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Sathyakumar S, Martinez M, Perreault S, Legault G, Bouffet E, Jabado N, Larouche V, Renzi S. Advances in pediatric gliomas: from molecular characterization to personalized treatments. Eur J Pediatr 2024; 183:2549-2562. [PMID: 38558313 DOI: 10.1007/s00431-024-05540-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
Pediatric gliomas, consisting of both pediatric low-grade (pLGG) and high-grade gliomas (pHGG), are the most frequently occurring brain tumors in children. Over the last decade, several milestone advancements in treatments have been achieved as a result of stronger understanding of the molecular biology behind these tumors. This review provides an overview of pLGG and pHGG highlighting their clinical presentation, molecular characteristics, and latest advancements in therapeutic treatments. Conclusion: The increasing understanding of the molecular biology characterizing pediatric low and high grade gliomas has revolutionized treatment options for these patients, especially in pLGG. The implementation of next generation sequencing techniques for these tumors is crucial in obtaining less toxic and more efficacious treatments. What is Known: • Pediatric Gliomas are the most common brain tumour in children. They are responsible for significant morbidity and mortality in this population. What is New: • Over the last two decades, there has been a significant increase in our global understanding of the molecular background of pediatric low and high grade gliomas. • The implementation of next generation sequencing techniques for these tumors is crucial in obtaining less toxic and more efficacious treatments, with the ultimate goal of improving both the survival and the quality of life of these patients.
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Affiliation(s)
| | - Matthew Martinez
- Department of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sébastien Perreault
- Division of Pediatric Neurology, Department of Neurosciences, CHU Sainte-Justine, Montreal, Québec, Canada
| | - Geneviève Legault
- Department of Pediatrics, Division of Neurology, Montreal Children's Hospital - McGill University Health Center, Montreal, Québec, Canada
- The Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Eric Bouffet
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nada Jabado
- Division of Experimental Medicine, Montreal Children's Hospital, McGill University and McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Valérie Larouche
- Division of Hemato-Oncology, Department of Pediatrics, CHU de Québec-Université Laval, 2705 Boulevard, Laurier, G1V 4G2, Québec, Canada
| | - Samuele Renzi
- Division of Hemato-Oncology, Department of Pediatrics, CHU de Québec-Université Laval, 2705 Boulevard, Laurier, G1V 4G2, Québec, Canada.
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Ricci AM, Emeny RT, Bagley PJ, Blunt HB, Butow ME, Morgan A, Alford-Teaster JA, Titus L, Walston RR, Rees JR. Causes of Childhood Cancer: A Review of the Recent Literature: Part I-Childhood Factors. Cancers (Basel) 2024; 16:1297. [PMID: 38610975 PMCID: PMC11011156 DOI: 10.3390/cancers16071297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/15/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE To review the childhood risk factors for pediatric cancer (diagnosis before age 20). METHODS We conducted literature searches using Ovid Medline and Scopus to find primary research studies, review articles, and meta-analyses published from 2014 to 3 March 2021. RESULTS Strong evidence indicates that an array of genetic and epigenetic phenomena, structural birth defects, and chromosomal anomalies are associated with an increased risk of various childhood cancers. Increased risk is also associated with prior cancer, likely due to previous treatment agents and therapeutic ionizing radiation. Convincing evidence supports associations between several pediatric cancers and ionizing radiation, immunosuppression, and carcinogenic virus infection both in healthy children and in association with immune suppression following organ transplantation. Breastfeeding and a childhood diet rich in fruits and vegetables appears to reduce the risk of pediatric leukemia but the evidence is less strong. Childhood vaccination against carcinogenic viruses is associated with a lower risk of several cancers; there is less strong evidence that other childhood vaccinations more broadly may also lower risk. Ultraviolet (UV) radiation is associated with increased melanoma risk, although most melanomas following childhood UV exposure occur later, in adulthood. Evidence is weak or conflicting for the role of body mass index, other childhood infections, allergies, and certain treatments, including immunomodulator medications and human growth therapy.
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Affiliation(s)
- Angela M. Ricci
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Dartmouth Health Childrens, Lebanon, NH 03756, USA
| | - Rebecca T. Emeny
- Department of Internal Medicine, Division of Molecular Medicine, UNM Comprehensive Cancer Center, Cancer Control & Population Sciences Research Program, University of New Mexico Health Sciences, Albuquerque, NM 87131, USA;
| | - Pamela J. Bagley
- Biomedical Libraries, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA; (P.J.B.); (H.B.B.)
| | - Heather B. Blunt
- Biomedical Libraries, Geisel School of Medicine at Dartmouth, Hanover, NH 03755, USA; (P.J.B.); (H.B.B.)
| | - Mary E. Butow
- New Hampshire Department of Environmental Services, Concord, NH 03302, USA
| | - Alexandra Morgan
- Department of Obstetrics and Gynecology, Dartmouth Health, Lebanon, NH 03756, USA
| | | | - Linda Titus
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Dartmouth Cancer Center, Hanover, NH 03755, USA
| | - Raymond R. Walston
- Department of Pediatric Hematology Oncology, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Judy R. Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth Cancer Center, Hanover, NH 03755, USA
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Morkovina O, Manukyan P, Sharapkova A. Picture naming test through the prism of cognitive neuroscience and linguistics: adapting the test for cerebellar tumor survivors-or pouring new wine in old sacks? Front Psychol 2024; 15:1332391. [PMID: 38566942 PMCID: PMC10985186 DOI: 10.3389/fpsyg.2024.1332391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
A picture naming test (PNT) has long been regarded as an integral part of neuropsychological assessment. In current research and clinical practice, it serves a variety of purposes. PNTs are used to assess the severity of speech impairment in aphasia, monitor possible cognitive decline in aging patients with or without age-related neurodegenerative disorders, track language development in children and map eloquent brain areas to be spared during surgery. In research settings, picture naming tests provide an insight into the process of lexical retrieval in monolingual and bilingual speakers. However, while numerous advances have occurred in linguistics and neuroscience since the classic, most widespread PNTs were developed, few of them have found their way into test design. Consequently, despite the popularity of PNTs in clinical and research practice, their relevance and objectivity remain questionable. The present study provides an overview of literature where relevant criticisms and concerns have been expressed over the recent decades. It aims to determine whether there is a significant gap between conventional test design and the current understanding of the mechanisms underlying lexical retrieval by focusing on the parameters that have been experimentally proven to influence picture naming. We discuss here the implications of these findings for improving and facilitating test design within the picture naming paradigm. Subsequently, we highlight the importance of designing specialized tests with a particular target group in mind, so that test variables could be selected for cerebellar tumor survivors.
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Affiliation(s)
- Olga Morkovina
- Laboratory of Diagnostics and Advancing Cognitive Functions, Research Institute for Brain Development and Peak Performance, RUDN University, Moscow, Russia
- Department of English, Faculty of Computational Mathematics and Cybernetics, Lomonosov Moscow State University, Moscow, Russia
| | - Piruza Manukyan
- Laboratory of Diagnostics and Advancing Cognitive Functions, Research Institute for Brain Development and Peak Performance, RUDN University, Moscow, Russia
| | - Anastasia Sharapkova
- Laboratory of Diagnostics and Advancing Cognitive Functions, Research Institute for Brain Development and Peak Performance, RUDN University, Moscow, Russia
- Department of English Linguistics, Faculty of Philology, Lomonosov Moscow State University, Moscow, Russia
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Chen S, He Y, Liu J, Wu R, Wang M, Jin A. Dynamic Survival Risk Prognostic Model and Genomic Landscape for Atypical Teratoid/Rhabdoid Tumors: A Population-Based, Real-World Study. Cancers (Basel) 2024; 16:1059. [PMID: 38473416 DOI: 10.3390/cancers16051059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/06/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND An atypical teratoid/rhabdoid tumor (AT/RT) is an uncommon and aggressive pediatric central nervous system neoplasm. However, a universal clinical consensus or reliable prognostic evaluation system for this malignancy is lacking. Our study aimed to develop a risk model based on comprehensive clinical data to assist in clinical decision-making. METHODS We conducted a retrospective study by examining data from the Surveillance, Epidemiology, and End Results (SEER) repository, spanning 2000 to 2019. The external validation cohort was sourced from the Children's Hospital Affiliated to Chongqing Medical University, China. To discern independent factors affecting overall survival (OS) and cancer-specific survival (CSS), we applied Least Absolute Shrinkage and Selection Operator (LASSO) and Random Forest (RF) regression analyses. Based on these factors, we structured nomogram survival predictions and initiated a dynamic online risk-evaluation system. To contrast survival outcomes among diverse treatments, we used propensity score matching (PSM) methodology. Molecular data with the most common mutations in AT/RT were extracted from the Catalogue of Somatic Mutations in Cancer (COSMIC) database. RESULTS The annual incidence of AT/RT showed an increasing trend (APC, 2.86%; 95% CI:0.75-5.01). Our prognostic study included 316 SEER database participants and 27 external validation patients. The entire group had a median OS of 18 months (range 11.5 to 24 months) and median CSS of 21 months (range 11.7 to 29.2). Evaluations involving C-statistics, DCA, and ROC analysis underscored the distinctive capabilities of our prediction model. An analysis via PSM highlighted that individuals undergoing triple therapy (integrating surgery, radiotherapy, and chemotherapy) had discernibly enhanced OS and CSS. The most common mutations of AT/RT identified in the COSMIC database were SMARCB1, BRAF, SMARCA4, NF2, and NRAS. CONCLUSIONS In this study, we devised a predictive model that effectively gauges the prognosis of AT/RT and briefly analyzed its genomic features, which might offer a valuable tool to address existing clinical challenges.
