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Flaadt T, Ebinger M, Schreiber M, Ladenstein RL, Simon T, Lode HN, Hero B, Schuhmann MU, Schäfer J, Paulsen F, Timmermann B, Eggert A, Lang P. Multimodal Therapy with Consolidating Haploidentical Stem Cell Transplantation and Dinutuximab Beta for Patients with High-Risk Neuroblastoma and Central Nervous System Relapse. J Clin Med 2023; 12:6196. [PMID: 37834840 PMCID: PMC10573405 DOI: 10.3390/jcm12196196] [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] [Received: 08/18/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023] Open
Abstract
Despite highly intensive multimodality treatment regimens, the prognosis of patients with high-risk neuroblastoma (HRNB) and central nervous system (CNS) relapse remains poor. We retrospectively reviewed data from 13 patients with HRNB and CNS relapse who received multimodal therapy with consolidating haploidentical stem cell transplantation (haplo-SCT) followed by dinutuximab beta ± subcutaneous interleukin-2 (scIL-2). Following individual relapse treatment, patients aged 1-21 years underwent haplo-SCT with T/B-cell-depleted grafts followed by dinutuximab beta 20 mg/m2/day × 5 days for 5-6 cycles. If a response was demonstrated after cycle 5 or 6, patients received up to nine treatment cycles. After haplo-SCT, eight patients had a complete response, four had a partial response, and one had a stable disease. All 13 patients received ≥3 cycles of immunotherapy. At the end of the follow-up, 9/13 patients (66.7%) demonstrated complete response. As of July 2023, all nine patients remain disease-free, with a median follow-up time of 5.1 years since relapse. Estimated 5-year event-free and overall survival rates were 55.5% and 65.27%, respectively. Dinutuximab beta ± scIL-2 following haplo-SCT is a promising treatment option with a generally well-tolerated safety profile for patients with HRNB and CNS relapse.
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Affiliation(s)
- Tim Flaadt
- Department of Hematology and Oncology, University Children’s Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (M.E.); (M.S.); (P.L.)
| | - Martin Ebinger
- Department of Hematology and Oncology, University Children’s Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (M.E.); (M.S.); (P.L.)
| | - Malin Schreiber
- Department of Hematology and Oncology, University Children’s Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (M.E.); (M.S.); (P.L.)
| | - Ruth L. Ladenstein
- Department of Pediatrics, St Anna Children’s Hospital, Medical University, 1090 Vienna, Austria;
- Studies and Statistics of Integrated Research and Projects, Children’s Cancer Research Institute, 1090 Vienna, Austria
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Hospital, University of Cologne, 50937 Köln, Germany; (T.S.); (B.H.)
| | - Holger N. Lode
- Department of Pediatric Hematology and Oncology, University Medicine Greifswald, 17489 Greifswald, Germany;
| | - Barbara Hero
- Department of Pediatric Oncology and Hematology, University Hospital, University of Cologne, 50937 Köln, Germany; (T.S.); (B.H.)
| | - Martin U. Schuhmann
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany;
| | - Jürgen Schäfer
- Department for Diagnostic and Interventional Radiology, University Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany;
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany;
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), 45147 Essen, Germany;
| | - Angelika Eggert
- Department of Pediatric Oncology/Hematology, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany;
| | - Peter Lang
- Department of Hematology and Oncology, University Children’s Hospital, Eberhard Karls University Tuebingen, 72076 Tuebingen, Germany; (M.E.); (M.S.); (P.L.)
