characterized by their rapid growth, short symptomatic prodrome, and large size upon presentation, often leading to brain compression and intracranial hypertension requiring urgent intervention. For decades, the mainstay of care has been a combination of maximal safe surgical resection followed by adjuvant chemotherapy and radiotherapy. Despite advances in each of these modalities, the relative paucity of data on these tumors, their inherently aggressive course, and a lack of molecular data have limited advances in treatment over the past 3 decades. Recent large-scale, multicenter interdisciplinary studies, however, have significantly advanced our understanding of the molecular pathogenesis of these tumors. Multiple clinical trials testing molecularly targeted therapies are underway, offering hope for patients with AT/RT and their families.
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Affiliation(s)
- Cody L Nesvick
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amulya A Nageswara Rao
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jaclyn A Biegel
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Keck School of Medicine of University of Southern California, USA
| | - David J Daniels
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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42
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Richardson EA, Ho B, Huang A. Atypical Teratoid Rhabdoid Tumour : From Tumours to Therapies. J Korean Neurosurg Soc 2018; 61:302-311. [PMID: 29742888 PMCID: PMC5957315 DOI: 10.3340/jkns.2018.0061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 12/29/2022] Open
Abstract
Atypical teratoid rhabdoid tumours (ATRTs) are the most common malignant central nervous system tumours in children ≤1 year of age and represent approximately 1–2% of all pediatric brain tumours. ATRT is a primarily monogenic disease characterized by the bi-allelic loss of the SMARCB1 gene, which encodes the hSNF5 subunit of the SWI/SNF chromatin remodeling complex. Though conventional dose chemotherapy is not effective in most ATRT patients, high dose chemotherapy with autologous stem cell transplant, radiotherapy and/or intrathecal chemotherapy all show significant potential to improve patient survival. Recent epigenetic and transcriptional studies highlight three subgroups of ATRT, each with distinct clinical and molecular characteristics with corresponding therapeutic sensitivities, including epigenetic targeting, and inhibition of tyrosine kinases or growth/lineage specific pathways.
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Affiliation(s)
- Elizabeth Anne Richardson
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Canada.,Department of Cell Biology, Hospital for Sick Children, Toronto, Canada
| | - Ben Ho
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Canada.,Department of Cell Biology, Hospital for Sick Children, Toronto, Canada
| | - Annie Huang
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Canada.,Department of Cell Biology, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
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43
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Nemes K, Frühwald MC. Emerging therapeutic targets for the treatment of malignant rhabdoid tumors. Expert Opin Ther Targets 2018. [PMID: 29528755 DOI: 10.1080/14728222.2018.1451839] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Malignant Rhabdoid Tumor (MRT) is a rare and highly aggressive malignancy primarily affecting infants and young children. The most common anatomic locations are the central nervous system (AT/RT), the kidneys (RTK) and other soft tissues (eMRT). The genetic origin of this disease is linked to mutations in SMARCB1, a gene encoding a core subunit of the SWI/SNF chromatin-remodeling complex. Areas covered: Conventional multimodal treatment may offer a significant survival benefit to certain patients. It remains to be determined, however, which patients will prove resistant to chemotherapy and need novel therapeutic approaches. Herein we discuss key signal transduction pathways involved in the pathogenesis of rhabdoid tumors for potential targeted therapy (EZH2, DNMT, HDAC, CDK4/6/Cyclin D1/Rb, AURKA, SHH/GLI1, Wnt/ß-Catenin, immunotherapy). Additional agents currently evaluated in preclinical settings and experimental clinical trials are discussed. Expert opinion: MRTs are genetically homogeneous, but epigenetically distinct malignancies. While there is an abundance of experimental in vitro studies evaluating potential therapeutic avenues, a dearth of clinical trials specifically for this entity persists. In order to improve outcome patients need to be carefully stratified and treated by targeted therapies combined with conventional chemotherapy or with new, less selective experimental agents in phase I/II clinical trials.