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Affiliation(s)
- Sihao Chen
- Department of Immunology, School of Basic Medical Sciences, Chongqing Medical University, Chongqing 400010, China
- Chongqing Key Laboratory of Tumor Immune Regulation and Immune Intervention, Chongqing 400010, China
| | - Yi He
- Department of Immunology, School of Basic Medical Sciences, Chongqing Medical University, Chongqing 400010, China
- Chongqing Key Laboratory of Tumor Immune Regulation and Immune Intervention, Chongqing 400010, China
| | - Jiao Liu
- Children's Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Ruixin Wu
- Department of Immunology, School of Basic Medical Sciences, Chongqing Medical University, Chongqing 400010, China
- Chongqing Key Laboratory of Tumor Immune Regulation and Immune Intervention, Chongqing 400010, China
| | - Menglei Wang
- Department of Pediatrics, Women and Children's Hospital of Chongqing Medical University, Chongqing 400010, China
- Department of Pediatrics, Chongqing Health Center for Women and Children, Chongqing 400010, China
| | - Aishun Jin
- Department of Immunology, School of Basic Medical Sciences, Chongqing Medical University, Chongqing 400010, China
- Chongqing Key Laboratory of Tumor Immune Regulation and Immune Intervention, Chongqing 400010, China
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El-Hemaly A, Samir M, Taha H, Refaat A, Maher E, El-Beltagy M, Zaghloul MS, El-Haddad A. Atypical teratoid rhabdoid tumor in a lower middle‑income country: Challenges to cure. Oncol Lett 2024; 27:129. [PMID: 38348388 PMCID: PMC10859823 DOI: 10.3892/ol.2024.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024] Open
Abstract
Atypical teratoid rhabdoid tumor (ATRT) is a rare type of potentially fatal childhood brain tumor. The present study aimed to examine the overall survival (OS) and event-free survival (EFS) outcomes of pediatric patients with ATRT and to analyze the impact of different prognostic factors, including age, sex, tumor site and size, metastatic disease, the extent of resection, radiotherapy, and chemotherapy, on survival. The present study included 47 patients with ATRT treated at the Children's Cancer Hospital of Egypt (Cairo, Egypt) between July 2007 and December 2017. These patients were treated according to the Dana-Farber Cancer Institute protocol 02-294 for 51 weeks. Various prognostic factors, including age, sex, tumor size and initial metastatic status, exhibited no impact on the radiological response measured at 6 weeks and at the end of treatment. The primary tumor site significantly affected the response to treatment at 6 weeks (P=0.008). Toxicity-related mortality occurred in 29.8% of patients. The median duration of the treatment protocol was 66.9 weeks. The duration of treatment was in the present cohort was longer than the actual 51 weeks of the protocol due to prolonged supportive care of the included patients. Patients who encountered toxicity received reduced dose of chemotherapy in the subsequent cycles in the protocol. Age, initial metastatic status, tumor site and resection extent did not significantly affect the patient outcomes. Preoperative tumor size significantly affected the EFS (P=0.03) and OS (P=0.04). Radiotherapy administration significantly affected the OS (P<0.001) and EFS (P<0.001). The median EFS and OS of patients were 9.3 and 10.3 months, respectively. A total of 24 (51.1%) patients exhibited disease progression or recurrence. The progression sites were local (n=6), metastatic (n=9) or both local and metastatic (n=9). The results of the present study demonstrated that the therapeutic regimen should be patient-adjusted to maintain the treatment intensity and avoid toxicity-related mortality. In lower middle-income countries, short and intensified induction followed by consolidation of treatment, either by single or tandem autologous stem cell transplant, is needed to avoid prolonged exposure to myelosuppression and toxicity-related mortality.
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Affiliation(s)
- Ahmed El-Hemaly
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, 11765 Cairo, Egypt
- Department of Pediatric Oncology, Children's Cancer Hospital of Egypt, 12556 Cairo, Egypt
| | - Marwa Samir
- Department of Pediatric Oncology, Children's Cancer Hospital of Egypt, 12556 Cairo, Egypt
| | - Hala Taha
- Department of Pathology, National Cancer Institute, Cairo University, 12556 Cairo, Egypt
- Department of Pathology, Children's Cancer Hospital of Egypt, 12556 Cairo, Egypt
| | - Amal Refaat
- Department of Radiodiagnosis, National Cancer Institute, Children's Cancer Hospital of Egypt, Cairo University, 41516 Cairo, Egypt
| | - Eslam Maher
- Department of Clinical Research, Children's Cancer Hospital of Egypt, 11765 Cairo, Egypt
| | - Mohamed El-Beltagy
- Department of Neurosurgery, Faculty of Medicine, Children's Cancer Hospital of Egypt, Cairo University, 35855 Cairo, Egypt
| | - Mohamed S. Zaghloul
- Department of Radiation Oncology, National Cancer Institute, Children's Cancer Hospital of Egypt, Cairo University, 12556 Cairo, Egypt
| | - Alaa El-Haddad
- Department of Pediatric Oncology, National Cancer Institute, Cairo University, 11765 Cairo, Egypt
- Department of Pediatric Oncology, Children's Cancer Hospital of Egypt, 12556 Cairo, Egypt
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Mirian C, Thastrup M, Mathiasen R, Schmiegelow K, Olsen JV, Østergaard O. Mass spectrometry-based proteomics of cerebrospinal fluid in pediatric central nervous system malignancies: a systematic review with meta-analysis of individual patient data. Fluids Barriers CNS 2024; 21:14. [PMID: 38350915 PMCID: PMC10863112 DOI: 10.1186/s12987-024-00515-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/26/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The cerebrospinal fluid (CSF) proteome could offer important insights into central nervous system (CNS) malignancies. To advance proteomic research in pediatric CNS cancer, the current study aims to (1) evaluate past mass spectrometry-based workflows and (2) synthesize previous CSF proteomic data, focusing on both qualitative summaries and quantitative re-analysis. MAIN: In our analysis of 11 studies investigating the CSF proteome in pediatric patients with acute lymphoblastic leukemia (ALL) or primary brain tumors, we observed significant methodological variability. This variability negatively affects comparative analysis of the included studies, as per GRADE criteria for quality of evidence. The qualitative summaries covered 161 patients and 134 non-tumor controls, while the application of validation cohort varied among the studies. The quantitative re-analysis comprised 15 B-ALL vs 6 "healthy" controls and 15 medulloblastoma patients vs 22 non-tumor controls. Certain CSF proteins were identified as potential indicators of specific malignancies or stages of neurotoxicity during chemotherapy, yet definitive conclusions were impeded by inconsistent data. There were no proteins with statistically significant differences when comparing cases versus controls that were corroborated across studies where quantitative reanalysis was feasible. From a gene ontology enrichment, we observed that age disparities between unmatched case and controls may mislead to protein correlations more indicative of age-related CNS developmental stages rather than neuro-oncological disease. Despite efforts to batch correct (HarmonizR) and impute missing values, merging of dataset proved unfeasible and thereby limited meaningful data integration across different studies. CONCLUSION Infrequent publications on rare pediatric cancer entities, which often involve small sample sizes, are inherently prone to result in heterogeneous studies-particularly when conducted within a rapidly evolving field like proteomics. As a result, obtaining clear evidence, such as CSF proteome biomarkers for CNS dissemination or early-stage neurotoxicity, is currently impractical. Our general recommendations comprise the need for standardized methodologies, collaborative efforts, and improved data sharing in pediatric CNS malignancy research. We specifically emphasize the possible importance of considering natural age-related variations in CSF due to different CNS development stages when matching cases and controls in future studies.
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Affiliation(s)
- Christian Mirian
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark.