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Wieczorek A, Stefanowicz J, Hennig M, Adamkiewicz-Drozynska E, Stypinska M, Dembowska-Baginska B, Gamrot Z, Woszczyk M, Geisler J, Szczepanski T, Skoczen S, Ussowicz M, Pogorzala M, Janczar S, Balwierz W. Isolated central nervous system relapses in patients with high-risk neuroblastoma -clinical presentation and prognosis: experience of the Polish Paediatric Solid Tumours Study Group. BMC Cancer 2022; 22:701. [PMID: 35752779 PMCID: PMC9233790 DOI: 10.1186/s12885-022-09776-x] [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] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 06/08/2022] [Indexed: 11/26/2022] Open
Abstract
Although isolated central nervous system (CNS) relapses are rare, they may become a serious clinical problem in intensively treated patients with high-risk neuroblastoma (NBL). The aim of this study is the presentation and assessment of the incidence and clinical course of isolated CNS relapses. Retrospective analysis involved 848 NBL patients treated from 2001 to 2019 at 8 centres of the Polish Paediatric Solid Tumours Study Group (PPSTSG). Group characteristics at diagnosis, treatment and patterns of relapse were analysed. Observation was completed in December 2020. We analysed 286 high risk patients, including 16 infants. Isolated CNS relapse, defined as the presence of a tumour in brain parenchyma or leptomeningeal involvement, was found in 13 patients (4.5%; 8.4% of all relapses), all of whom were stage 4 at diagnosis. Isolated CNS relapses seem to be more common in young patients with stage 4 MYCN amplified NBL, and in this group they may occur early during first line therapy. The only or the first symptom may be bleeding into the CNS, especially in younger children, even without a clear relapse picture on imaging, or the relapse may be clinically asymptomatic and found during routine screening. Although the incidence of isolated CNS relapses is not statistically significantly higher in patients after immunotherapy, their occurrence should be carefully monitored, especially in intensively treated infants, with potential disruption of the brain-blood barrier.
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Affiliation(s)
- Aleksandra Wieczorek
- Department of Paediatric Oncology and Haematology, Faculty of Medicine, Jagiellonian University, Medical College, Krakow, Poland.
| | - Joanna Stefanowicz
- Department of Paediatrics, Haematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Hennig
- Department of Paediatrics, Haematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | | | - Marzena Stypinska
- Department of Oncology, The Children Memorial Health Institute in Warsaw, Warsaw, Poland
| | | | - Zuzanna Gamrot
- Unit of Paediatric Haematology and Oncology, City Hospital, Chorzow, Poland
| | - Mariola Woszczyk
- Unit of Paediatric Haematology and Oncology, City Hospital, Chorzow, Poland
| | - Julia Geisler
- Department of Paediatric Haematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Szczepanski
- Department of Paediatric Haematology and Oncology, Medical University of Silesia, Zabrze, Poland
| | - Szymon Skoczen
- Department of Paediatric Oncology and Haematology, Faculty of Medicine, Jagiellonian University, Medical College, Krakow, Poland
| | - Marek Ussowicz
- Department and Clinic of Paediatric Oncology, Haematology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Monika Pogorzala
- Paediatric Haematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Szymon Janczar
- Department of Paediatrics, Oncology and Haematology, Medical University of Lodz, Lodz, Poland
| | - Walentyna Balwierz
- Department of Paediatric Oncology and Haematology, Faculty of Medicine, Jagiellonian University, Medical College, Krakow, Poland
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Kashyap R, Reddy R, Prasanna V. Meningeal Relapse of Neuroblastoma-Utility of 68Ga-DOTATOC PET/CT for Detection. Clin Nucl Med 2021; 46:e339-e341. [PMID: 33512945 DOI: 10.1097/rlu.0000000000003495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In treatment of metastatic neuroblastoma, the central nervous system seems to act as a sanctuary leading to often unexpected relapse of disease. We present a case of neuroblastoma treated with chemotherapy and autologous stem cell transplantation only to relapse in central nervous system with meningeal metastases visualized on 68Ga-DOTATOC imaging.