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Affiliation(s)
- Karolina Nemes
- a Swabian Children's Cancer Center , Children's Hospital, Klinikum Augsburg , Augsburg , Germany
| | - Michael C Frühwald
- a Swabian Children's Cancer Center , Children's Hospital, Klinikum Augsburg , Augsburg , Germany
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Bertrand A, Rondenet C, Masliah-Planchon J, Leblond P, de la Fourchardière A, Pissaloux D, Aït-Raïs K, Lequin D, Jouvet A, Freneaux P, Sevestre H, Ranchere-Vince D, Tauziede-Espariat A, Maurage CA, Silva K, Pierron G, Delattre O, Varlet P, Frappaz D, Bourdeaut F. Rhabdoid component emerging as a subclonal evolution of paediatric glioneuronal tumours. Neuropathol Appl Neurobiol 2018; 44:224-228. [DOI: 10.1111/nan.12379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 11/28/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
Affiliation(s)
- A. Bertrand
- Pediatric Oncology Unit; Centre Leon Berard; Lyon France
| | - C. Rondenet
- Department of Neuropathology; Sainte-Anne Hospital; Paris France
| | - J. Masliah-Planchon
- Institut Curie; Somatic Genetics Unit; Paris France
- Cancer Genetics and Biology Laboratory; Institut Curie; INSERM U830; Paris France
| | - P. Leblond
- Pediatric Oncology Unit; Centre Oscar Lambret; Lille France
| | | | - D. Pissaloux
- Biopathology Unit; Centre Leon Berard; Lyon France
| | - K. Aït-Raïs
- Institut Curie; Somatic Genetics Unit; Paris France
| | - D. Lequin
- Institut Curie; Somatic Genetics Unit; Paris France
| | - A. Jouvet
- Department of Neuropathology; Groupement Hospitalier Est; Bron France
| | - P. Freneaux
- Department of Pathology; Institut Curie; Paris France
| | - H. Sevestre
- Neuropathology; University Hospital; Amiens France
| | | | | | - C.-A. Maurage
- Department of Neuropathology; Lille University Hospital; Lille France
| | - K. Silva
- Department of Neuropathology; Groupement Hospitalier Est; Bron France
| | - G. Pierron
- Institut Curie; Somatic Genetics Unit; Paris France
| | - O. Delattre
- Cancer Genetics and Biology Laboratory; Institut Curie; INSERM U830; Paris France
| | - P. Varlet
- Department of Neuropathology; Sainte-Anne Hospital; Paris France
| | - D. Frappaz
- Pediatric Oncology Unit; Centre Leon Berard; Lyon France
| | - F. Bourdeaut
- Cancer Genetics and Biology Laboratory; Institut Curie; INSERM U830; Paris France
- Pediatric Oncology Translational Research Laboratory; SiRIC Institut Curie; Paris France
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Timmermann B, Kortmann RD. Embryonal Tumors. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_5-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Abstract
The SMARCB1 gene ( INI1, BAF47) is a member of the SWItch/Sucrose Non-Fermentable (SWI/SNF) chromatin remodeling complex, involved in the epigenetic regulation of gene transcription. SMARCB1 acts as a tumor suppressor gene, and loss of function of both alleles gives rise to SMARCB1-deficient tumors. The prototypical SMARCB1-deficient tumor is the malignant rhabdoid tumor (MRT) which was first described in the kidney but also occurs in soft tissue, viscera, and the brain (where it is referred to as atypical teratoid rhabdoid tumor or AT/RT). These are overwhelmingly tumors of the very young, and most follow an aggressive and ultimately lethal course. Morphologically, most but not all contain a population of "rhabdoid" cells, which are large cells with abundant cytoplasm, perinuclear spherical inclusions, and eccentric vesicular nuclei with large inclusion-like nucleoli. MRT immunohistochemistry reveals complete loss of SMARCB1 nuclear expression, and molecular analysis confirms biallelic SMARCB1 inactivation in the vast majority. Rare AT/RTs have loss of SMARCA4, another SWI/SNF member, rather than SMARCB1. With the widespread adoption of SMARCB1 immunohistochemistry, an increasing number of SMARCB1-deficient tumors outside of the MRT-AT/RT spectrum have been described. In addition to MRT and AT/RT, pediatric tumors with complete loss of SMARCB1 expression include cribriform neuroepithelial tumor, renal medullary carcinoma, and epithelioid sarcoma. Tumors with variable loss of SMARCB1 expression include subsets of epithelioid malignant peripheral nerve sheath tumor, schwannomas arising in schwannomatosis, subsets of chordomas, myoepithelial carcinomas, and sinonasal carcinomas. Variable and reduced expression of SMARCB1 is characteristic of synovial sarcoma. In this review, the historical background, clinical characteristics, morphology, immunohistochemical features, and molecular genetics most germane to these tumors are summarized. In addition, familial occurrence of these tumors (the rhabdoid tumor predisposition syndrome) is discussed. It is hoped that this review may provide practical guidance to pathologists encountering tumors that have altered expression of SMARCB1.