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Maria Thastrup
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Kjeld Schmiegelow
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Velgaard Olsen
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Østergaard
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Satomi K, Ichimura K, Shibahara J. Decoding the DNA methylome of central nervous system tumors: An emerging modality for integrated diagnosis. Pathol Int 2024; 74:51-67. [PMID: 38224248 DOI: 10.1111/pin.13402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
The definitive diagnosis and classification of individual cancers are crucial for patient care and cancer research. To achieve a robust diagnosis of central nervous system (CNS) tumors, a genotype-phenotype integrated diagnostic approach was introduced in recent versions of the World Health Organization classification, followed by the incorporation of a genome-wide DNA methylome-based classification. Microarray-based platforms are widely used to obtain DNA methylome data, and the German Cancer Research Center (Deutsches Krebsforschungszentrum [DKFZ]) has a webtool for a DNA methylation-based classifier (DKFZ classifier). Integration of DNA methylome will further enhance the precision of CNS tumor classification, especially in diagnostically challenging cases. However, in the clinical application of DNA methylome-based classification, challenges related to data interpretation persist, in addition to technical caveats, regulations, and limited accessibility. Dimensionality reduction (DMR) can complement integrated diagnosis by visualizing a profile and comparing it with other known samples. Therefore, DNA methylome-based classification is a highly useful research tool for auxiliary analysis in challenging diagnostic and rare disease cases, and for establishing novel tumor concepts. Decoding the DNA methylome, especially by DMR in addition to DKFZ classifier, emphasizes the capability of grasping the fundamental biological principles that provide new perspectives on CNS tumors.
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Affiliation(s)
- Kaishi Satomi
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Koichi Ichimura
- Department of Brain Disease Translational Research, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Junji Shibahara
- Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
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Dias SF, Richards O, Elliot M, Chumas P. Pediatric-Like Brain Tumors in Adults. Adv Tech Stand Neurosurg 2024; 50:147-183. [PMID: 38592530 DOI: 10.1007/978-3-031-53578-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Pediatric brain tumors are different to those found in adults in pathological type, anatomical site, molecular signature, and probable tumor drivers. Although these tumors usually occur in childhood, they also rarely present in adult patients, either as a de novo diagnosis or as a delayed recurrence of a pediatric tumor in the setting of a patient that has transitioned into adult services.Due to the rarity of pediatric-like tumors in adults, the literature on these tumor types in adults is often limited to small case series, and treatment decisions are often based on the management plans taken from pediatric studies. However, the biology of these tumors is often different from the same tumors found in children. Likewise, adult patients are often unable to tolerate the side effects of the aggressive treatments used in children-for which there is little or no evidence of efficacy in adults. In this chapter, we review the literature and summarize the clinical, pathological, molecular profile, and response to treatment for the following pediatric tumor types-medulloblastoma, ependymoma, craniopharyngioma, pilocytic astrocytoma, subependymal giant cell astrocytoma, germ cell tumors, choroid plexus tumors, midline glioma, and pleomorphic xanthoastrocytoma-with emphasis on the differences to the adult population.
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Affiliation(s)
- Sandra Fernandes Dias
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Division of Pediatric Neurosurgery, University Children's Hospital of Zurich - Eleonor Foundation, Zurich, Switzerland
| | - Oliver Richards
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Martin Elliot
- Department of Paediatric Oncology and Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Ghalibafian M, Mirzaei S, Girinsky T, Sadeghi Y, Saffar A, Ghodsinezhad N, Elmi S, Bouffet E. Challenges in Treating Childhood Infratentorial Ependymoma: A Low- and Middle-Income Country Experience. Int J Radiat Oncol Biol Phys 2023; 117:1181-1190. [PMID: 37454918 DOI: 10.1016/j.ijrobp.2023.06.2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/30/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Patients and physicians in low- and middle-income countries (LMICs) face challenges owing to limited expertise and suboptimal access to appropriate diagnostic and treatment modalities. We report our experience in treating posterior fossa ependymoma (PFE) at MAHAK, a charity organization in Iran whose radiation oncology department is the only one exclusively dedicated to childhood cancer in the whole country. METHODS AND MATERIALS Pediatric patients with PFE referred to MAHAK between November 2008 and January 2016 were identified. Details on investigations and management done before referral were collected. Management at MAHAK and patient outcomes were analyzed. RESULTS Of 80 patients diagnosed as having ependymoma, 54 with PFE were identified. Forty-three patients received adjuvant radiation therapy, and 11 were irradiated initially after recurrence. At a median follow-up of 5.1 years (range, 0.3-9.7 years), the latter group had the worst outcome, with a 5-year overall survival (OS) rate of 27% (95% CI, 7%-54%). Patients who started radiation therapy within 77 days after initial surgery had a better outcome compared with those who started later (5-year OS: 74% vs 32%; P = .05). Compliance with follow-up recommendations was poor. Only 22% of the patients had at least 2 IQ test assessments, and 50% showed some decline over time. Three cases of growth hormone deficiency were detected, but none of the patients received replacement therapy. CONCLUSIONS Access to pediatric neurosurgery, anesthesia, and timely radiation therapy are among the most challenging obstacles to be overcome in LMICs. Our series confirmed that chemotherapy is not an appropriate option for delaying radiation therapy, especially in young children. The importance of long-term follow-up should be acknowledged by the parents and medical team.
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Affiliation(s)
- Mithra Ghalibafian
- Department of Radiation Oncology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran.
| | - Sajad Mirzaei
- Department of Radiation Physics, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | | | - Yasaman Sadeghi
- MAHAK Hematology Oncology Research Center (MAHAK-HORC), MAHAK Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Saffar
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Ghodsinezhad
- Department of Psychology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Sara Elmi
- Department of Audiology, MAHAK Pediatric Cancer Treatment and Research Center, Tehran, Iran
| | - Eric Bouffet
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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Li D, Liang Y, Yao G, Guan Z, Zhao H, Zhang N, Jiang J, Gao W. Monte Carlo-based optimization of glioma capsule design for enhanced brachytherapy. Appl Radiat Isot 2023; 201:111014. [PMID: 37688904 DOI: 10.1016/j.apradiso.2023.111014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/15/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
The use of radiotherapy in tumor treatment has become increasingly prominent and has emerged as one of the main tools for treating malignant tumors. Current radiation therapy for glioma employs 125I seeds for brachytherapy, which cannot be combined with radiotherapy and chemotherapy. To address this limitation, this paper proposes a dual-microcavity capsule structure that integrates radiotherapy and chemotherapy. The Monte Carlo simulation method is used to simulate the structure of the dual-microcavity capsule with a 125I liquid radioactive source. Based on the simulation results, two kinds of dual-microcavity capsule structures are optimized, and the optimized dual-microcavity capsule structure is obtained. Finally, the dosimetric parameters of the two optimized dual-microcavity capsule structures are analyzed and compared with those of other 125I seeds. The optimization tests show that the improved dual-capsule dual-microcavity structure is more effective than the single-capsule dual-microcavity structure. At an activity of 5 mCi, the average absorbed dose rate is 71.2 cGy/h in the center of the optimized dual-capsule dual-microcavity structure and 45.8 cGy/h in the center of the optimized single-capsule dual-microcavity structure. Although the radial dose function and anisotropy function exhibite variations from the data of other 125I seeds, they are generally similar. The absorbed dose rate decreases exponentially with increasing distance from the center of the capsule, which can reduce the damage to the surrounding tissues and organs while increasing the dose. The capsule structure has a better irradiation effect than conventional 125I seeds and can accomplish long-term, stable, low-dose continuous irradiation to form local high-dose radiation therapy for glioma.
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Affiliation(s)
- Dongjie Li
- School of Measurement and Communication Engineering, Harbin University of Science and Technology, Harbin, China; Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, China.
| | - Yu Liang
- School of Measurement and Communication Engineering, Harbin University of Science and Technology, Harbin, China; Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, China
| | - Gang Yao
- Heilongjiang Institute of Atomic Energy, Harbin, China
| | - Zhongbao Guan
- Key Laboratory of Advanced Manufacturing and Intelligent Technology, Ministry of Education, Harbin University of Science and Technology, Harbin, China
| | - Hongtao Zhao
- Heilongjiang Institute of Atomic Energy, Harbin, China
| | - Nan Zhang
- Heilongjiang Institute of Atomic Energy, Harbin, China
| | - Jicheng Jiang
- Heilongjiang Institute of Atomic Energy, Harbin, China
| | - Weida Gao
- Harbin Medical University, Harbin, China
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11
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Marshall M, Ivanovich J, Schmitt M, Helvie A, Langsford L, Casterline J, Ferguson M. Pediatric precision oncology: "better three hours too soon than a minute too late". Front Oncol 2023; 13:1279953. [PMID: 38023209 PMCID: PMC10643134 DOI: 10.3389/fonc.2023.1279953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Precision oncology is defined as the selection of an effective treatment for a cancer patient based upon genomic profiling of the patient's tumor to identify targetable alterations. The application of precision oncology toward pediatric cancer patients has moved forward more slowly than with adults but is gaining momentum. Clinical and pharmaceutical advances developed over the past decade for adult cancer indications have begun to move into pediatric oncology, expanding treatment options for young high-risk and refractory patients. As a result, the FDA has approved 23 targeted drugs for pediatric cancer indications, moving targeted drugs into the standard of care. Our precision oncology program is in a medium sized children's hospital, lacking internal sequencing capabilities and bioinformatics. We have developed methods, medical and business partnerships to provide state-of-the-art tumor characterization and targeted treatment options for our patients. We present here a streamlined and practical protocol designed to enable any oncologist to implement precision oncology options for their patients.