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Affiliation(s)
| | | | - Veni Prasanna
- Pathology, Mahatma Gandhi Cancer Hospital and Research Institute, Visakhapatnam, Andhra Pradesh, India
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Luo LY, Kramer K, Cheung NKV, Kushner BH, Modak S, Basu EM, Roberts SS, Wolden SL. Reduced-dose craniospinal irradiation for central nervous system relapsed neuroblastoma. Pediatr Blood Cancer 2020; 67:e28364. [PMID: 32608559 PMCID: PMC8279229 DOI: 10.1002/pbc.28364] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/12/2020] [Accepted: 04/07/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE In patients with high-risk neuroblastoma, there is an increased recognition of relapse in the central nervous system (CNS). Craniospinal irradiation (CSI) has been an effective treatment but carries significant long-term complications. It is unclear whether reducing the CSI dose from 21 to 18 Gy can achieve similar CNS tumor control. PATIENTS AND METHODS A retrospective review of pediatric patients with CNS-relapsed neuroblastoma treated with CSI and boost to parenchymal lesions between 2003 and 2019 was performed. The goal was to assess CNS control comparing 18 Gy and 21 Gy regimens. RESULTS Ninety-four patients with CNS-relapsed neuroblastoma were treated with CSI followed by intraventricular compartmental radioimmunotherapy. Median age at the time of CNS disease was 4 years (range 1-13 years). Forty-one patients (44%) received 21 Gy CSI prior to an institutional decision to lower the dose; 53 patients (56%) received 18 Gy CSI. Seventy-nine patients (84%) received additional boosts. With a median follow up of 4.1 years for surviving patients, 2-year CNS relapse-free survival was 74% for 18 Gy group versus 77% for 21 Gy group, and 5-year CNS relapse-free survival was 66% for 18 Gy versus 72% for 21 Gy group, respectively (P = .40). Five-year overall survival rate was 43% in 18 Gy group versus 47% in 21 Gy group (P = .72). CONCLUSION For patients with CNS-relapsed neuroblastoma, CNS disease control is comparable between 18 Gy and 21 Gy CSI dose regimens, in conjunction with radioimmunotherapy and CNS penetrating chemotherapy. More than 65% of the patients remain CNS disease free after 5 years. The findings support 18 Gy as the new standard CSI dose for CNS-relapsed neuroblastoma.
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Affiliation(s)
- Leo Y. Luo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Kim Kramer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Nai-Kong V. Cheung
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Brian H. Kushner
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Shakeel Modak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Ellen M. Basu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Stephen S. Roberts
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York 10065
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York 10065,Corresponding author address: Suzanne L. Wolden, M.D., Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, Phone: 212-639-5148, Fax: 212-639-2417,
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Odone-Filho V, Cristofani LM, Maluf PT, Almeida MTA, Halley N, Vince CSC, de Azambuja AMP, Brumatti M, Lubraico P, da Camara Lopes LHA, Leite KRM, Silva JLF, Plese JPP, Weltman E. Involvement of the central nervous system in neuroblastomas: A potential direct pathway. Med Hypotheses 2019; 136:109479. [PMID: 31778890 DOI: 10.1016/j.mehy.2019.109479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/25/2019] [Accepted: 11/08/2019] [Indexed: 11/24/2022]
Abstract
Although frequently disseminated to other anatomical sites, neuroblastoma (NB) is rarely reported as involving the central nervous system (CNS), which may reflect insufficient research in poorly controlled systemic disease. Here we demonstrate the involvement of the CNS in patients with NB over 18 months of age at diagnosis of extensive systemic disease. Meningeal metastases were observed even in the presence of complete systemic control. Although no improvement in patient's survival was observed, radiotherapy was effective in preventing CNS recurrence after observation of actual or previous dural disease. In conclusion, this study uncovered the uncommon pathologic involvement of the CNS in children with advanced NB and underscores the meningeal surface as a potential pathway for this to occur.
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Affiliation(s)
- Vicente Odone-Filho
- Sao Paulo University Medical School, Pediatric Department, Hematology-Oncology Division, Brazil.
