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Goudie C, Coltin H, Witkowski L, Mourad S, Malkin D, Foulkes WD. The McGill Interactive Pediatric OncoGenetic Guidelines: An approach to identifying pediatric oncology patients most likely to benefit from a genetic evaluation. Pediatr Blood Cancer 2017; 64. [PMID: 28097779 DOI: 10.1002/pbc.26441] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/01/2016] [Accepted: 12/12/2016] [Indexed: 11/09/2022]
Abstract
Identifying cancer predisposition syndromes in children with tumors is crucial, yet few clinical guidelines exist to identify children at high risk of having germline mutations. The McGill Interactive Pediatric OncoGenetic Guidelines project aims to create a validated pediatric guideline in the form of a smartphone/tablet application using algorithms to process clinical data and help determine whether to refer a child for genetic assessment. This paper discusses the initial stages of the project, focusing on its overall structure, the methodology underpinning the algorithms, and the upcoming algorithm validation process.
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Affiliation(s)
- Catherine Goudie
- Division of Hematology/Oncology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hallie Coltin
- Division of Hematology/Oncology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.,Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Leora Witkowski
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Stephanie Mourad
- Division of Hematology/Oncology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - David Malkin
- Division of Hematology/Oncology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada.,Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Rios P, Bailey HD, Orsi L, Lacour B, Valteau-Couanet D, Levy D, Corradini N, Leverger G, Defachelles AS, Gambart M, Sirvent N, Thebaud E, Ducassou S, Clavel J. Risk of neuroblastoma, birth-related characteristics, congenital malformations and perinatal exposures: A pooled analysis of the ESCALE and ESTELLE French studies (SFCE). Int J Cancer 2016; 139:1936-48. [DOI: 10.1002/ijc.30239] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/07/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Paula Rios
- Inserm U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA); Villejuif France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS); Paris France
| | - Helen D Bailey
- Inserm U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA); Villejuif France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS); Paris France
| | - Laurent Orsi
- Inserm U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA); Villejuif France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS); Paris France
| | - Brigitte Lacour
- Inserm U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA); Villejuif France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS); Paris France
- CHU Nancy, Registre National Des Tumeurs Solides De L'Enfant; Vandœuvre-lès-Nancy France
| | | | - Dominique Levy
- Institut Curie, Département D'Oncologie Pédiatrique, Adolescents Et Jeunes Adultes; Paris France
| | - Nadège Corradini
- Centre Léon Bérard; Institut D'Hématologie Et D'Oncologie Pédiatrique; Lyon France
| | - Guy Leverger
- Hôpital Armand-Trousseau; Assistance Publique - Hôpitaux De Paris, Service D'Oncohématologie Pédiatrique; Paris France
| | | | - Marion Gambart
- Hôpital Des Enfants, Sce D'Hématologie Oncologie Pédiatrique; Toulouse France
| | - Nicolas Sirvent
- Service d'Hémato-Oncologie Pédiatrique; Hôpital Arnaud De Villeneuve Montpellier France
| | - Estelle Thebaud
- Hôpital De La Mère Et L'enfant, Service D'Oncologie Pédiatrique; Nantes France
| | - Stéphane Ducassou
- Service D'Oncohématologie Pédiatrique, Hôpital Pellegrin Tripode; Bordeaux France
| | - Jacqueline Clavel
- Inserm U1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Epidemiology of Childhood and Adolescent Cancers Team (EPICEA); Villejuif France
- Paris-Descartes University, UMRS-1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS); Paris France
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Abstract
There is no disputing that cancer susceptibility genes, when mutated, may give rise to bilateral cancers in those who inherit a mutation. But is it equally true that all bilateral cancers have a hereditary origin—that is, are they all caused by an inherited germline mutation? [...]
