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Antonini TN, Ris MD, Grosshans DR, Mahajan A, Okcu MF, Chintagumpala M, Paulino A, Child AE, Orobio J, Stancel HH, Kahalley LS. Attention, processing speed, and executive functioning in pediatric brain tumor survivors treated with proton beam radiation therapy. Radiother Oncol 2017; 124:89-97. [PMID: 28655455 DOI: 10.1016/j.radonc.2017.06.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/31/2017] [Accepted: 06/08/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE This study examines attention, processing speed, and executive functioning in pediatric brain tumor survivors treated with proton beam radiation therapy (PBRT). MATERIAL AND METHODS We examined 39 survivors (age 6-19years) who were 3.61years post-PBRT on average. Craniospinal (CSI; n=21) and focal (n=18) subgroups were analyzed. Attention, processing speed, and executive functioning scores were compared to population norms, and clinical/demographic risk factors were examined. RESULTS As a group, survivors treated with focal PBRT exhibited attention, processing speed, and executive functioning that did not differ from population norms (all p>0.05). Performance in the CSI group across attention scales was normative (all p>0.05), but areas of relative weakness were identified on one executive functioning subtest and several processing speed subtests (all p<0.01). CONCLUSIONS Survivors treated with PBRT may exhibit relative resilience in cognitive domains traditionally associated with radiation late effects. Attention, processing speed, and executive functioning remained intact and within normal limits for survivors treated with focal PBRT. Among survivors treated with CSI, a score pattern emerged that was suggestive of difficulties in underlying component skills (i.e., processing speed) rather than true executive dysfunction. No evidence of profound cognitive impairment was found in either group.
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Affiliation(s)
- Tanya N Antonini
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - M Douglas Ris
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - David R Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Anita Mahajan
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - M Fatih Okcu
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, United States
| | - Murali Chintagumpala
- Department of Pediatrics, Section of Hematology Oncology, Baylor College of Medicine, Houston, United States
| | - Arnold Paulino
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Amanda E Child
- Department of Psychology, University of Houston, Houston, United States
| | - Jessica Orobio
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - Heather H Stancel
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States
| | - Lisa S Kahalley
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, United States.
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202
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Abstract
Current therapies for medulloblastoma were introduced primarily in the 1980s and consist of predominantly cytotoxic, nontargeted approaches. Mortality from medulloblastoma remains significant. In addition, many survivors suffer from severe treatment-related effects of radiation and cytotoxic chemotherapy. Further intensification of nonspecific therapy is unlikely to offer additional benefits, because survival rates have reached a plateau. Recent publications in medulloblastoma have revolved largely around the recognition that medulloblastoma per se does not exist, but rather, that there are a group of histologically similar but clinically and molecularly distinct entities that have been grouped under that rubric. Distinguishing the four molecular subgroups of medulloblastoma-wingless (WNT), sonic hedgehog (SHH), group 3, and group 4-in the daily treatment of patients, as well in the setting of clinical trials, is an important challenge in the near term for the pediatric neuro-oncology community. The preponderance of morbidity in treating patients with medulloblastoma is secondary to the treatment or prophylaxis of leptomeningeal metastases, and the cause of most deaths is leptomeningeal metastases. Recurrence of medulloblastoma is a nearly universally fatal event, with no significant salvage rate. The extent of spatial and temporal intratumoral heterogeneity as medulloblastoma metastasizes to leptomeninges and as it evolves in the face of radiation and cytotoxic chemotherapy is just beginning to be understood as a major barrier to therapeutic success. Pediatric neuro-oncology clinicians and scientists must now determine how best to incorporate rapid changes in our biologic understanding of medulloblastoma into the next generation of upfront clinical trials, with the goal of both improving survival for the highest-risk patients and improving quality of life for survivors.
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Affiliation(s)
- Vijay Ramaswamy
- All authors: Hospital for Sick Children, Toronto, Ontario, Canada
| | - Michael D Taylor
- All authors: Hospital for Sick Children, Toronto, Ontario, Canada
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203
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Mizumoto M, Oshiro Y, Yamamoto T, Kohzuki H, Sakurai H. Proton Beam Therapy for Pediatric Brain Tumor. Neurol Med Chir (Tokyo) 2017; 57:343-355. [PMID: 28603224 PMCID: PMC5566707 DOI: 10.2176/nmc.ra.2017-0003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cancer is a major cause of childhood death, with central nervous system (CNS) neoplasms being the second most common pediatric malignancy, following hematological cancer. Treatment of pediatric CNS malignancies requires multimodal treatment using a combination of surgery, chemotherapy, and radiotherapy, and advances in these treatments have given favorable results and longer survival. However, treatment-related toxicities have also occurred, particularly for radiotherapy, after which secondary cancer, reduced function of irradiated organs, and retarded growth are significant problems. Proton beam therapy (PBT) is a particle radiotherapy with excellent dose localization that permits treatment of liver and lung cancer by administration of a high dose to the tumor while minimizing damage to surrounding normal tissues. Thus, PBT has the potential advantages for pediatric cancer. In this context, we review the current knowledge on PBT for treatment of pediatric CNS malignancies.