| | - Lilian Maria Cristofani
- Sao Paulo University Medical School, Pediatric Department, Hematology-Oncology Division, Brazil
| | - Paulo Taufi Maluf
- Sao Paulo University Medical School, Pediatric Department, Hematology-Oncology Division, Brazil
| | | | - Nathalia Halley
- Hematology-Oncology Division, Pediatric Department, Sao Paulo University Medical School, Brazil
| | | | | | - Melina Brumatti
- Hematology-Oncology Division, Pediatric Department, Sao Paulo University Medical School, Brazil
| | - Priscilla Lubraico
- Hematology-Oncology Division, Pediatric Department, Sao Paulo University Medical School, Brazil
| | | | | | | | | | - Eduardo Weltman
- Hospital Israelita Albert Einstein, Department of Radiotherapy, Brazil
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6
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Isolated late CNS relapse in a young adult 10 years after initial treatment for neuroblastoma. J Pediatr Hematol Oncol 2015; 37:75-7. [PMID: 24755834 DOI: 10.1097/mph.0000000000000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Nabavizadeh SA, Feygin T, Harding BN, Bilaniuk LT, Zimmerman RA, Vossough A. Imaging findings of patients with metastatic neuroblastoma to the brain. Acad Radiol 2014; 21:329-37. [PMID: 24365052 DOI: 10.1016/j.acra.2013.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/25/2013] [Accepted: 10/25/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES Metastatic involvement of brain is rare in neuroblastoma (NB). We retrospectively evaluated conventional and advanced imaging and clinical findings of seven patients with secondary intra-axial brain NB metastases. MATERIALS AND METHODS Magnetic resonance imaging and computed tomography examinations of patients with metastatic brain NB were reviewed. Recent iodine-123 metaiodobenzylguanidine ((123)I-MIBG) scans were also reviewed. A medical record review was performed for relevant clinical, laboratory, histopathologic, and genetic data. RESULTS Mean age at the time of primary tumor diagnosis was 35 months, and all were considered high-risk NB at diagnosis. Mean time interval between diagnosis and brain involvement was 23.2 months. Extensive prior extra-central nervous system (CNS) disease was present in all patients, but concomitant extra-CNS disease at the time of brain involvement was absent in three (43%) patients. Various forms of disease, including intraparenchymal, intraventricular, and leptomeningeal lesions were detected. Most intraparenchymal lesions were supratentorial and hemorrhagic; however, hemorrhage was absent in multiple leptomeningeal nodules in one patient. Contrast enhancement of lesions was present on all contrast-enhanced studies. Restricted diffusion of lesions was present in two patients. Arterial spin labeling (ASL) perfusion in two patients also revealed increased cerebral blood flow. Recent (123)I-MIBG scans were available in four patients and showed lesions in two patients with larger metastases but failed to demonstrate lesions in another two patients with smaller lesions. CONCLUSIONS Brain metastases of NB are often supratentorial and hemorrhagic and demonstrate contrast enhancement. Diffusion-weighted imaging can show restricted diffusion. ASL images may reveal increased perfusion. MIBG scans may not show smaller brain metastases.
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Goldberg AA, Beach A, Davies GF, Harkness TAA, Leblanc A, Titorenko VI. Lithocholic bile acid selectively kills neuroblastoma cells, while sparing normal neuronal cells. Oncotarget 2012; 2:761-82. [PMID: 21992775 PMCID: PMC3248158 DOI: 10.18632/oncotarget.338] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aging is one of the major risk factors of cancer. The onset of cancer can be postponed by pharmacological and dietary anti-aging interventions. We recently found in yeast cellular models of aging that lithocholic acid (LCA) extends longevity. Here we show that, at concentrations that are not cytotoxic to primary cultures of human neurons, LCA kills the neuroblastoma (NB) cell lines BE(2)-m17, SK-n-SH, SK-n-MCIXC and Lan-1. In BE(2)-m17, SK-n-SH and SK-n-MCIXC cells, the LCA anti-tumor effect is due to apoptotic cell death. In contrast, the LCA-triggered death of Lan-1 cells is not caused by apoptosis. While low concentrations of LCA sensitize BE(2)-m17 and SK-n-MCIXC cells to hydrogen peroxide-induced apoptotic cell death controlled by mitochondria, these LCA concentrations make primary cultures of human neurons resistant to such a form of cell death. LCA kills BE(2)-m17 and SK-n-MCIXC cell lines by triggering not only the intrinsic (mitochondrial) apoptotic cell death pathway driven by mitochondrial outer membrane permeabilization and initiator caspase-9 activation, but also the extrinsic (death receptor) pathway of apoptosis involving activation of the initiator caspase-8. Based on these data, we propose a mechanism underlying a potent and selective anti-tumor effect of LCA in cultured human NB cells. Moreover, our finding that LCA kills cultured human breast cancer and rat glioma cells implies that it has a broad anti-tumor effect on cancer cells derived from different tissues and organisms.