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Affiliation(s)
- Mark Marshall
- Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jennifer Ivanovich
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Morgan Schmitt
- Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amy Helvie
- The Medical Affairs Company, Kennesaw, GA, United States
| | - Lisa Langsford
- Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jennifer Casterline
- Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michael Ferguson
- Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
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12
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Tam OCH, Ho RSL, Chan S, Li KKW, Lam TL, Cheung ETY, Cheung OY, Ho WWS, Cheng KKF, Shing MMK, Ku DTL, Chung BHY, Yang W, Chan GCF, Ng HK, Liu APY. Genome-Wide DNA Methylation Profiling as Frontline Diagnostics for Central Nervous System Embryonal Tumors in Hong Kong. Cancers (Basel) 2023; 15:4880. [PMID: 37835574 PMCID: PMC10571663 DOI: 10.3390/cancers15194880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
This paper examines the link between CNS tumor biology and heterogeneity and the use of genome-wide DNA methylation profiling as a clinical diagnostic platform. CNS tumors are the most common solid tumors in children, and their prognosis remains poor. This study retrospectively analyzed pediatric patients with CNS embryonal tumors in Hong Kong between 1999 and 2017, using data from the territory-wide registry and available formalin-fixed paraffin-embedded tumor tissue. After processing archival tumor tissue via DNA extraction, quantification, and methylation profiling, the data were analyzed by using the web-based DKFZ classifier (Molecular Neuropathology (MNP) 2.0 v11b4) and t-SNE analysis. Methylation profiles were deemed informative in 85 samples. Epigenetic data allowed molecular subgrouping and confirmed diagnosis in 65 samples, verified histologic diagnosis in 8, and suggested an alternative diagnosis in 12. This study demonstrates the potential of DNA methylation profiling in characterizing pediatric CNS embryonal tumors in a large cohort from Hong Kong, which should enable regional and international collaboration in future pediatric neuro-oncology research.
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Affiliation(s)
- Otto C. H. Tam
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong; (O.C.H.T.)
| | - Ronnie S. L. Ho
- Department of Pathology, Gleneagles Hospital, Wong Chuk Hang, Hong Kong
| | - Shing Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong; (O.C.H.T.)
| | - Kay K. W. Li
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Tit-Leung Lam
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | | | - Oi-Yee Cheung
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Wilson W. S. Ho
- Department of Neurosurgery, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- Department of Neurosurgery, Hong Kong Children’s Hospital, Kowloon, Hong Kong
| | - Kevin K. F. Cheng
- Department of Neurosurgery, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- Department of Neurosurgery, Hong Kong Children’s Hospital, Kowloon, Hong Kong
| | - Matthew M. K. Shing
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Kowloon, Hong Kong
| | - Dennis T. L. Ku
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Kowloon, Hong Kong
| | - Brian H. Y. Chung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong; (O.C.H.T.)
| | - Wanling Yang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong; (O.C.H.T.)
| | - Godfrey C. F. Chan
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong; (O.C.H.T.)
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Kowloon, Hong Kong
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Anthony P. Y. Liu
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong; (O.C.H.T.)
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Kowloon, Hong Kong
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13
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Li Z, Wang Y, Liu Y, Jiang Y, Han X, Zhao L, Li Y. Atypical teratoid/rhabdoid tumour with CDK6 amplification in a child: a case report and literature review. Front Pediatr 2023; 11:1237572. [PMID: 37727617 PMCID: PMC10505807 DOI: 10.3389/fped.2023.1237572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023] Open
Abstract
Atypical teratoid/rhabdoid tumours (AT/RTs) are rare central nervous system neoplasms that frequently occur in infants and children and have a very poor prognosis. In recent years, molecular analysis of AT/RTs has shown that biallelic inactivation of SMARCB1 (INI1, SNF5, BAF47) or SMARCA4 (BRG1) frequently occurs. Here, we present a case of basal ganglia AT/RT with SMARCB1 gene deficiency and CDK6 gene amplification in a 5-year-old child. A 5-year-old boy was hospitalized due to a 1-week history of frontal and parietal headache. Magnetic resonance imaging (MRI) demonstrated a 3 cm × 2 cm × 1.5 cm heterogeneous enhanced mass located at the right basal ganglia that partially protruded into the right lateral ventricle. The lesion was successfully resected under electrophysiological monitoring and neuronavigation. The postoperative pathological examination implied an AT/RT diagnosis, with loss of SMARCB1 protein, SMARCB1 gene deficiency and CDK6 gene amplification. Unfortunately, the patient died due to respiratory and circulatory failure at 5 weeks after the operation. To date, standard regimens have not yet been established due to the lack of large-scale prospective studies for AT/RT. The p16-RB signalling pathway should be considered as a potential target for AT/RT treatment modalities. Apart from traditional regimens, targeted therapies, especially CDK4/6 inhibitors, are likely a promising therapeutic option for AT/RT treatment.
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Affiliation(s)
- Zhibin Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yubo Wang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yuanhao Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xuefei Han
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Liyan Zhao
- Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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14
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Obrecht D, Mynarek M, Stickan-Verfürth M, Bison B, Schüller U, Pajtler K, Hagel C, Thomale UW, Fleischhack G, Timmermann B, Rutkowski S. [Pediatric Intracranial Ependymoma - Recommendations for First-Line Treatment from the German HIT-MED study group]. KLINISCHE PADIATRIE 2023; 235:167-177. [PMID: 37172610 DOI: 10.1055/a-2070-7572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Biological subtypes of ependymoma (EPN) have been introduced by the recent WHO classification and appear to have great impact on the clinical course, but have not yet found their way into clinical risk stratification. Further, the overall unfavorable prognosis underlines the fact that current therapeutic strategies need further evaluation for improvement. To date, there is no international consensus regarding first-line treatment for children with intracranial EPN. Extent of resection is known to be the most important clinical risk factor, leading to the consensus that consequent evaluation for re-surgery of postoperative residual tumor needs to have highest priority. Furthermore, efficacy of local irradiation is unquestioned and recommended for patients aged>1 year. In contrast, efficacy of chemotherapy is still under discussion. The European trial SIOP Ependymoma II aims at evaluating efficacy of different chemotherapy elements, leading to the recommendation to include German patients. The BIOMECA study, as biological accompanying study, aims at identifying new prognostic parameters. These results might help to develop targeted therapies for unfavorable biological subtypes. For patient who are not qualified for inclusion into the interventional strata, the HIT-MED Guidance 5.2 provides specific recommendations. This article is meant as an overview of national guidelines regarding diagnostics and treatment as well as of treatment according to the SIOP Ependymoma II trial protocol.
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Affiliation(s)
- Denise Obrecht
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Mynarek
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Stickan-Verfürth
- Department of Particle Therapy, West German Proton Therapy Centre Essen (WPE), University Hospital Essen, Essen, Germany
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children's Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kristian Pajtler
- Hopp Children's Cancer Center Heidelberg (KiTZ), University Hospital Heidelberg, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), University Hospital Heidelberg, Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich-Wilhelm Thomale
- Department of Neurosurgery, Section of pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Beate Timmermann
- Department of Particle Therapy, West German Proton Therapy Centre Essen (WPE), University Hospital Essen, Essen, Germany
| | - Stefan Rutkowski
- Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Hedrich C, Gojo J, Azizi A, Peyrl A, Slavc I, Winter F, Czech T, Dorfer C. Placement of EVD in pediatric posterior fossa tumors: safe and efficient or old-fashioned? The Vienna experience. Childs Nerv Syst 2023:10.1007/s00381-023-05917-0. [PMID: 36951979 PMCID: PMC10390595 DOI: 10.1007/s00381-023-05917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/12/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE The perioperative treatment of hydrocephalus in pediatric posterior fossa tumors with an external ventricular drain (EVD) is the treatment of choice in our center. We analyzed our experience in using EVD concerning safety and effectivity. METHODS This is a single-center retrospective cohort study of 100 consecutive pediatric patients who underwent resection for a newly diagnosed tumor in the posterior fossa between 2011 and 2022. RESULTS Of the 100 patients with posterior fossa tumors, 80 patients (80%) had radiological signs of hydrocephalus at presentation, 49 patients (49%) of whom underwent placement of an EVD. In 40 patients, the EVD was inserted at a mean of 2.25 days prior to the tumor resection; 9 had the EVD inserted during tumor resection (frontal trajectory in 7 patients, occipital trajectory in 2 patients). Histology revealed pilocytic astrocytoma in 48 patients, medulloblastoma in 32, ependymoma in 11, and other histologic entities in 9 patients. Gross total/near-total resection was achieved in 46 (95.83%) of the 48 pilocytic astrocytomas, 30 (93.75%) of the 32 medulloblastomas, and 11 (100%) of the 11 ependymomas. The mean number of total days with the EVD in place was 8.61 ± 3.82 (range 2-16 days). The mean number of days with an EVD after tumor resection was 6.35 ± 3.8 (range 0-16 days). EVD-associated complications were seen in 6 patients (12.24%) including one infection. None of these resulted in a worse clinical course or any long-term sequelae. Permanent CSF diversion at 6 months after surgery was necessary in 13 patients (13%), including two VP shunt, two SD-shunt, six endoscopic third ventriculostomy (ETV), and three combined VP shunt and ETV procedures. Patients with a medulloblastoma or ependymoma had a higher rate of permanent CSF diversion needed than the group of pilocytic astrocytoma patients (27.9% versus 2.13%, p < 0.001). In patients with metastatic disease, 7 of 17 patients (41.18%) needed a permanent CSF diversion, compared to 6 of 83 patients (7.23%) in the group without metastasis (p = 0.001). CONCLUSION The treatment of hydrocephalus in pediatric posterior fossa tumors with an EVD as a temporary measure is safe and effective, provided that a multi-professional understanding for its handling is given and there is no need for a long transport of the children.