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Martinez-Quintana E, Rodriguez-Gonzalez F, Alberiche-Ruano MP, Martinez-Martin MS. Tetralogy of fallot associated with invasive adrenocortical tumor in an adult woman. Int J Endocrinol Metab 2012; 10:503-5. [PMID: 23843811 PMCID: PMC3693618 DOI: 10.5812/ijem.3769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/03/2012] [Accepted: 02/04/2012] [Indexed: 11/23/2022] Open
Abstract
Migration of cardiac neural crest cells into the pharyngeal arches and the pharyngeal and splanchnic mesoderm contributes to the development of the cardiac outflow tract. The adrenal cortex is derived from the splanchnic mesoderm. Neuroblastoma is more prevalent in patients with congenital heart disease than in the general population, because both originate from embryonal neural crest-derived cells. Similarly, and in light of recent embryological findings, abnormal development or migration of splanchnic mesoderm, possibly due to an underlying genetic defect, could contribute to the association of adrenocortical carcinoma and tetralogy of Fallot. We present the case of a cardiologically asymptomatic 49-year-old woman with total correction of tetralogy of Fallot in the first year of life.
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Affiliation(s)
- Efren Martinez-Quintana
- Cardiology Service. Insular-Materno Infantil University Hospital, Las Palmas de Gran Canaria, Spain
- Corresponding author: Efren Martinez-Quintana, Alcalde Ramirez Bethencourt, 10, 3-A-35003, Las Palmas de Gran Canaria, Spain. Tel.: +34-928373050, Fax: +34-928373050, E-mail:
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van Engelen K, Merks JHM, Lam J, Kremer LCM, Backes M, Baars MJH, van der Pal HJH, Postma AV, Versteeg R, Caron HN, Mulder BJM. Prevalence of congenital heart defects in neuroblastoma patients: a cohort study and systematic review of literature. Eur J Pediatr 2009; 168:1081-90. [PMID: 19089449 PMCID: PMC2714905 DOI: 10.1007/s00431-008-0891-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 11/13/2008] [Indexed: 11/26/2022]
Abstract
Data on the prevalence of congenital heart defects (CHD) in neuroblastoma patients are inconsistent. If CHD are more common in neuroblastoma patients than in the general population, cardiac screening might be warranted. In this study we used echocardiography to determine the prevalence of CHD in a single centre cohort of surviving neuroblastoma patients. In addition, we performed a systematic review of the literature. Echocardiography was performed in 119 of 133 patients (89.5%). Only two patients (1.7%) had CHD. The prevalence of CHD was not significantly different from a previously published control group of 192 leukaemia patients examined by echocardiography (P = 0.49). Literature search revealed 17 studies, showing prevalence rates of CHD in neuroblastoma patients ranging from 0 to 20%. Prevalence was less than 3.6% in the majority of studies. Most studies lacked information on validity. We conclude that current evidence does not support standard cardiac screening in all patients with neuroblastoma.
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Bluhm E, McNeil DE, Cnattingius S, Gridley G, El Ghormli L, Fraumeni JF. Prenatal and perinatal risk factors for neuroblastoma. Int J Cancer 2009; 123:2885-90. [PMID: 18798548 DOI: 10.1002/ijc.23847] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Neuroblastoma is a rare embryonal tumor of childhood for which risk factors are not well known. Using a nested case-control design, we investigated prenatal, perinatal and neonatal risk factors in detail by linking 245 pediatric neuroblastoma cases identified in the Swedish Cancer Register diagnosed in the year 1973-1995 with the Swedish Medical Birth Register. Five living controls per case were randomly selected from the birth registry, matched by gender and age. Increased risks were associated with maternal anemia during pregnancy (odds ratio (OR) = 2.95, 95% confidence interval (CI): 1.53, 5.69), neonatal respiratory distress (OR = 3.61, 95% CI: 1.41, 9.24) and low (below or equal to 7) 1-min Apgar score (OR = 2.23, 95% CI: 1.41, 3.52). Increased risks were limited to cases diagnosed before 1 year of age. Markers of prenatal, perinatal and neonatal distress may be associated with neuroblastoma in infancy, but not with diagnoses at 1 year or above.
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Affiliation(s)
- Elizabeth Bluhm
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA.