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Affiliation(s)
| | - Yoshiko Oshiro
- Department of Radiation Oncology, University of Tsukuba.,Department of Radiation Oncology, Tsukuba Medical Center Hospital
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204
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Farace P, Bizzocchi N, Righetto R, Fellin F, Fracchiolla F, Lorentini S, Widesott L, Algranati C, Rombi B, Vennarini S, Amichetti M, Schwarz M. Supine craniospinal irradiation in pediatric patients by proton pencil beam scanning. Radiother Oncol 2017; 123:112-118. [DOI: 10.1016/j.radonc.2017.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/19/2017] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
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205
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Wang Y, Zhou K, Li T, Xu Y, Xie C, Sun Y, Zhang Y, Rodriguez J, Blomgren K, Zhu C. Inhibition of autophagy prevents irradiation-induced neural stem and progenitor cell death in the juvenile mouse brain. Cell Death Dis 2017; 8:e2694. [PMID: 28333139 PMCID: PMC5386526 DOI: 10.1038/cddis.2017.120] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 02/06/2017] [Accepted: 02/23/2017] [Indexed: 01/24/2023]
Abstract
Radiotherapy is an effective tool in the treatment of malignant brain tumors. However, damage to brain stem and progenitor cells constitutes a major problem and is associated with long-term side effects. Autophagy has been shown to be involved in cell death, and the purpose of this study was to evaluate the effect of autophagy inhibition on neural stem and progenitor cell death in the juvenile brain. Ten-day-old selective Atg7 knockout (KO) mice and wild-type (WT) littermates were subjected to a single 6Gy dose of whole-brain irradiation. Cell death and proliferation as well as microglia activation and inflammation were evaluated in the dentate gyrus of the hippocampus and in the cerebellum at 6 h after irradiation. We found that cell death was reduced in Atg7 KO compared with WT mice at 6 h after irradiation. The number of activated microglia increased significantly in both the dentate gyrus and the cerebellum of WT mice after irradiation, but the increase was lower in the Atg7 KO mice. The levels of proinflammatory cytokines and chemokines decreased, especially in the cerebellum, in the Atg7 KO group. These results suggest that autophagy might be a potential target for preventing radiotherapy-induced neural stem and progenitor cell death and its associated long-term side effects.
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Affiliation(s)
- Yafeng Wang
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Kai Zhou
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Karolinska Institutet, Department of Women's and Children's Health, Karolinska University Hospital Q2:07, Stockholm, Sweden
| | - Tao Li
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Zhengzhou Children's Hospital, Zhengzhou, China.,Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yiran Xu
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Cuicui Xie
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Yanyan Sun
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yaodong Zhang
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Juan Rodriguez
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Klas Blomgren
- Karolinska Institutet, Department of Women's and Children's Health, Karolinska University Hospital Q2:07, Stockholm, Sweden.,Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Changlian Zhu
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Henan Key Laboratory of Child Brain Injury, Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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206
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Noble DJ, Ajithkumar T, Lambert J, Gleeson I, Williams MV, Jefferies SJ. Highly Conformal Craniospinal Radiotherapy Techniques Can Underdose the Cranial Clinical Target Volume if Leptomeningeal Extension through Skull Base Exit Foramina is not Contoured. Clin Oncol (R Coll Radiol) 2017; 29:439-447. [PMID: 28318880 PMCID: PMC5479365 DOI: 10.1016/j.clon.2017.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/13/2017] [Accepted: 02/14/2017] [Indexed: 01/03/2023]
Abstract
AIMS Craniospinal irradiation (CSI) remains a crucial treatment for patients with medulloblastoma. There is uncertainty about how to manage meningeal surfaces and cerebrospinal fluid (CSF) that follows cranial nerves exiting skull base foramina. The purpose of this study was to assess plan quality and dose coverage of posterior cranial fossa foramina with both photon and proton therapy. MATERIALS AND METHODS We analysed the radiotherapy plans of seven patients treated with CSI for medulloblastoma and primitive neuro-ectodermal tumours and three with ependymoma (total n = 10). Four had been treated with a field-based technique and six with TomoTherapy™. The internal acoustic meatus (IAM), jugular foramen (JF) and hypoglossal canal (HC) were contoured and added to the original treatment clinical target volume (Plan_CTV) to create a Test_CTV. This was grown to a test planning target volume (Test_PTV) for comparison with a Plan_PTV. Using Plan_CTV and Plan_PTV, proton plans were generated for all 10 cases. The following dosimetry data were recorded: conformity (dice similarity coefficient) and homogeneity index (D2 - D98/D50) as well as median and maximum dose (D2%) to Plan_PTV, V95% and minimum dose (D99.9%) to Plan_CTV and Test_CTV and Plan_PTV and Test_PTV, V95% and minimum dose (D98%) to foramina PTVs. RESULTS Proton and TomoTherapy™ plans were more conformal (0.87, 0.86) and homogeneous (0.07, 0.04) than field-photon plans (0.79, 0.17). However, field-photon plans covered the IAM, JF and HC PTVs better than proton plans (P = 0.002, 0.004, 0.003, respectively). TomoTherapy™ plans covered the IAM and JF better than proton plans (P = 0.000, 0.002, respectively) but the result for the HC was not significant. Adding foramen CTVs/PTVs made no difference for field plans. The mean Dmin dropped 3.4% from Plan_PTV to Test_PTV for TomoTherapy™ (not significant) and 14.8% for protons (P = 0.001). CONCLUSIONS Highly conformal CSI techniques may underdose meninges and CSF in the dural reflections of posterior fossa cranial nerves unless these structures are specifically included in the CTV.