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Affiliation(s)
- Cora Hedrich
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Amedeo Azizi
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Fabian Winter
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
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16
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Chen D, Lin S, She D, Chen Q, Xing Z, Zhang Y, Cao D. Apparent Diffusion Coefficient in the Differentiation of Common Pediatric Brain Tumors in the Posterior Fossa: Different Region-of-Interest Selection Methods for Time Efficiency, Measurement Reproducibility, and Diagnostic Utility. J Comput Assist Tomogr 2023; 47:291-300. [PMID: 36723407 PMCID: PMC10045963 DOI: 10.1097/rct.0000000000001420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aimed to explore the diagnostic ability of apparent diffusion coefficient (ADC) values obtained from different region of interest (ROI) measurements in tumor parenchyma for differentiating posterior fossa tumors (PFTs) and the correlations between ADC values and Ki-67. METHODS Seventy-three pediatric patients with PFTs who underwent conventional diffusion-weighted imaging were recruited in this study. Five different ROIs were manually drawn by 2 radiologists (ROI-polygon, ROI-3 sections, ROI-3-5 ovals, ROI-more ovals, and ROI-whole). The interreader/intrareader repeatability, time required, diagnostic ability, and Ki-67 correlation analysis of the ADC values based on these ROI strategies were calculated. RESULTS Both interreader and intrareader reliabilities were excellent for ADC values among the different ROI strategies (intraclass correlation coefficient, 0.899-0.992). There were statistically significant differences in time consumption among the 5 ROI selection methods ( P < 0.001). The time required for the ROI-3-5 ovals was the shortest (32.23 ± 5.14 seconds), whereas the time required for the ROI-whole was the longest (204.52 ± 92.34 seconds). The diagnostic efficiency of the ADC values showed no significant differences among the different ROI measurements ( P > 0.05). The ADC value was negatively correlated with Ki-67 ( r = -0.745 to -0.798, all P < 0.0001). CONCLUSIONS The ROI-3-5 ovals method has the best interobserver repeatability, the shortest amount of time spent, and the best diagnostic ability. Thus, it is considered an effective measurement to produce ADC values in the evaluation of pediatric PFTs.
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Affiliation(s)
| | - Shan Lin
- From the Departments of Radiology
| | | | - Qi Chen
- From the Departments of Radiology
| | | | - Yu Zhang
- Pathology, the First Affiliated Hospital of Fujian Medical University
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17
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Cardoni A, Barresi S, Piccirilli E, Alesi V, Miele E, Giovannoni I, Genovese S, Del Baldo G, Diomedi-Camassei F, Antonelli M, Giangaspero F, Puggioni C, Carai A, Colafati GS, Mastronuzzi A, Gessi M, Alaggio R, Rossi S. A non-hemispheric transtentorial ZFTA fusion-positive ependymoma in a 6-month-old boy. Neuropathol Appl Neurobiol 2023; 49:e12886. [PMID: 36709981 DOI: 10.1111/nan.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/23/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023]
Affiliation(s)
- Antonello Cardoni
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sabina Barresi
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eleonora Piccirilli
- Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Neuroscience, Imaging and Clinical Sciences (DNISC), University "Gabriele D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Viola Alesi
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Evelina Miele
- Department of Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Silvia Genovese
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giada Del Baldo
- Department of Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Manila Antonelli
- Department of Radiology, Oncology and Anatomic Pathology, University La Sapienza, Rome, Italy
| | - Felice Giangaspero
- Department of Radiology, Oncology and Anatomic Pathology, University La Sapienza, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Chiara Puggioni
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanna Stefania Colafati
- Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Neuroscience, Imaging and Clinical Sciences (DNISC), University "Gabriele D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Angela Mastronuzzi
- Department of Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Pathology Division Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica S. Cuore, Rome, Italy
| | - Rita Alaggio
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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18
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Calandrelli R, Massimi L, Pilato F, Verdolotti T, Ruggiero A, Attinà G, Gessi M, Colosimo C. Atypical Teratoid Rhabdoid Tumor: Proposal of a Diagnostic Pathway Based on Clinical Features and Neuroimaging Findings. Diagnostics (Basel) 2023; 13:diagnostics13030475. [PMID: 36766580 PMCID: PMC9914341 DOI: 10.3390/diagnostics13030475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To assess the main imaging and clinical features in adult- and pediatric-onset atypical teratoid rhabdoid tumor (ATRT) in order to build a predefined pathway useful for the diagnosis. METHODS We enrolled 11 ATRT patients (10 children, one adult) and we conducted a literature search on PubMed Central using the key terms "adult" or "pediatric" and "atypical teratoid/rhabdoid tumor". We collected clinical and neuroradiological data reported in previous studies and combined them with those from our case series. A three step process was built to reach diagnosis by identifying the main distinctive clinical and imaging features. RESULTS Clinical evaluation: neurological symptoms were nonspecific. ATRT was more frequent in children under 3 years of age (7 out of 10 children) and infratentorial localization was reported more frequently in children under the age of 24 months. Midline/off-midline localization was influenced by the age. IMAGING FINDINGS Preferential location near the ventricles and liquor spaces and the presence of eccentric cysts were hallmark for ATRT; higher frequency of peripheral cysts was detected in children and in the supratentorial compartment (five out of eight patients with solid-cystic ATRT). Leptomeningeal dissemination at diagnosis was common (5 out of 10 children), while intratumoral hemorrhage, calcifications, and high cellularity were non-specific findings. Histopathological analysis: specific immunohistochemical markers were essential to confirm the diagnosis. CONCLUSION In younger children, a bulky, heterogeneous mass with eccentric cystic components and development near ventricles or cisternal spaces may be suggestive of ATRT. ATRT diagnosis is more challenging in adults and relies exclusively on neuropathological examination.
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Affiliation(s)
- Rosalinda Calandrelli
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
- Correspondence:
| | - Luca Massimi
- Pediatric Neurosurgery, Neurosurgery Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
| | - Fabio Pilato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
| | - Tommaso Verdolotti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
| | - Antonio Ruggiero
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy
| | - Giorgio Attinà
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cesare Colosimo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
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19
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Yang W, Cai Y, Chen J, Yang P, Ying Z, Liang Y, Ling M, Zhu K, Sun H, Ji Y, Peng X, Zhang N, Ma W, Ge M. Epidemiological characteristics, clinical presentations, and prognoses of pediatric brain tumors: Experiences of national center for children's health. Front Oncol 2023; 13:1067858. [PMID: 36776329 PMCID: PMC9915562 DOI: 10.3389/fonc.2023.1067858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
Background We aimed to describe the epidemiological characteristics, clinical presentations, and prognoses in a national health center for children. Methods From January 2015 to December 2020, 484 patients aged 0-16 years, who were diagnosed with brain tumors and received neurosurgery treatment, were enrolled in the study. Pathology was based on the World Health Organization 2021 nervous system tumor classification, and tumor behaviors were classified according to the International Classification of Diseases for Oncology, third edition. Results Among the 484 patients with brain tumors, the median age at diagnosis was 4.62 [2.19, 8.17] years (benign tumors 4.07 [1.64, 7.13] vs. malignant tumors 5.36 [2.78, 8.84], p=0.008). The overall male-to-female ratio was 1.33:1(benign 1.09:1 vs. malignant 1.62:1, p=0.029). Nausea, vomiting, and headache were the most frequent initial symptoms. The three most frequent tumor types were embryonal tumors (ET, 22.8%), circumscribed astrocytic gliomas (20.0%), and pediatric-type diffuse gliomas (11.0%). The most common tumor locations were the cerebellum and fourth ventricle (38.67%), the sellar region (22.9%) and ventricles (10.6%). Males took up a higher proportion than females in choroid plexus tumors (63.6%), ET (61.1%), ependymal tumors (68.6%), and germ cell tumors (GCTs, 78.1%). Patients were followed for 1 to 82 months. The overall 5-year survival rate was 77.5%, with survival rates of 91.0% for benign tumors and 64.6% for malignant tumors. Conclusion Brain tumors presented particularly sex-, age-, and regional-dependent epidemiological characteristics. Our results were consistent with previous reports and might reflect the real epidemiological status in China.