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Johnson KJ, Puumala SE, Soler JT, Spector LG. Perinatal characteristics and risk of neuroblastoma. Int J Cancer 2008; 123:1166-72. [DOI: 10.1002/ijc.23645] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Munzer C, Menegaux F, Lacour B, Valteau-Couanet D, Michon J, Coze C, Bergeron C, Auvrignon A, Bernard F, Thomas C, Vannier JP, Kanold J, Rubie H, Hémon D, Clavel J. Birth-related characteristics, congenital malformation, maternal reproductive history and neuroblastoma: the ESCALE study (SFCE). Int J Cancer 2008; 122:2315-21. [PMID: 18076072 DOI: 10.1002/ijc.23301] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Since neuroblastoma occurs very early in children's lives, it has been hypothesized that pre- and perinatal factors may play a role in its etiology. This study investigated the role of birth characteristics, congenital malformation and maternal reproductive history in neuroblastoma. The data used were generated by the national population-based case-control study, ESCALE, conducted in France in 2003-2004. The mothers of 191 neuroblastoma cases and 1,681 controls, frequency-matched by age and gender, were interviewed by telephone, using a standardized questionnaire, on several factors including pregnancy, medical history, lifestyle, childhood medical conditions and exposures. A positive association between congenital malformation and all neuroblastoma cases was observed [Odds ratio (OR) = 2.2, 95% confidence interval (95% CI): 1.1-4.5]. Congenital malformations were highly associated to neuroblastoma in children aged less than 1 year (OR = 16.8, 95% CI: 3.1-90), while no association was observed in children aged 1 year or more (OR = 1.0, 95% CI: 0.3-2.9). A negative association with a maternal history of spontaneous abortions was also found (OR = 0.6, 95% CI: 0.4-0.9). The results strongly support the hypothesis that congenital anomalies may be associated with neuroblastoma, particularly in infant (less than 1 year of age).
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Chow EJ, Friedman DL, Mueller BA. Maternal and perinatal characteristics in relation to neuroblastoma. Cancer 2007; 109:983-92. [PMID: 17285600 DOI: 10.1002/cncr.22486] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Neuroblastoma is the most common malignancy among infants, but risk factors remain poorly understood. Because most patients present in the first few years of life, it has been hypothesized that prenatal and perinatal exposures may contribute to the pathogenesis of neuroblastoma. METHODS A population-based case-control study was conducted by using linked birth and cancer registry records from 1980 to 2004 in Washington State. Maternal and infant characteristics from birth and hospital discharge records for 240 cases of neuroblastoma and 2400 controls were compared. RESULTS Neuroblastoma was associated with the presence of major congenital abnormalities (odds ratio [OR], 6.86; [95% CI], 2.92-16.08), particularly with cardiac abnormalities (OR, 5.84; 95% CI, 1.93-17.66), even after excluding abnormalities near the primary tumor. A borderline association was observed with maternal gestational diabetes (OR, 1.84; 95% CI, 0.98-3.47). The magnitude of both associations was greater when the analysis was limited to children who were diagnosed at age <1 year. CONCLUSIONS The findings from this population-based study supported prior case-control studies that identified an etiologic link between neuroblastoma and congenital abnormalities. However, to the authors' knowledge, the association between neuroblastoma and maternal diabetes has not been reported previously and requires further study.
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Affiliation(s)
- Eric J Chow
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.
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Menegaux F, Olshan AF, Reitnauer PJ, Blatt J, Cohn SL. Positive association between congenital anomalies and risk of neuroblastoma. Pediatr Blood Cancer 2005; 45:649-55. [PMID: 15547919 DOI: 10.1002/pbc.20263] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Case reports and epidemiological studies have suggested a relationship between congenital anomalies and childhood cancer, but some potential associations remain inconsistent. In this study, we investigated the association between congenital anomalies and neuroblastoma. PROCEDURE We used data of a case-control study on neuroblastoma conducted from 1992 to 1994, including 538 children aged 0-19 years with newly diagnosed, histologically confirmed neuroblastoma and 504 controls identified by telephone random-digit dialing and matched to cases on date of birth. Information on congenital anomalies and potential confounding factors was collected through maternal telephone interviews using a structured questionnaire. We estimated odds ratios (OR) and 95% confidence intervals (CI), adjusted for reference age at diagnosis, mother's educational level, mother's race, and household income at birth. RESULTS An association between the maternal report of any congenital anomalies and neuroblastoma (OR = 2.58; CI = 1.57-4.25) was observed. Neuroblastoma risk increased with increasing number of anomalies per child (OR = 3.90, CI = 1.27-11.9 for two anomalies or more), and when we restricted analyses to major anomalies (OR = 7.53, CI = 2.23-25.5). Genitourinary anomalies (OR = 5.84, CI = 1.67-20.4) and cardiac anomalies (OR = 4.27, CI = 1.22-15.0) had an elevated, but imprecise neuroblastoma risk. CONCLUSIONS Our findings support the hypothesis of an association between neuroblastoma and congenital, especially urogenital and cardiac, anomalies.