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Sidi-Fragandrea V, Hatzipantelis E, Panagopoulou P, Fragandrea I, Anastasiou A, Koliouskas DE. Isolated central nervous system recurrence in a child with stage IV neuroblastoma. Pediatr Hematol Oncol 2010; 27:387-92. [PMID: 20469973 DOI: 10.3109/08880011003749652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuroblastoma is the most common extracranial solid tumor in children. Survival rates have improved due to advances in treatment with aggressive chemotherapy and autologous bone marrow transplantation. Usual sites of recurrence include the site of primary tumor, residual gross disease, bone, bone narrow, liver, and lungs. The authors describe a 16-month-old boy with stage IV extracerebral primary neuroblastoma who died because of an isolated central nervous system (CNS) relapse. The CNS is a rare site of relapse that is, however, increasingly diagnosed due to prolonged survival. Criteria to identify patients at increased risk of CNS relapse are urgently needed. High-risk patients should be followed-up with brain and spine magnetic resonance imaging (MRI) for timely detection of metastases and appropriate management.
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Affiliation(s)
- Vasiliki Sidi-Fragandrea
- Department of Paediatric Oncology, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
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10
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Croog VJ, Kramer K, Cheung NKV, Kushner BH, Modak S, Souweidane MM, Wolden SL. Whole neuraxis irradiation to address central nervous system relapse in high-risk neuroblastoma. Int J Radiat Oncol Biol Phys 2010; 78:849-54. [PMID: 20207502 DOI: 10.1016/j.ijrobp.2009.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Revised: 08/31/2009] [Accepted: 09/02/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND As systemic control of high-risk neuroblastoma (NB) has improved, relapse in the central nervous system (CNS) is an increasingly recognized entity that carries a grim prognosis. This study describes the use of craniospinal irradiation (CSI) for CNS relapse and compares outcomes to patients who received focal radiotherapy (RT). METHODS A retrospective query identified 29 children with NB treated at Memorial Sloan-Kettering Cancer Center since 1987 who received RT for CNS relapse. At CNS relapse, 16 patients received CSI (median dose, 2160cGy), and 13 received focal RT. Of those who underwent CSI, 14 (88%) received intra-Ommaya (IO) radioimmunotherapy (RIT); one patient in the non-CSI cohort received IO-RIT. RESULTS Patient characteristics were similar between the groups. Time to CNS relapse was 20 and 17 months for the CSI and non-CSI cohorts, respectively. At a median follow-up of 28 months, 12 patients (75%) in the CSI group are alive without CNS disease, including two patients with isolated skeletal relapse. Another patient is alive without disease after a brain relapse was retreated with RT. Three patients died-one with no NB at autopsy, one of CNS disease, and one of systemic disease. The two patients who died of NB did not receive IO-RIT. All 13 patients in the non-CSI cohort died at a median of 8.8 months. CONCLUSIONS Low-dose CSI together with IO-RIT provides durable CNS remissions and improved survival compared with focal RT and conventional therapies. Further evaluation of long-term NB survivors after CSI is warranted to determine the treatment consequences for this cohort.
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Affiliation(s)
- Victoria J Croog
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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11
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Balaji R, Ramachandran K, Kusumakumari P. Neuroimaging patterns of central nervous system metastases in neuroblastoma: report of 2 recent cases and literature review. J Child Neurol 2009; 24:1290-3. [PMID: 19564645 DOI: 10.1177/0883073809333532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors describe imaging patterns of intracranial metastases in 2 children with grade 4 neuroblastoma. Central nervous system metastases from neuroblastoma are extremely rare and may involve the cerebral parenchyma, leptomeninges, or dura. Cerebral parenchymal metastases can be cystic with mural nodules or solid with hemorrhagic elements. The first patient in our study had multiple cystic parenchymal metastases with calcific mural nodules, while the second patient developed solid hemorrhagic parenchymal metastatic lesions along with extensive leptomeningeal and dural deposits. Central nervous system involvement in both patients occurred within a time span ranging from 12 to 14 months from the time of initial diagnosis.
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Affiliation(s)
- Ravikanth Balaji
- Imageology Division, Regional Cancer Centre, Medical College PO, Trivandrum, Kerala, India.