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Affiliation(s)
- D J Noble
- Cancer Research UK VoxTox Research Group, Department of Oncology, University of Cambridge, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK; Department of Oncology, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK.
| | - T Ajithkumar
- Department of Oncology, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK
| | - J Lambert
- West German Proton Therapy Centre Essen, Essen, Germany
| | - I Gleeson
- Medical Physics Department, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK
| | - M V Williams
- Department of Oncology, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK
| | - S J Jefferies
- Department of Oncology, Cambridge University Hospital's NHS Foundation Trust, Cambridge, UK
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207
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Odei BCL, Boothe D, Keole SR, Vargas CE, Foote RL, Schild SE, Ashman JB. A 20-Year Analysis of Clinical Trials Involving Proton Beam Therapy. Int J Part Ther 2017; 3:398-406. [PMID: 31772989 DOI: 10.14338/ijpt-d-16-00030.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/06/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose Clinical trials (CTs) in proton beam therapy (PBT) are important for determining its benefits relative to other treatments. An analysis of PBT trials is, thus, warranted to understand the current state of PBT CTs and the factors affecting current and future trials. Materials and Methods We queried the clinicaltrials.gov Website using the search terms: proton beam therapy, proton radiation, and protons. A total of 152 PBT CTs were identified. We used χ2 analysis and logistic regression to evaluate trial characteristics. Results Most CTs were recruiting (n = 79; 52.0%), phase II (n = 95; 62.5%), open label (n = 134; 88.2%), single-group assignment (n = 84; 55.3%), and with primary treatment endpoints of safety and efficacy (n = 94; 61.8%). The primary treatment sites included gastrointestinal (n = 32; 21.1%), central nervous system (n = 31; 20.4%), lung (n = 21; 13.8%), prostate (n = 19; 12.5%), sarcoma (n = 15; 9.9%), and others (n = 24; 15.8%). Comparison studies between radiation modalities involved PBT and intensity-modulated photon therapy (n = 11; 7.2%), PBT and general photon therapy (n = 8; 5.3%), and PBT and carbon-ion therapy (n = 7; 4.6%). The PBT CTs underwent substantial growth after 2008 but now appear to be in decline. Nongovernmental institutions, comprising university centers, hospital systems, and research groups, have funded the greatest number of CTs (n= 106; 69.7%). The National Institutes of Health (NIH) were more likely to fund CTs involving the central nervous system (P = 0.02). Trials involving NIH funding were more likely to result in successful trial completion (P = 0.02). Conclusion Among PBT CTs, most were phase II trials, with a very few being phase III CTs. Funding of PBT CTs originating from industry or the NIH is limited. Recently, there has been a declining trajectory of newly initiated PBT trials. It is not yet clear whether this represents a true trend or just a pause in CT implementation. Despite multiple impediments to PBT CTs, the particle therapy community continues to work toward evidence generation.