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Affiliation(s)
- Florence Menegaux
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
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11
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Agha MM, Williams JI, Marrett L, To T, Zipursky A, Dodds L. Congenital abnormalities and childhood cancer. Cancer 2005; 103:1939-48. [PMID: 15770693 DOI: 10.1002/cncr.20985] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The examination of specific characteristics of neoplasms diagnosed in children have suggested that a significant proportion can be attributed to a genetic mutation or genetic predisposition. Although the study of a genetic predisposition to cancer in children remains in the early stages, congenital abnormalities could provide essential information for mapping predisposing lesions in children with cancer. METHODS In the current study, 2 large cohorts of children with and without congenital abnormalities were followed for the occurrence of cancer and death up to 18 years. Through this study, the risk of developing cancer by age at diagnosis, effects of birth characteristics on cancer risk, and possible associations between specific anomalies and tumor types were examined. RESULTS Based on the follow-up of 90,400 children, the risk of developing cancer during the first year of life was found to be nearly 6 times higher in children with anomalies (rate ratio [RR] of 5.8; 95% confidence interval [95% CI], 3.7-9.1). Children with birth defects were found to be at a higher risk for developing leukemia (RR of 2.7; 95% CI, 2.1-3.6), tumors of the central nervous system (RR of 2.5; 95% CI, 1.8-3.4), sympathetic nervous system tumors (RR of 2.2; 95% CI, 1.4-3.4), and soft tissue sarcomas (RR of 1.9; 95% CI, 1.0-3.5). Among children with birth defects, children with Down syndrome, nervous system anomalies, and anomalies of the urinary system had the highest incidence rates of cancer. In the presence of birth defects, other factors such as birth weight, gestational age, age of the mother, and birth order were not found to be associated significantly with the risk of cancer. CONCLUSIONS The significant relative risks found in the current study provided evidence of links between the presence of abnormalities and the development of cancer. Some "cancer-prone" abnormalities were identified in the current study. Such anomalies may be markers of other exposures or processes that increase the risk of developing cancer.
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Affiliation(s)
- Mohammad M Agha
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.
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Satgé D, Moore SW, Stiller CA, Niggli FK, Pritchard-Jones K, Bown N, Bénard J, Plantaz D. Abnormal constitutional karyotypes in patients with neuroblastoma: a report of four new cases and review of 47 others in the literature. ACTA ACUST UNITED AC 2003; 147:89-98. [PMID: 14623457 DOI: 10.1016/s0165-4608(03)00203-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anomalies of constitutional karyotype, which have led to the discovery of oncogenes and tumor-suppressor genes in embryonal tumors such as retinoblastoma and Wilms tumor, have, until recently, rarely been reported until recently in neuroblastoma. We present four new cases of neuroblastoma associated with (a) a mosaicism for monosomy 22; (b) an 11q interstitial deletion; (c) a pericentric inversion of chromosome 9 at band 9p21; and (d) a Robertsonian translocation t(13;14). These anomalies and 47 others in the literature are worthy of interest, because some are recurrent, involving the same chromosome regions (1p36, 2p23, 3q, 11q23, and 15q), and some anomalies are situated on chromosome regions known to contain genes involved in neuroblastoma development (1p, 2p, 9p, 11q, 16q, and 17q). Chromosome regions 3q and 15q, observed several times, may also contain genes significant for neuroblastoma onset or development. Furthermore, the lack of neuroblastoma in patients with Down syndrome and Klinefelter or triple-X syndromes, together with a probable excess of neuroblastoma in patients with Turner syndrome, suggests that genes of importance for neuroblastoma may map to chromosomes X and 21. A search for genes implicated in neuroblastoma biology should use these data.
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Affiliation(s)
- Daniel Satgé
- Laboratory of Pathology, Centre Hospitalier, 19000 Tulle, France.