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12
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Sirachainan N, Visudtibhan A, Tuntiyatorn L, Pakakasama S, Chuansumrit A, Hongeng S. Favorable response of intraommaya topotecan for leptomeningeal metastasis of neuroblastoma after intravenous route failure. Pediatr Blood Cancer 2008; 50:169-72. [PMID: 16572404 DOI: 10.1002/pbc.20848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 3-year-old male, diagnosed with stage 4 neuroblastoma, developed recurrent leptomeningeal metastasis after multi-modality treatment including multi-agent chemotherapy, surgery, high dose chemotherapy plus stem cell rescue, cis-retinoic acid and intravenous (IV) topotecan. He then received intraommaya (IO) topotecan three times weekly (maximum dose; 0.4 mg). A complete response was achieved by a resolution of malignant cells in cerebrospinal fluid and resolution leptomeningeal enhancement by brain MRI. Treatment toxicities included low-grade fever and minimal headache. The duration of treatment response from IO topotecan was 18 weeks. The survival time from CNS recurrence in this patient was 13 months. We suggest IO topotecan be considered for neoplastic meningitis of tumors with known sensitivity to topotecan.
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Affiliation(s)
- Nongnuch Sirachainan
- Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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13
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Kramer K, Kushner BH, Allen JC, Krol G, Cheung NKV. Favorable-biology neuroblastoma presenting with leptomeningeal metastases?: a case presentation. J Pediatr Hematol Oncol 2004; 26:703-5. [PMID: 15543002 DOI: 10.1097/00043426-200411000-00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intrinsic biologic tumor features are critical prognosticators of survival in patients with neuroblastoma. Patients with localized neuroblastoma and favorable biologic parameters may be observed without treatment. Conversely, leptomeningeal metastases in patients with primary extracranial neuroblastoma are highly unusual and, despite aggressive multimodality therapies, invariably fatal. The authors describe a newly diagnosed infant with neuroblastoma and radiographic imaging suggestive of leptomeningeal metastases. The patient underwent partial surgical resection of the primary tumor. The primary tumor revealed favorable biologic characteristics. The patient was observed with no cytotoxic therapy and remained well with no evidence of disease progression more than 3 years since diagnosis. This case illustrates that some infants with favorable-biology neuroblastoma may be observed without treatment despite the advanced INSS stage.
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Affiliation(s)
- Kim Kramer
- Department of Pediatrics, Sloan-Kettering Cancer Center, New York, New York, USA.
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14
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Chi SN, Conklin LS, Qin J, Meyers PA, Huvos AG, Healey JH, Gorlick R. The patterns of relapse in osteosarcoma: the Memorial Sloan-Kettering experience. Pediatr Blood Cancer 2004; 42:46-51. [PMID: 14752794 DOI: 10.1002/pbc.10420] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND With the introduction of intensive high-dose chemotherapy for the treatment of osteosarcoma, changes in the pattern of metastases observed at relapse have been reported. To further investigate this hypothesis, the relapse patterns among groups receiving chemotherapy regimens of variable intensity at Memorial Sloan-Kettering Cancer Center were analyzed. PROCEDURE All patients treated with the protocols T4, T5, T7, T10, and T12 were included. Patients were divided into two groups, one including those patients treated with less intense therapy (T4, T5, and T7) and the other, those treated with current regimens (T10 and T12). RESULTS Of the 25 patients who relapsed on the earlier protocols, 76% relapsed to the lungs, 8% had local recurrences, and 16% distant metastases to the bone. The median time to first relapse was 12 months. Of the 69 patients who relapsed on the T10 and T12 protocols, 75% relapsed in the lungs, 9% had local recurrences, and 16% distant bone metastases. The median time to first relapse was 17 months. There was no statistically significant difference in the timing of relapse between the two groups studied, although a longer median time to relapse was observed for patients treated on the later protocols. The range of time to relapse was also wider in the later protocols. CONCLUSIONS These data do not support the hypothesis that patterns of relapse are changing with alterations in osteosarcoma treatment. This limited single institutional experience can be explored further in the context of a multi-institutional effort.
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Affiliation(s)
- Susan N Chi
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Jaing TH, Yang CP, Hung IJ, Wang HS, Tseng CK, Hsueh C. Brain metastases in children with neuroblastoma?A single-institution experience. ACTA ACUST UNITED AC 2003; 41:570-1. [PMID: 14595720 DOI: 10.1002/mpo.10425] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tang-Her Jaing
- Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan.