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Affiliation(s)
- Bismarck C L Odei
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Dustin Boothe
- Huntsman Cancer Center, University of Utah, Salt Lake City, UT, USA
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, USA
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208
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Durante M, Orecchia R, Loeffler JS. Charged-particle therapy in cancer: clinical uses and future perspectives. Nat Rev Clin Oncol 2017; 14:483-495. [DOI: 10.1038/nrclinonc.2017.30] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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209
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MacEwan I, Chou B, Moretz J, Loredo L, Bush D, Slater JD. Effects of vertebral-body-sparing proton craniospinal irradiation on the spine of young pediatric patients with medulloblastoma. Adv Radiat Oncol 2017; 2:220-227. [PMID: 28740935 PMCID: PMC5514252 DOI: 10.1016/j.adro.2017.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/07/2017] [Accepted: 03/02/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose To investigate the long-term effects of vertebral-body-sparing proton craniospinal irradiation (CSI) on the spine of young patients with medulloblastoma. Methods and materials Six children between the ages of 3 and 5 years with medulloblastoma were treated with vertebral-body-sparing proton CSI after maximal safe resection. Radiation therapy was delivered in the supine position with posterior beams targeting the craniospinal axis, and the proton beam was stopped anterior to the thecal sac. Patients were treated with a dose of either 23.4 Gy or 36 Gy to the craniospinal axis followed by a boost to the posterior fossa and any metastatic lesions. Chemotherapy varied by protocol. Radiographic effects on the spine were evaluated with serial imaging, either with magnetic resonance imaging scans or plain film using Cobb angle calculations, the presence of thoracic lordosis, lumbar vertebral body-to-disc height ratios, and anterior-posterior height ratios. Clinical outcomes were evaluated by patient/family interview and medical chart review. Results Overall survival and disease free survival were 83% (5/6) at follow-up. Median clinical and radiographic follow-up were 13.6 years and 12.3 years, respectively. Two patients were clinically diagnosed with scoliosis and treated conservatively. At the time of follow-up, no patients had experienced chronic back pain or required spine surgery. No patients were identified to have thoracic lordosis. Diminished growth of the posterior portions of vertebral bodies was identified in all patients, with an average posterior to anterior ratio of 0.88, which was accompanied by compensatory hypertrophy of the posterior intervertebral discs. Conclusion Vertebral-body-sparing CSI with proton beam did not appear to cause increased severe spinal abnormalities in patients treated at our institution. This approach could be considered in future clinical trials in an effort to reduce toxicity and the risk of secondary malignancy and to improve adult height.
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Affiliation(s)
- Iain MacEwan
- Loma Linda University Medical Center, Department of Radiation Medicine, Loma Linda, California
| | - Brian Chou
- Loma Linda University, School of Medicine, Loma Linda, California
| | - Jeremy Moretz
- Loma Linda University Medical Center, Department of Radiology, Loma Linda, California
| | - Lilia Loredo
- Loma Linda University Medical Center, Department of Radiation Medicine, Loma Linda, California
| | - David Bush
- Loma Linda University Medical Center, Department of Radiation Medicine, Loma Linda, California
| | - Jerry D Slater
- Loma Linda University Medical Center, Department of Radiation Medicine, Loma Linda, California
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210
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Sato M, Gunther JR, Mahajan A, Jo E, Paulino AC, Adesina AM, Jones JY, Ketonen LM, Su JM, Okcu MF, Khatua S, Dauser RC, Whitehead WE, Weinberg J, Chintagumpala MM. Progression-free survival of children with localized ependymoma treated with intensity-modulated radiation therapy or proton-beam radiation therapy. Cancer 2017; 123:2570-2578. [PMID: 28267208 DOI: 10.1002/cncr.30623] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND The treatment for childhood intracranial ependymoma includes maximal surgical resection followed by involved-field radiotherapy, commonly in the form of intensity-modulated radiation therapy (IMRT). Proton-beam radiation therapy (PRT) is used at some centers in an effort to decrease long-term toxicity. Although protons have the theoretical advantage of a minimal exit dose to the surrounding uninvolved brain tissue, it is unknown whether they have the same efficacy as photons in preventing local recurrence. METHODS A retrospective review of medical records from September 2000 to April 2013 was performed. Seventy-nine children with newly diagnosed localized intracranial ependymomas treated with either IMRT (n = 38) or PRT (n = 41) were identified, and progression-free survival (PFS) was analyzed with Kaplan-Meier and Cox multivariate analyses. RESULTS The median age at diagnosis was 3.7 years for all patients (range, 0.4-18.7 years). There were 54 patients with infratentorial tumors (68% of the total population). Patients treated with PRT were younger (median age, 2.5 vs 5.7 years; P = .001) and had a shorter median follow-up (2.6 vs 4.9 years; P < .0001). Gross total resection (GTR) was achieved in 67 patients (85%) and was more frequent in the PRT group versus the IMRT group (93% vs 76%; P = .043). The 3-year PFS rates were 60% and 82% with IMRT and PRT, respectively (P = .031). CONCLUSIONS Children with localized ependymomas treated with PRT have a 3-year PFS rate comparable to that of children treated with IMRT. This analysis suggests that local control is not compromised by the use of PRT. The data also support GTR as the only prognostic factor for PFS. Cancer 2017;123:2570-78. © 2017 American Cancer Society.