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Paulino AC, Mayr NA, Simon JH, Buatti JM. Locoregional control in infants with neuroblastoma: role of radiation therapy and late toxicity. Int J Radiat Oncol Biol Phys 2002; 52:1025-31. [PMID: 11958898 DOI: 10.1016/s0360-3016(01)02713-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To review patterns of failure in infants with neuroblastoma and determine late toxicity and efficacy of radiotherapy (RT) on locoregional control. MATERIALS AND METHODS From 1955 to 1998, 53 children (35 males and 18 females) <1 year old with neuroblastoma were seen at our institution. Twenty-one (40%) were </=1 month of age (neonates). Seven congenital anomalies were seen in 4 children (atrial septal defect, pulmonary valve stenosis, and absent corpus callosum were seen in 1 patient each; the other child had atrial and ventricular septal defect, aortic arch hypoplasia, and mitral valve stenosis). Primary tumor was located in the adrenal gland in 26 (49%), abdomen/nonadrenal in 14 (26%), thorax in 9 (17%), neck in 2 (4%), and pelvis in 2 (4%). All infants were retrospectively staged according to the International Neuroblastoma Staging System (INSS); 8 had Stage 1, 7 Stage 2A, 6 Stage 2B, 15 Stage 3, 6 Stage 4, and 11 Stage 4S. All patients, except 11 with Stage 4S and 4 with Stage 4, had resection of the primary tumor. Sixteen infants had pathologic involvement of regional lymph nodes (LN+). Twenty patients received RT. Kilovoltage beams were used in 10, megavoltage photons in 9, and electrons in 1 child. Fifteen received RT to the primary site and regional nodes (postoperative 8, preoperative 7). Postoperative doses ranged from 15 to 25 Gy whereas preoperative doses ranged from 12 to 31 Gy using a median fraction size of 1.5 Gy. Chemotherapy was employed in 22 of 53 patients (42%) with the most common agents being cyclophosphamide in 22 and doxorubicin in 11. Median follow-up was 13.1 years (range, 2-41 years). RESULTS Tumor control: The 5-year overall and freedom from progression rates were 79 +/- 9% and 81 +/- 11%; the locoregional control rate was 88 +/- 9%. INSS Stage was a prognostic factor for overall survival (p = 0.03) and freedom from progression (p = 0.035). Gender, age (</=1 month vs. >1 month), and primary site were not found to impact on survival or progression. None of the Stage 1, 2A, or 2B patients recurred. One of 15 Stage 3 and 5 of 6 Stage 4 children recurred (6 distant metastases, 4 local failure). Four of 6 (67%) LN+ patients treated with locoregional RT and 8 of 10 (80%) LN+ patients treated without RT were locally controlled. There was no isolated locoregional relapse. Two Stage 4S patients died of respiratory compromise secondary to hepatomegaly. RT toxicity: For the 20 infants who received RT, 13 are alive with long-term follow-up ranging from 9.3 to 41 years, median 23 years. The 10 and 15-year musculoskeletal toxicity rates were 38.5% and 47.3% for those receiving RT and 3.3% for no RT (p = 0.02, log-rank test). Five of 6 infants <6 months of age and 1 of 7 >/=6 months developed musculoskeletal toxicity. Musculoskeletal effects were seen in 6 RT patients and included bony hypoplasia in 6, scoliosis in 5, soft tissue hypoplasia in 3, slipped capital femoral epiphysis in 2, kyphosis in 1, and osteochondroma in 1. Three required orthopedic intervention, all receiving >/=20 Gy. One child developed bowel obstruction at 21 months and another developed a leiomyosarcoma in the treatment field 34 years after RT. CONCLUSION Our study shows that most LN+ infants achieve locoregional control without RT. Infants <6 months receiving RT were the most susceptible to musculoskeletal abnormalities. Further studies are needed to determine if cardiovascular anomalies are more frequently seen in children with neuroblastoma.
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Affiliation(s)
- Arnold C Paulino
- Department ofRadiation Oncology, The University of Iowa College of Medicine and Children's Hospital of Iowa, Iowa City, IA 52242, USA.
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Affiliation(s)
- M Trebo
- Division of Hematology/Oncology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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