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Matthay KK, Brisse H, Couanet D, Couturier J, Bénard J, Mosseri V, Edeline V, Lumbroso J, Valteau-Couanet D, Michon J. Central nervous system metastases in neuroblastoma: radiologic, clinical, and biologic features in 23 patients. Cancer 2003; 98:155-65. [PMID: 12833468 DOI: 10.1002/cncr.11448] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Central nervous system (CNS) metastases rarely occur in patients with neuroblastoma, although recent reports suggest an increase in the rate. CNS recurrence may represent a different mechanism of spread than bone and bone marrow metastases and may be associated with unique genetic determinants. Further definition of the radiologic, clinical, and biologic features may provide clues to the predisposing factors and mechanisms of CNS dissemination. METHODS A retrospective analysis of all children ages 0-21 years with Stage IV neuroblastoma who were diagnosed at the Institut Curie and the Institut Gustave-Roussy between 1985 and 2000 was performed with direct review of medical records and magnetic resonance images, computed tomography scans, and iodine-123 or iodine-131 metaiodobenzylguanidine scintiscans (MIBG scans). When tumor tissue was available, genetic analysis was performed using comparative genomic hybridization (CGH). RESULTS Of 434 patients with Stage 4 disease, 23 children had the CNS as their site of first recurrence. The estimated risk of CNS recurrence was 8.0% at 3 years, with no significant change in risk over the 15-year period. Eleven patients had isolated CNS recurrences, and the remaining patients developed recurrences concomitantly in other sites. The sites of recurrences were parenchymal (n = 8 patients), parenchymal with meningeal (n = 7 patients), and meningeal alone (n = 8 patients). MIBG scans detected CNS lesions in only 43% of patients. Significant risk factors for CNS recurrence included lumbar puncture at diagnosis, ages 2-3 years, and MYCN gene amplification. Abnormalities that were identified using CGH, in addition to 2p24 amplification in 5/7, included gains of 17q and 18q and losses of 1p, 3p, 10q25-26, and 11q. CONCLUSIONS The risk of CNS recurrence in patients with neuroblastoma is 8% at 3 years after diagnosis and has not increased in the last 15 years. Because the CNS often is the sole site of recurrence, either it may be a sanctuary site, or the biologic determinants of CNS metastasis may be unique. Elucidation of risk factors and pathogenesis may allow prevention of this fatal event. Cancer 2003;98:155-65.
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Affiliation(s)
- Katherine K Matthay
- Department of Pediatrics, University of California-San Francisco, San Francisco, California 94143, USA.
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Ito F, Watanabe Y, Harada T, Horibe K. Cerebral metastases of alveolar rhabdomyosarcoma in an infant with multiple skin nodules. J Pediatr Hematol Oncol 1997; 19:466-9. [PMID: 9329472 DOI: 10.1097/00043426-199709000-00012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE This report describes extremely rare cases of infantile rhabdomyosarcoma with multiple skin nodules. They are of interest not only for their anatomic sites, but also for subsequent cerebral metastases with sudden cranial hypertension. PATIENTS Two infants had multiple skin nodules and excisional biopsy revealed alveolar type rhabdomyosarcomas. The patients were treated with tumor resection and combined chemotherapy without any clinical progression for 9 and 16 months, respectively. RESULTS Evidence of cerebral metastases developed with sudden vomiting and convulsion as the first manifestation. In one patient, urgent radiographic examinations failed to reveal lesions except for dilated cerebral ventricles. Seven weeks after the onset of the neurologic symptoms, only Gd-DPTA-enhanced magnetic resonance imaging (MRI) revealed multiple punctate metastatic lesions hyperintense to the surrounding cerebral tissue. Despite appropriate chemotherapy, both patients had disease progression and died of central nervous system metastases. CONCLUSIONS The authors emphasize the need to recognize the multiple cutaneous presentation of infantile rhabdomyosarcoma and the association of cerebral metastases as a potential and fatal complication. The diagnosis is facilitated by Gd-DPTA-enhanced MRI, particularly when cerebral computed tomography scans fail to disclose metastatic lesions.
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Affiliation(s)
- F Ito
- Department of Pediatric Surgery and Pediatrics, Nagoya University School of Medicine, Japan
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