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Affiliation(s)
- Wei Yang
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yingjie Cai
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jiashu Chen
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ping Yang
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zesheng Ying
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuting Liang
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Miao Ling
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Kaiyi Zhu
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Hailang Sun
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuanqi Ji
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xiaojiao Peng
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Nan Zhang
- Department of Pathology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wenping Ma
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China,*Correspondence: Ming Ge,
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20
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Keck MK, Sill M, Wittmann A, Joshi P, Stichel D, Beck P, Okonechnikow K, Sievers P, Wefers AK, Roncaroli F, Avula S, McCabe MG, Hayden JT, Wesseling P, Øra I, Nistér M, Kranendonk MEG, Tops BBJ, Zapotocky M, Zamecnik J, Vasiljevic A, Fenouil T, Meyronet D, von Hoff K, Schüller U, Loiseau H, Figarella-Branger D, Kramm CM, Sturm D, Scheie D, Rauramaa T, Pesola J, Gojo J, Haberler C, Brandner S, Jacques T, Sexton Oates A, Saffery R, Koscielniak E, Baker SJ, Yip S, Snuderl M, Ud Din N, Samuel D, Schramm K, Blattner-Johnson M, Selt F, Ecker J, Milde T, von Deimling A, Korshunov A, Perry A, Pfister SM, Sahm F, Solomon DA, Jones DTW. Amplification of the PLAG-family genes-PLAGL1 and PLAGL2-is a key feature of the novel tumor type CNS embryonal tumor with PLAGL amplification. Acta Neuropathol 2023; 145:49-69. [PMID: 36437415 PMCID: PMC9807491 DOI: 10.1007/s00401-022-02516-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/28/2022]
Abstract
Pediatric central nervous system (CNS) tumors represent the most common cause of cancer-related death in children aged 0-14 years. They differ from their adult counterparts, showing extensive clinical and molecular heterogeneity as well as a challenging histopathological spectrum that often impairs accurate diagnosis. Here, we use DNA methylation-based CNS tumor classification in combination with copy number, RNA-seq, and ChIP-seq analysis to characterize a newly identified CNS tumor type. In addition, we report histology, patient characteristics, and survival data in this tumor type. We describe a biologically distinct pediatric CNS tumor type (n = 31 cases) that is characterized by focal high-level amplification and resultant overexpression of either PLAGL1 or PLAGL2, and an absence of recurrent genetic alterations characteristic of other pediatric CNS tumor types. Both genes act as transcription factors for a regulatory subset of imprinted genes (IGs), components of the Wnt/β-Catenin pathway, and the potential drug targets RET and CYP2W1, which are also specifically overexpressed in this tumor type. A derived PLAGL-specific gene expression signature indicates dysregulation of imprinting control and differentiation/development. These tumors occurred throughout the neuroaxis including the cerebral hemispheres, cerebellum, and brainstem, and were predominantly composed of primitive embryonal-like cells lacking robust expression of markers of glial or neuronal differentiation (e.g., GFAP, OLIG2, and synaptophysin). Tumors with PLAGL1 amplification were typically diagnosed during adolescence (median age 10.5 years), whereas those with PLAGL2 amplification were diagnosed during early childhood (median age 2 years). The 10-year overall survival was 66% for PLAGL1-amplified tumors, 25% for PLAGL2-amplified tumors, 18% for male patients, and 82% for female patients. In summary, we describe a new type of biologically distinct CNS tumor characterized by PLAGL1/2 amplification that occurs predominantly in infants and toddlers (PLAGL2) or adolescents (PLAGL1) which we consider best classified as a CNS embryonal tumor and which is associated with intermediate survival. The cell of origin and optimal treatment strategies remain to be defined.
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Affiliation(s)
- Michaela-Kristina Keck
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Pediatric Glioma Research (B360), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrea Wittmann
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Pediatric Glioma Research (B360), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Piyush Joshi
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Damian Stichel
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pengbo Beck
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Konstantin Okonechnikow
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Sievers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Federico Roncaroli
- Geoffrey Jefferson Brain Research Centre, Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - James T Hayden
- Department of Pediatric Hematology and Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Pieter Wesseling
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pathology, Amsterdam University Medical Centers, Location VUmc and Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
| | - Ingrid Øra
- Department of Pediatric Oncology and Hematology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Monica Nistér
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | | | - Bastiaan B J Tops
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Michal Zapotocky
- Prague Brain Tumor Research Group, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
- Department of Pediatric Haematology and Oncology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Alexandre Vasiljevic
- Institut de Pathologie Multisite-Site Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Tanguy Fenouil
- Institut de Pathologie Multisite-Site Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - David Meyronet
- Institut de Pathologie Multisite-Site Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Katja von Hoff
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrich Schüller
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Hugues Loiseau
- University of Bordeaux, Bordeaux Institute of Oncology (BRIC)-INSERM U1312 Université de Bordeaux, 146 rue Leo Saignat, Case 76, 33076, Bordeaux, France
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Dominik Sturm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Pediatric Glioma Research (B360), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - David Scheie
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | - Tuomas Rauramaa
- Department of Clinical Pathology, Kuopio University Hospital and Unit of Pathology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jouni Pesola
- Department of Pediatrics, Pediatric Hematology and Oncology Ward, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Comprehensive Cancer Center and Comprehensive Center for Pediatrics, Medical University of Vienna, 1090, Vienna, Austria
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sebastian Brandner
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Tom Jacques
- Department of Developmental Biology and Cancer, UCL GOS Institute of Child Health, University College London, London, UK
| | - Alexandra Sexton Oates
- Murdoch Children's Research Institute and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute and Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Melbourne, Australia
| | - Ewa Koscielniak
- Department of Pediatric Oncology/Hematology/Immunology, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Suzanne J Baker
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stephen Yip
- Department of Pathology and Laboratory Medicine, The University of British Colombia, Vancouver, Canada
| | - Matija Snuderl
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
| | - Nasir Ud Din
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - David Samuel
- Department of Pediatric Hematology-Oncology, Valley Children's Hospital, Madera, CA, USA
| | - Kathrin Schramm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Pediatric Glioma Research (B360), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Mirjam Blattner-Johnson
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Pediatric Glioma Research (B360), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Florian Selt
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonas Ecker
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Milde
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrey Korshunov
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Arie Perry
- Division of Neuropathology, Department of Pathology, University of California San Francisco (UCSF), 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Felix Sahm
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David A Solomon
- Division of Neuropathology, Department of Pathology, University of California San Francisco (UCSF), 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA, 94143, USA.
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
- Division of Pediatric Glioma Research (B360), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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21
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Salomão JFM, Protzenko T. Intracranial Tumors in the First Year of Life. Adv Tech Stand Neurosurg 2023; 46:23-52. [PMID: 37318568 DOI: 10.1007/978-3-031-28202-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Intracranial tumors in the first year of life are rare and, in this age group, are the second most common type of pediatric cancer after leukemias. As the more common solid tumor in neonates and infants, they present some peculiarities such as the high incidence of malignancies. Routine ultrasonography made easier to detect intrauterine tumors, but diagnosis can be delayed due to the lack or scarcity of recognizable symptoms. These neoplasms are often very large and highly vascular. Their removal is challenging, and there is a higher rate of morbidity and mortality than seen in older children, adolescents, and adults. They also differ from older children with respect to location, histological features, clinical behavior, and management. Pediatric low-grade gliomas represent 30% of the tumors in this age group and comprise circumscribed and diffuse tumors. They are followed by medulloblastoma and ependymoma. Other non-medulloblastoma embryonal neoplasms, former known as PNETS, are also commonly diagnosed in neonates and infants. Teratomas have an expressive incidence in newborns but decline gradually until the end of the first year of life. Immunohistochemical, molecular, and genomic advances are impacting the understanding and targeting of the treatment of some tumors, but, despite all these advances, the extent of resection remains the most important factor in the prognosis and survival of almost all types of tumors. The outcome is difficult to estimate, and 5-year survival ranges from one-quarter to three-quarters of the patients.
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Affiliation(s)
- José Francisco M Salomão
- Fernandes Figueira Institute - Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Tatiana Protzenko
- Fernandes Figueira Institute - Oswaldo Cruz Foundation (IFF-Fiocruz), Hospital Municipal Jesus, Rio de Janeiro, RJ, Brazil
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22
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Advances in the Treatment of Pediatric Brain Tumors. CHILDREN (BASEL, SWITZERLAND) 2022; 10:children10010062. [PMID: 36670613 PMCID: PMC9856380 DOI: 10.3390/children10010062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022]
Abstract
Pediatric brain tumors are the most common solid malignancies in children. Advances in the treatment of pediatric brain tumors have come in the form of imaging, biopsy, surgical techniques, and molecular profiling. This has led the way for targeted therapies and immunotherapy to be assessed in clinical trials for the most common types of pediatric brain tumors. Here we review the latest efforts and challenges in targeted molecular therapy, immunotherapy, and newer modalities such as laser interstitial thermal therapy.