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Affiliation(s)
- Mariko Sato
- University of Iowa Children's Hospital, Iowa City, Iowa
| | | | - Anita Mahajan
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eunji Jo
- Biostatistics and Informatics Shared Resource, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Arnold C Paulino
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adekunle M Adesina
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - Jeremy Y Jones
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - Leena M Ketonen
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack M Su
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - M Fatih Okcu
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - Soumen Khatua
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert C Dauser
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - William E Whitehead
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
| | - Jeffrey Weinberg
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Murali M Chintagumpala
- Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas
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211
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Smith GL, Ganz PA, Bekelman JE, Chmura SJ, Dignam JJ, Efstathiou JA, Jagsi R, Johnstone PA, Steinberg ML, Williams SB, Yu JB, Zietman AL, Weichselbaum RR, Tina Shih YC. Promoting the Appropriate Use of Advanced Radiation Technologies in Oncology: Summary of a National Cancer Policy Forum Workshop. Int J Radiat Oncol Biol Phys 2017; 97:450-461. [PMID: 28011046 PMCID: PMC6044722 DOI: 10.1016/j.ijrobp.2016.10.042] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/28/2016] [Accepted: 10/23/2016] [Indexed: 02/03/2023]
Abstract
PURPOSE Leaders in the oncology community are sounding a clarion call to promote "value" in cancer care decisions. Value in cancer care considers the clinical effectiveness, along with the costs, when selecting a treatment. To discuss possible solutions to the current obstacles to achieving value in the use of advanced technologies in oncology, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop, "Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology" in July 2015. The present report summarizes the discussions related to radiation oncology. METHODS AND MATERIALS The workshop convened stakeholders, including oncologists, researchers, payers, policymakers, and patients. Speakers presented on key themes, including the rationale for a value discussion on advanced technology use in radiation oncology, the generation of scientific evidence for value of advanced radiation technologies, the effect of both scientific evidence and "marketplace" (or economic) factors on the adoption of technologies, and newer approaches to improving value in the practice of radiation oncology. The presentations were followed by a panel discussion with dialogue among the stakeholders. RESULTS Challenges to generating evidence for the value of advanced technologies include obtaining contemporary, prospective, randomized, and representative comparative effectiveness data. Proposed solutions include the use of prospective registry data; integrating radiation oncology treatment, outcomes, and quality benchmark data; and encouraging insurance coverage with evidence development. Challenges to improving value in practice include the slow adoption of higher value and the de-adoption of lower value treatments. The proposed solutions focused on engaging stakeholders in iterative, collaborative, and evidence-based efforts to define value and promote change in radiation oncology practice. Recent examples of ongoing or successful responses to the discussed challenges were provided. CONCLUSIONS Discussions of "value" have increased as a priority in the radiation oncology community. Practitioners in the radiation oncology community can play a critical role in promoting a value-oriented framework to approach radiation oncology treatment.
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Affiliation(s)
- Grace L Smith
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Patricia A Ganz
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Justin E Bekelman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois
| | - James J Dignam
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Peter A Johnstone
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, Texas
| | - James B Yu
- Department of Radiation Oncology, Yale University School of Medicine, New Haven, Connecticut
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ralph R Weichselbaum
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois
| | - Ya-Chen Tina Shih
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
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A comparative study of dose distribution of PBT, 3D-CRT and IMRT for pediatric brain tumors. Radiat Oncol 2017; 12:40. [PMID: 28228150 PMCID: PMC5322597 DOI: 10.1186/s13014-017-0775-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/06/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction It was reported that proton beam therapy (PBT) reduced the normal brain dose compared with X-ray therapy for pediatric brain tumors. We considered whether there was not the condition that PBT was more disadvantageous than intensity modulated photon radiotherapy (IMRT) and 3D conventional radiotherapy (3D-CRT) for treatment of pediatric brain tumors about the dose reduction for the normal brain when the tumor location or tumor size were different. Methods The subjects were 12 patients treated with PBT at our institute, including 6 cases of ependymoma treated by local irradiation and 6 cases of germinoma treated by irradiation of all four cerebral ventricles. IMRT and 3D-CRT treatment plans were made for these 12 cases, with optimization using the same planning conditions as those for PBT. Model cases were also compared using sphere targets with different diameters or locations in the brain, and the normal brain doses with PBT, IMRT and 3D-CRT were compared using the same planning conditions. Results PBT significantly reduced the average dose to normal brain tissue compared to 3D-CRT and IMRT in all cases. There was no difference between 3D-CRT and IMRT. The average normal brain doses for PBT, 3D-CRT, and IMRT were 5.1–34.8% (median 14.9%), 11.0–48.5% (23.8%), and 11.5–53.1% (23.5%), respectively, in ependymoma cases; and 42.3–61.2% (48.9%), 54.5–74.0% (62.8%), and 56.3–72.1% (61.2%), respectively, in germinoma cases. In the model cases, PBT significantly reduced the average normal brain dose for larger tumors and for tumors located at the periphery of the brain. Conclusion PBT reduces the average dose to normal brain tissue, compared with 3D-CRT and IMRT. The effect is higher for a tumor that is larger or located laterally.