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Affiliation(s)
- Bruce R Pawel
- 1 Division of Anatomic Pathology, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Babgi M, Samkari A, Al-Mehdar A, Abdullah S. Atypical Teratoid/Rhabdoid Tumor of the Spinal Cord in a Child: Case Report and Comprehensive Review of the Literature. Pediatr Neurosurg 2018; 53:254-262. [PMID: 29788028 DOI: 10.1159/000488459] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/13/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system is characterized by SMARCB1/INI deletion or mutation in the long arm of chromosome 22 11(22q11.2), also resulting in loss of nuclear expression of INI1 protein immunohistochemically. AT/RT tumors usually occur in children below 3 years. The tumor is usually seen in the cerebellum or the cerebrum, with an extremely rare incidence in the spinal cord. MATERIALS AND METHODS We report a rare case of AT/RT in a 6-year-old boy who had a primary spinal cord lesion in the thoracolumbar junction. Pathology revealed loss of nuclear staining of INI1 immunohistochemically. This is the first case reported with mixed intraspinal lesion (intra- and extramedullary). The patient underwent two surgeries and received radiotherapy and chemotherapy; however, he died 16 months after the initial presentation. RESULTS AND DISCUSSION We reviewed the literature on all children with spinal cord AT/RT. The review showed that the cervical region is the most common location of origin, especially in younger children. Reported cases were treated with a combination of surgery, systemic and intrathecal chemotherapy, and radiation therapy, and a survival time of 18 months represented the best outcome. Overall mean survival time was 10 months.
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Affiliation(s)
- Mohammed Babgi
- College of Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Alaa Samkari
- College of Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,Department of Pathology, National Guard Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abeer Al-Mehdar
- College of Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,Department of Radiology, National Guard Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Shaker Abdullah
- College of Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,Department of Pediatric Oncology, National Guard Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Berland M, Padovani L, Rome A, Pech-Gourg G, Figarella-Branger D, André N. Sustained Complete Response to Metronomic Chemotherapy in a Child with Refractory Atypical Teratoid Rhabdoid Tumor: A Case Report. Front Pharmacol 2017; 8:792. [PMID: 29163174 PMCID: PMC5671977 DOI: 10.3389/fphar.2017.00792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/19/2017] [Indexed: 12/18/2022] Open
Abstract
Atypical teratoid rhabdoid tumor (ATRT) is a rare and highly aggressive embryonal tumor of the central nervous system with a dismal prognosis and no definitive guidelines for treatment, especially at relapse or in case of refractory disease. Metronomic chemotherapy (MC) has emerged as a new treatment option in solid malignancies, with lower toxicity and is frequently combined with drug repositioning. We report a case of ATRT in an 8-year-old boy who progressed during multimodal therapy including surgical resection, chemotherapy and radiotherapy. He was treated with MC involving continuous oral celecoxib with alternating metronomic etoposide and cyclophosphamide, in combination with biweekly bevacizumab and monthly intrathecal liposomal cytarabine. To date, he remains clinically and symptomatically disease-free with a follow-up of 10 months. The treatment was well-tolerated. Metronomics represent a possible alternative regimen for children with recurrent or progressive ATRT.