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23
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Zebrafish Models of Paediatric Brain Tumours. Int J Mol Sci 2022; 23:ijms23179920. [PMID: 36077320 PMCID: PMC9456103 DOI: 10.3390/ijms23179920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Paediatric brain cancer is the second most common childhood cancer and is the leading cause of cancer-related deaths in children. Despite significant advancements in the treatment modalities and improvements in the 5-year survival rate, it leaves long-term therapy-associated side effects in paediatric patients. Addressing these impairments demands further understanding of the molecularity and heterogeneity of these brain tumours, which can be demonstrated using different animal models of paediatric brain cancer. Here we review the use of zebrafish as potential in vivo models for paediatric brain tumour modelling, as well as catalogue the currently available zebrafish models used to study paediatric brain cancer pathophysiology, and discuss key findings, the unique attributes that these models add, current challenges and therapeutic significance.
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24
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Gindin T, Hsiao SJ. Analytical Principles of Cancer Next Generation Sequencing. Clin Lab Med 2022; 42:395-408. [DOI: 10.1016/j.cll.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Li S, Chen LN, Zhong L. A 7-year-old boy with recurrent cyanosis and tachypnea: A case report. World J Clin Cases 2022; 10:6974-6980. [PMID: 36051109 PMCID: PMC9297426 DOI: 10.12998/wjcc.v10.i20.6974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/10/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Brain tumors are the most common solid tumors in children and comprise 25% of all malignancies in children. Common presentations include headache, nausea and vomiting, gait abnormality, papilledema, and epileptic seizure; however, some symptoms can be very insidious, with atypical and misleading manifestations.
CASE SUMMARY Here, we report a 7-year-old boy who presented with recurrent cyanosis and tachypnea after exercise for 2 years. His body mass index was 26.43 kg/m2. Hepatosplenomegaly, blood gas analysis, biochemical parameters, chest computed tomography scan, and echocardiograph suggested type II respiratory failure, pulmonary heart disease, and mild liver injury. Non-invasive breathing support, antibiotics, and anti-heart failure therapy were given. The patient’s pulse oxygen saturation increased to over 95% when he was awake but dropped to 50%-60%, accompanied by cyanosis, during sleep while receiving high-flow nasal cannula oxygen. Sleep-related breathing disorder was suspected. In the intensive care unit, however, polysomnography was unavailable. Brain magnetic resonance imaging revealed a space-occupying (cerebellum and brainstem) lesion, which was later confirmed to be pleomorphic xanthoastrocytoma by surgery and histopathology by tissue biopsy.
CONCLUSION When treating patients with cyanosis and tachypnea, a broad differential diagnosis should be considered, including brain tumor.
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Affiliation(s)
- Shu Li
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610066, Sichuan Province, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Li-Na Chen
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610066, Sichuan Province, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Lin Zhong
- Department of Pediatric Pulmonology and Immunology, West China Second University Hospital of Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital of Sichuan University, Chengdu 610066, Sichuan Province, China
- NHC Key Laboratory of Chronobiology, Sichuan University, Chengdu 610066, Sichuan Province, China
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26
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Affiliation(s)
- Alan R Cohen
- From the Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore
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27
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Paun L, Lavé A, Patet G, Bartoli A. Supratentorial Pediatric Midline Tumors and Tumor-like Lesions: Clinical Spectrum, Natural History and Treatment Options. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040534. [PMID: 35455578 PMCID: PMC9032564 DOI: 10.3390/children9040534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/29/2022] [Accepted: 04/05/2022] [Indexed: 04/10/2023]
Abstract
Childhood Central Nervous System tumors account for 25% of all pediatric tumors. Large availability and broadening of indications to imaging has made incidental findings more common. Among these, midline lesions have different clinical relevance depending on their intrinsic pattern of behaviour and on their specific location. In this narrative review we describe the natural history and treatment options of midline lesions in children.
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28
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Lutz K, Jünger ST, Messing-Jünger M. Essential Management of Pediatric Brain Tumors. CHILDREN 2022; 9:children9040498. [PMID: 35455542 PMCID: PMC9031600 DOI: 10.3390/children9040498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023]
Abstract
Brain tumors are the most common solid tumors in children and are associated with high mortality. The most common childhood brain tumors are grouped as low-grade gliomas (LGG), high grade gliomas (HGG), ependymomas, and embryonal tumors, according to the World Health Organization (WHO). Advances in molecular genetics have led to a shift from pure histopathological diagnosis to integrated diagnosis. For the first time, these new criteria were included in the WHO classification published in 2016 and has been further updated in the 2021 edition. Integrated diagnosis is based on molecular genomic similarities of the tumor subclasses, and it can better explain the differences in clinical courses of previously histopathologically identical entities. Important advances have also been made in pediatric neuro-oncology. A growing understanding of the molecular-genetic background of tumorigenesis has improved the diagnostic accuracy. Re-stratification of treatment protocols and the development of targeted therapies will significantly affect overall survival and quality of life. For some pediatric tumors, these advances have significantly improved therapeutic management and prognosis in certain tumor subgroups. Some therapeutic approaches also have serious long-term consequences. Therefore, optimized treatments are greatly needed. Here, we discuss the importance of multidisciplinary collaboration and the role of (pediatric) neurosurgery by briefly describing the most common childhood brain tumors and their currently recognized molecular subgroups.
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Affiliation(s)
- Katharina Lutz
- Neurosurgery Department, Inselspital, 3010 Bern, Switzerland
- Pediatric Neurosurgery, Asklepios Children’s Hospital, 53757 Sankt Augustin, Germany;
- Correspondence:
| | - Stephanie T. Jünger
- Center for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
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29
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Lanini I, Tringali D, Lauro Grotto R. Psychological Needs and Resources of the Staff in a Pediatric Neurosurgery Ward: A Phenomenological-Hermeneutic Study. Front Psychol 2022; 12:751651. [PMID: 35046865 PMCID: PMC8761729 DOI: 10.3389/fpsyg.2021.751651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Brain tumors are a common form of solid tumors in children and, unfortunately, they are characterized by a very uncertain prognosis. The treatment of this pathology often includes one or more very invasive surgical procedures, quite often in the very first steps of the treatment. Cases of brain tumors in children represent one of the greatest challenges for health care professionals in the domain of pediatric neurosurgery. This is clearly due to the complexity of the therapeutic plan, but also to the nature of the bond that is established between the child, the parents, and the members of the staff during the often-dramatic initial phase of the illness. In this phenomenological-hermeneutic study, we explore both the emotional and organizational needs, as well as the available professional and personal resources of the staff in the Neurosurgery ward of the Meyer Children’s Hospital in Florence (Italy). The ward staff, composed of 7 surgeons, a pediatric neuro-oncologist, 12 nurses, and 4 auxiliary health care professionals, underwent in-depth interviews that were recorded (with the consensus of the participants). The recordings were then transcribed and submitted to content analysis according to COREQ standards. A complex picture of emotional as well as organizational demands emerged from the data. Shared experiences were pointed out, together with more specific and idiosyncratic contents characteristic of different professional roles. The focus of the present paper was twofold, first, we considered the needs that are overtly expressed by the staff, and then we discussed the main sources of their motivational drives. We found that the latter is mainly found in the quality of the therapeutic bond that is established with the children and the family members, together with the deep interest in one’s own professional activity and the effective complementarity and integration of the personal and professional qualities of the staff members within the multidisciplinary caring group.
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Affiliation(s)
- Iacopo Lanini
- Department of Health Sciences, University of Florence, Florence, Italy.,Laboratory for Multidisciplinary Analysis of Relationships in Health Care, UNISER, Pistoia, Italy
| | - Debora Tringali
- Laboratory for Multidisciplinary Analysis of Relationships in Health Care, UNISER, Pistoia, Italy.,Associazione LAPO O.N.L.U.S., Florence, Italy
| | - Rosapia Lauro Grotto
- Department of Health Sciences, University of Florence, Florence, Italy.,Laboratory for Multidisciplinary Analysis of Relationships in Health Care, UNISER, Pistoia, Italy
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30
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Lim KY, Lee K, Shim Y, Park JW, Kim H, Kang J, Won JK, Kim SK, Phi JH, Park CK, Chung CK, Yun H, Park SH. Molecular subtyping of ependymoma and prognostic impact of Ki-67. Brain Tumor Pathol 2021; 39:1-13. [PMID: 34812989 PMCID: PMC8752536 DOI: 10.1007/s10014-021-00417-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/26/2021] [Indexed: 10/25/2022]
Abstract
Although ependymomas (EPNs) have similar histopathology, they are heterogeneous tumors with diverse immunophenotypes, genetics, epigenetics, and different clinical behavior according to anatomical locations. We reclassified 141 primary EPNs from a single institute with immunohistochemistry (IHC) and next-generation sequencing (NGS). Supratentorial (ST), posterior fossa (PF), and spinal (SP) EPNs comprised 12%, 41%, and 47% of our cohort, respectively. Fusion genes were found only in ST-EPNs except for one SP-EPN with ZFTA-YAP1 fusion, NF2 gene alterations were found in SP-EPNs, but no driver gene was present in PF-EPNs. Surrogate IHC markers revealed high concordance rates between L1CAM and ZFTA-fusion and H3K27me3 loss or EZHIP overexpression was used for PFA-EPNs. The 7% cut-off of Ki-67 was sufficient to classify EPNs into two-tiered grades at all anatomical locations. Multivariate analysis also delineated that a Ki-67 index was the only independent prognostic factor in both overall and progression-free survivals. The gain of chromosome 1q and CDKN2A/2B deletion were associated with poor outcomes, such as multiple recurrences or extracranial metastases. In this study, we propose a cost-effective schematic diagnostic flow of EPNs by the anatomical location, three biomarkers (L1CAM, H3K27me3, and EZHIP), and a cut-off of a 7% Ki-67 labeling index.