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Abstract
OBJECTIVE This article considered why the proton therapy (PT) relative biological effect (RBE) should be a variable rather than a constant. METHODS The reasons for a variable proton RBE are enumerated, with qualitative and quantitative arguments. The heterogeneous data sets collated by Paganetti et al (2002) and the more homogeneous data of Britten et al (2013) are further analyzed using linear regression fitting and RBE-inclusive adaptations of the linear-quadratic (LQ) radiation model. RESULTS The in vitro data show RBE increasing as dose per fraction is lowered. In the Paganetti et al (2002) data sets, the differences between observed and expected effects are smaller when the LQ model is used, but with such data heterogeneity, firm statistical conclusions cannot be obtained. The more homogeneous data set shows an unequivocal variation in RBE with dose per faction. The in vivo data are inappropriate for assessments of late normal tissue effects in radiotherapy. Also, if there is the same degree of uncertainty in an RBE of 1.1 or in an RBE of 2-3 for C ions, the fractional and biological effective doses can vary considerably and be greater in the proton case. So, errors in RBE assignment are important for protons, just as with C ions. CONCLUSION Further experimental programmes are proposed, including late normal tissue end points. Better RBE allocations might further improve PT outcomes. ADVANCES IN KNOWLEDGE This study provides a rigorous critique of the 1.1 RBE used for protons, from theoretical and practical standpoints. Data analysis shows that the LQ model is more appropriate than simple linear regression. Comprehensive research programmes are suggested.
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Affiliation(s)
- Bleddyn Jones
- Gray Laboratory, CRUK/MRC Oxford Oncology Institute, University of Oxford, Oxford, UK
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214
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Prevention of radiotherapy-induced neurocognitive dysfunction in survivors of paediatric brain tumours: the potential role of modern imaging and radiotherapy techniques. Lancet Oncol 2017; 18:e91-e100. [DOI: 10.1016/s1470-2045(17)30030-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 02/06/2023]
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215
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Shen S, Liu M, Li T, Lin S, Mo R. Recent progress in nanomedicine-based combination cancer therapy using a site-specific co-delivery strategy. Biomater Sci 2017; 5:1367-1381. [DOI: 10.1039/c7bm00297a] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review article highlights the recent progresses in nanomedicine-based combination cancer therapy via site-specific co-delivery strategies.
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Affiliation(s)
- Shiyang Shen
- State Key Laboratory of Natural Medicines
- Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases
- Center of Advanced Pharmaceuticals and Biomaterials
- China Pharmaceutical University
- Nanjing 210009
| | - Meng Liu
- State Key Laboratory of Natural Medicines
- Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases
- Center of Advanced Pharmaceuticals and Biomaterials
- China Pharmaceutical University
- Nanjing 210009
| | - Teng Li
- State Key Laboratory of Natural Medicines
- Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases
- Center of Advanced Pharmaceuticals and Biomaterials
- China Pharmaceutical University
- Nanjing 210009
| | - Shiqi Lin
- State Key Laboratory of Natural Medicines
- Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases
- Center of Advanced Pharmaceuticals and Biomaterials
- China Pharmaceutical University
- Nanjing 210009
| | - Ran Mo
- State Key Laboratory of Natural Medicines
- Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases
- Center of Advanced Pharmaceuticals and Biomaterials
- China Pharmaceutical University
- Nanjing 210009
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216
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Odei B, Frandsen JE, Boothe D, Ermoian RP, Poppe MM. Patterns of Care in Proton Radiation Therapy for Pediatric Central Nervous System Malignancies. Int J Radiat Oncol Biol Phys 2017; 97:60-63. [DOI: 10.1016/j.ijrobp.2016.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/29/2016] [Accepted: 09/10/2016] [Indexed: 10/21/2022]
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Doyen J, Bondiau PY, Benezery K, Thariat J, Vidal M, Gérard A, Hérault J, Carrie C, Hannoun-Lévi JM. [Indications and results for protontherapy in cancer treatments]. Cancer Radiother 2016; 20:513-8. [PMID: 27614508 DOI: 10.1016/j.canrad.2016.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 06/10/2016] [Indexed: 12/16/2022]
Abstract
Purpose was to summarize results for proton therapy in cancer treatment. A systematic review has been done by selecting studies on the website www.pubmed.com (Medline) and using the following keywords: proton therapy, radiation therapy, cancer, chordoma, chondrosarcoma, uveal melanoma, retinoblastoma, meningioma, glioma, neurinoma, pituitary adenoma, medulloblastoma, ependymoma, craniopharyngioma and nasal cavity. There are several retrospective studies reporting results for proton therapy in cancer treatments in the following indications: ocular tumors, nasal tumors, skull-based tumors, pediatric tumors. There is no prospective study except one phase II trial in medulloblastoma. The use of proton therapy for these indications is due to dosimetric advantages offering better tumor coverage and organ at risk sparing in comparison with photon therapy. Clinical results are historically at least as efficient as photon therapy with a better toxicity profile in pediatric tumors (cognitive and endocrine functions, radiation-induced cancer) and a better tumoral control in tumors of the nasal cavity. Clinical advantages of proton therapy counterbalance its cost especially in pediatric tumors. Proton therapy could be used in other types of cancer. Proton therapy showed good outcome in ocular, nasal tumors, pediatric, skull-based and paraspinal tumors. Because of some dosimetric advantages, proton therapy could be proposed for other indications in cancer treatments.