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Affiliation(s)
- Mahe Berland
- Department of Pediatric Hematology-Oncology, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Laetitia Padovani
- Department of Radiation Oncology and Pediatrics, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Angélique Rome
- Department of Pediatric Hematology-Oncology, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Grégoire Pech-Gourg
- Department of Neurosurgery, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Dominique Figarella-Branger
- Department of Pathology, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, Aix-Marseille University, Marseille, France.,Centre de Recherche en Oncologie Biologique et en Oncopharmacologie, INSERM-UMR 79 911, Aix-Marseille University, Marseille, France
| | - Nicolas André
- Department of Pediatric Hematology-Oncology, Assistance Publique Hôpitaux de Marseille, La Timone Hospital, Marseille, France.,Centre de Recherche en Oncologie Biologique et en Oncopharmacologie, INSERM-UMR 79 911, Aix-Marseille University, Marseille, France.,Metronomics Global Health Initiative, Marseille, France
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Chao MF, Su YF, Jaw TS, Chiou SS, Lin CH. Atypical teratoid/rhabdoid tumor of lumbar spine in a toddler child. Spinal Cord Ser Cases 2017; 3:16026. [PMID: 28503314 DOI: 10.1038/scsandc.2016.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/06/2016] [Accepted: 07/16/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumor (AT/RT) is a rare pediatric central nervous system malignancy with poor outcome. AT/RT is infrequently located in the spinal cord. CLINICAL PRESENTATION A 16-month-old boy presented with progressive urinary retention and weakness of the lower extremities. Magnetic resonance imaging of the spine revealed an intradural extramedullary mass occupying the spinal canal at the level of T10-L3. The tumor was successfully resected by using neuroendoscopy. Histopathology demonstrated rhabdoid cells with eccentric nuclei and eosinophilic cytoplasmic hyaline inclusions. Immunohistologically, the tumor cells showed positive for epithelial membrane antigen, vimentin and neuron-specific enolase, and negative for integrase interactor 1. After surgery, the patient showed significant improvement in sitting and other neurological signs but presenting with flaccid neurogenic bladder. Intrathecal chemotherapy under European Rhabdoid Registry (EU-RHAB) protocol with Doxorubicin, Carboplatin, Etoposide, Ifosfamide, Vincristine, Cyclophosphamide and Actinomycin-D was given. However, recurrent intradural extramedullary tumor at the level of T11-L2 developed in 3 months. CONCLUSION We report a young Asian case of AT/RT in thoracolumbar spine with recurrent tumor shortly after complete surgical resection of the tumor.
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Affiliation(s)
- Min Fang Chao
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Feng Su
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Twei-Shiun Jaw
- Department of Medical Imaging, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Radiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shyh-Shin Chiou
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Lin
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Lach B, Kameda-Smith M, Singh S, Ajani O. Development of an Atypical Teratoid Rhabdoid Tumor in a Meningioma. Int J Surg Pathol 2017; 25:567-572. [DOI: 10.1177/1066896917707039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe an atypical teratoid rhabdoid tumor (AT/RT) with a component of low-grade and anaplastic rhabdoid meningioma in a 7-year-old child. The AT/RT was uniformly negative for INI1 and displayed immunoreactivity for vimentin, P53, CD99, cytokeratins with AE1/AE3 antibodies, epithelial membrane antigen, β-catenin, smooth muscle actin, E-cadherin, and S-100 protein. AT/RT was continuous, with small foci of recognizable low-grade and anaplastic meningioma. The low-grade meningioma was INI1 positive with scattered INI1-negative nuclei, whereas the remaining tumor components were INI1 negative. A recurrent tumor 6 months after partial resection contained only INI1-negative AT/RT. This case supports the hypothesis that rare examples of AT/RT may emerge from a preexisting “parent” neoplasm as a result of a second hit mutation.
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Affiliation(s)
- Boleslaw Lach
- Hamilton Health Sciences, Hamilton General Site, Hamilton, ON, Canada
| | | | - Sheila Singh
- McMaster Children’s Hospital, Hamilton, ON, Canada
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