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Affiliation(s)
- J Doyen
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France.
| | - P-Y Bondiau
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - K Benezery
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - J Thariat
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - M Vidal
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - A Gérard
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - J Hérault
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
| | - C Carrie
- Centre Léon-Bérard, radiation oncology, 28, rue Laennec, 69008 Lyon, France
| | - J-M Hannoun-Lévi
- Centre Antoine-Lacassagne, radiation oncology, 33, avenue de Valombrose, 06189 Nice, France
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218
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Chevignard M, Câmara-Costa H, Doz F, Dellatolas G. Core deficits and quality of survival after childhood medulloblastoma: a review. Neurooncol Pract 2016; 4:82-97. [PMID: 31385962 DOI: 10.1093/nop/npw013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Medulloblastoma is the most common malignant central nervous system tumor in children. Treatment most often includes surgical resection, craniospinal irradiation, and adjuvant chemotherapy. Although survival has improved dramatically, the tumor and its treatments have devastating long-term side effects that negatively impact quality of survival (QoS). The objective was to review the literature on QoS following childhood medulloblastoma. Methods This narrative review is based on a Medline database search and examination of the reference lists of papers selected. Results Frequent problems after medulloblastoma treatment include medical complications, such as long-term neurological and sensory (hearing loss) impairments; endocrine deficits, including growth problems; and secondary tumors. Neurocognitive impairment is repeatedly reported, with decreasing cognitive performances over time. Although all cognitive domains may be affected, low processing speed, attention difficulties, and working memory difficulties are described as the core cognitive deficits resulting from both cerebellar damage and the negative effect of radiation on white matter development. Long-term psychosocial limitations include low academic achievement, unemployment, and poor community integration with social isolation. Important negative prognostic factors include young age at diagnosis, conventional craniospinal radiotherapy, presence of postoperative cerebellar mutism, and perioperative complications. The influence of environmental factors, such as family background and interventions, remains understudied. Conclusion Future studies should focus on the respective impact of radiation, cerebellar damage, genomic and molecular subgroup parameters, and environmental factors on cognitive and psychosocial outcomes. Long-term (probably lifelong) follow-up into adulthood is required in order to monitor development and implement timely, suitable, multi-disciplinary rehabilitation interventions and special education or support when necessary.
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Affiliation(s)
- Mathilde Chevignard
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
| | - Hugo Câmara-Costa
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
| | - François Doz
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
| | - Georges Dellatolas
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
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219
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Ivanov DP, Coyle B, Walker DA, Grabowska AM. In vitro models of medulloblastoma: Choosing the right tool for the job. J Biotechnol 2016; 236:10-25. [PMID: 27498314 DOI: 10.1016/j.jbiotec.2016.07.028] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/29/2016] [Indexed: 02/06/2023]
Abstract
The recently-defined four molecular subgroups of medulloblastoma have required updating of our understanding of in vitro models to include molecular classification and risk stratification features from clinical practice. This review seeks to build a more comprehensive picture of the in vitro systems available for modelling medulloblastoma. The subtype classification and molecular characterisation for over 40 medulloblastoma cell-lines has been compiled, making it possible to identify the strengths and weaknesses in current model systems. Less than half (18/44) of established medulloblastoma cell-lines have been subgrouped. The majority of the subgrouped cell-lines (11/18) are Group 3 with MYC-amplification. SHH cell-lines are the next most common (4/18), half of which exhibit TP53 mutation. WNT and Group 4 subgroups, accounting for 50% of patients, remain underrepresented with 1 and 2 cell-lines respectively. In vitro modelling relies not only on incorporating appropriate tumour cells, but also on using systems with the relevant tissue architecture and phenotype as well as normal tissues. Novel ways of improving the clinical relevance of in vitro models are reviewed, focusing on 3D cell culture, extracellular matrix, co-cultures with normal cells and organotypic slices. This paper champions the establishment of a collaborative online-database and linked cell-bank to catalyse preclinical medulloblastoma research.
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Affiliation(s)
- Delyan P Ivanov
- Division of Cancer and Stem Cells, Cancer Biology, University of Nottingham, Nottingham, UK.
| | - Beth Coyle
- Children's Brain Tumour Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, UK.
| | - David A Walker
- Children's Brain Tumour Research Centre, Queens Medical Centre, University of Nottingham, Nottingham, UK.
| | - Anna M Grabowska
- Division of Cancer and Stem Cells, Cancer Biology, University of Nottingham, Nottingham, UK.
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220
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The Prognostic Factors and Outcome of Adult Medulloblastoma: Where We Stand. Int Surg 2016. [DOI: 10.9738/intsurg-d-16-00104.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We designed our study to analyze the prognostic factors and treatment outcomes of adult medulloblastoma patients who received postoperative craniospinal irradiation. Fourty-three patients who were treated due to medulloblastoma at Istanbul University, Institute of Oncology between 1990 and 2013 were retrospectively analyzed. All of the patients were older than 18 years, with a median age of 27 years (range, 18–51 years). In 40 (93%) patients, total resection of the tumor was achieved, and 3 (7%) patients had undergone a subtotal tumoral resection. Risk assessment revealed 7 high-risk and 36 standard-risk patients. All patients received postoperative craniospinal irradiation, delivering a median craniospinal dose of 36 Gy, with an additional boost to the posterior fossa up to 54 Gy. Fifteen patients received chemotherapy. The median follow-up was 62 months (range, 3–213 months). The 5-year, 10-year, overall, and disease-free survival rates were 63%, 51%, 66%, and 55%, respectively. Univariate analysis revealed that hydrocephalus, initial local recurrence, subtotal resection in primary surgery, initial Karnofsky performance status ≤70, duration of symptoms shorter than 30 days, and primary site dose < 54 Gy were found to be negative prognostic factors. Toxicity was moderate. The main therapy in adult medulloblatoms is craniospinal irradiation following surgery. The prognostic factors and outcomes of the patients in our study are concordant with previous reports in the literature.
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221
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English M, Grundy RG, Peet A, Lowis S, Walker D. Proton beam therapy for medulloblastoma. Lancet Oncol 2016; 17:e174. [PMID: 27301037 DOI: 10.1016/s1470-2045(16)00102-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Andrew Peet
- University of Birmingham, Edgbaston, Birmingham, UK
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222
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Proton therapy for paediatric CNS tumours — improving treatment-related outcomes. Nat Rev Neurol 2016; 12:334-45. [DOI: 10.1038/nrneurol.2016.70] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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223
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Ramaswamy V, Bouffet E. Proton beam therapy for medulloblastoma. Lancet Oncol 2016; 17:e173-4. [DOI: 10.1016/s1470-2045(16)00156-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/02/2016] [Indexed: 10/21/2022]
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224
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Shah A, Ricci KI, Efstathiou JA. Beyond a moonshot: insurance coverage for proton therapy. Lancet Oncol 2016; 17:559-61. [DOI: 10.1016/s1470-2045(16)00171-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 10/21/2022]
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225
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226
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Proton therapy for paediatric medulloblastoma. Lancet Oncol 2016; 17:258-259. [PMID: 26830376 DOI: 10.1016/s1470-2045(15)00217-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 11/23/2022]
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227
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Eaton BR, MacDonald SM, Yock TI, Tarbell NJ. Secondary Malignancy Risk Following Proton Radiation Therapy. Front Oncol 2015; 5:261. [PMID: 26636040 PMCID: PMC4659915 DOI: 10.3389/fonc.2015.00261] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/09/2015] [Indexed: 01/17/2023] Open
Abstract
Radiation-induced secondary malignancies are a significant, yet uncommon cause of morbidity and mortality among cancer survivors. Secondary malignancy risk is dependent upon multiple factors including patient age, the biological and genetic predisposition of the individual, the volume and location of tissue irradiated, and the dose of radiation received. Proton therapy (PRT) is an advanced particle therapy with unique dosimetric properties resulting in reduced entrance dose and minimal to no exit dose when compared with standard photon radiation therapy. Multiple dosimetric studies in varying cancer subtypes have demonstrated that PRT enables the delivery of adequate target volume coverage with reduced integral dose delivered to surrounding tissues, and modeling studies taking into account dosimetry and radiation cell biology have estimated a significantly reduced risk of radiation-induced secondary malignancy with PRT. Clinical data are emerging supporting the lower incidence of secondary malignancies after PRT compared with historical photon data, though longer follow-up in proton treated cohorts is awaited. This article reviews the current dosimetric and clinical literature evaluating the incidence of and risk factors associated with radiation-induced secondary malignancy following PRT.
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Affiliation(s)
- Bree R Eaton
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Nancy J Tarbell
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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