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Affiliation(s)
- Ka Young Lim
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kwanghoon Lee
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yumi Shim
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jin Woo Park
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyunhee Kim
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jeongwan Kang
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jae Kyung Won
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Chun-Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hongseok Yun
- Department of Precision Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Institute of Neuroscience, Seoul National University College of Medicine, 101 Daehak-ro, Jongo-gu, Seoul, 03080, Republic of Korea.
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31
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Melcher V, Kerl K. The Growing Relevance of Immunoregulation in Pediatric Brain Tumors. Cancers (Basel) 2021; 13:5601. [PMID: 34830753 PMCID: PMC8615622 DOI: 10.3390/cancers13225601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 12/19/2022] Open
Abstract
Pediatric brain tumors are genetically heterogeneous solid neoplasms. With a prevailing poor prognosis and widespread resistance to conventional multimodal therapy, these aggressive tumors are the leading cause of childhood cancer-related deaths worldwide. Advancement in molecular research revealed their unique genetic and epigenetic characteristics and paved the way for more defined prognostication and targeted therapeutic approaches. Furthermore, uncovering the intratumoral metrics on a single-cell level placed non-malignant cell populations such as innate immune cells into the context of tumor manifestation and progression. Targeting immune cells in pediatric brain tumors entails unique challenges but promising opportunities to improve outcome. Herein, we outline the current understanding of the role of the immune regulation in pediatric brain tumors.
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Affiliation(s)
- Viktoria Melcher
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Münster, 48149 Münster, Germany
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children’s Hospital Münster, 48149 Münster, Germany
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32
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Ferreras C, Fernández L, Clares-Villa L, Ibáñez-Navarro M, Martín-Cortázar C, Esteban-Rodríguez I, Saceda J, Pérez-Martínez A. Facing CAR T Cell Challenges on the Deadliest Paediatric Brain Tumours. Cells 2021; 10:2940. [PMID: 34831165 PMCID: PMC8616287 DOI: 10.3390/cells10112940] [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: 09/16/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Central nervous system (CNS) tumours comprise 25% of the paediatric cancer diagnoses and are the leading cause of cancer-related death in children. Current treatments for paediatric CNS tumours are far from optimal and fail for those that relapsed or are refractory to treatment. Besides, long-term sequelae in the developing brain make it mandatory to find new innovative approaches. Chimeric antigen receptor T cell (CAR T) therapy has increased survival in patients with B-cell malignancies, but the intrinsic biological characteristics of CNS tumours hamper their success. The location, heterogeneous antigen expression, limited infiltration of T cells into the tumour, the selective trafficking provided by the blood-brain barrier, and the immunosuppressive tumour microenvironment have emerged as the main hurdles that need to be overcome for the success of CAR T cell therapy. In this review, we will focus mainly on the characteristics of the deadliest high-grade CNS paediatric tumours (medulloblastoma, ependymoma, and high-grade gliomas) and the potential of CAR T cell therapy to increase survival and patients' quality of life.
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Affiliation(s)
- Cristina Ferreras
- Translational Research in Paediatric Oncology, Haematopoietic Transplantation and Cell Therapy, Hospital La Paz Institute for Health Research, IdiPAZ, University Hospital La Paz, 28046 Madrid, Spain; (C.F.); (L.C.-V.); (C.M.-C.)
| | - Lucía Fernández
- Haematological Malignancies H12O, Clinical Research Department, Spanish National Cancer Research Centre (CNIO), 28029 Madrid, Spain; (L.F.); (M.I.-N.)
| | - Laura Clares-Villa
- Translational Research in Paediatric Oncology, Haematopoietic Transplantation and Cell Therapy, Hospital La Paz Institute for Health Research, IdiPAZ, University Hospital La Paz, 28046 Madrid, Spain; (C.F.); (L.C.-V.); (C.M.-C.)
| | - Marta Ibáñez-Navarro
- Haematological Malignancies H12O, Clinical Research Department, Spanish National Cancer Research Centre (CNIO), 28029 Madrid, Spain; (L.F.); (M.I.-N.)
| | - Carla Martín-Cortázar
- Translational Research in Paediatric Oncology, Haematopoietic Transplantation and Cell Therapy, Hospital La Paz Institute for Health Research, IdiPAZ, University Hospital La Paz, 28046 Madrid, Spain; (C.F.); (L.C.-V.); (C.M.-C.)
| | | | - Javier Saceda
- Department of Paediatric Neurosurgery, University Hospital La Paz, 28046 Madrid, Spain;
| | - Antonio Pérez-Martínez
- Translational Research in Paediatric Oncology, Haematopoietic Transplantation and Cell Therapy, Hospital La Paz Institute for Health Research, IdiPAZ, University Hospital La Paz, 28046 Madrid, Spain; (C.F.); (L.C.-V.); (C.M.-C.)
- Paediatric Haemato-Oncology Department, University Hospital La Paz, 28046 Madrid, Spain
- Faculty of Medicine Universidad Autónoma de Madrid, 28029 Madrid, Spain
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Stanić D, Grujičić D, Pekmezović T, Bokun J, Popović-Vuković M, Janić D, Paripović L, Ilić V, Pudrlja Slović M, Ilić R, Raičević S, Sarić M, Mišković I, Nidžović B, Nikitović M. Clinical profile, treatment and outcome of pediatric brain tumors in Serbia in a 10-year period: A national referral institution experience. PLoS One 2021; 16:e0259095. [PMID: 34699548 PMCID: PMC8547703 DOI: 10.1371/journal.pone.0259095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Objective This study aimed to evaluate the characteristics of children with primary brain tumors, the effectiveness of treatment modalities, and to detect factors related to the outcome. Methods A detailed analysis was performed on a series of 173 pediatric patients treated in a Serbian referral oncology institution between 2007 and 2016, based on their clinical, histological, treatment, and follow-up data. Results Mean survival time of all children was 94.5months. 2-, 5- and 10-year overall survival probabilities were 68.8%, 59.4%, and 52.8%, respectively. Patients with supratentorial tumors had longer survival than patients with infratentorial tumors and patients with tumors in both compartments (p = 0.011). Children with the unknown histopathology (brainstem glioma) and high-grade glioma had a shorter life than embryonal tumors, ependymoma, and low-grade glioma (p<0.001). Survival of the children who underwent gross total resection was longer than the children in whom lesser degrees of resection were achieved (p = 0.015). The extent of the disease is a very important parameter found to be associated with survival. Patients with no evidence of disease after surgery had a mean survival of 123 months, compared with 82 months in patients with local residual disease and 55 months in patients with disseminated disease (p<0.001). By the univariate analysis, factors predicting poor outcome in our series were the presentation of disease with hormonal abnormalities, tumor location, and the extent of the disease, while the factors predicting a better outcome were age at the time of diagnosis, presentation of the disease with neurological deficit, and type of resection. By the multivariate analysis, the extent of the disease remained as the only strong adverse risk factor for survival (HR 2.06; 95% CI = 1.38–3.07; p<0.001). Conclusions With an organized and dedicated multidisciplinary team, the adequate outcomes can be achieved in a middle-income country setting. The presence of local residual disease after surgery and disseminated disease has a strong negative effect on survival.
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Affiliation(s)
- Dragana Stanić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Pediatric Radiation Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Danica Grujičić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Neuro-Oncology Department, Clinic of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
- Pediatric Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Tatjana Pekmezović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Bokun
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Pediatric Radiation Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Marija Popović-Vuković
- Pediatric Radiation Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Dragana Janić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Pediatric Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Lejla Paripović
- Pediatric Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Vesna Ilić
- Pediatric Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Marija Pudrlja Slović
- Pediatric Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Rosanda Ilić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Neuro-Oncology Department, Clinic of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Savo Raičević
- Neuro-Oncology Department, Clinic of Neurosurgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Sarić
- Medical Physics Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Ivana Mišković
- Medical Physics Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Borko Nidžović
- Medical Physics Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Marina Nikitović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Pediatric Radiation Oncology Department, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
- * E-mail:
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Haydar D, Ibañez-Vega J, Krenciute G. T-Cell Immunotherapy for Pediatric High-Grade Gliomas: New Insights to Overcoming Therapeutic Challenges. Front Oncol 2021; 11:718030. [PMID: 34760690 PMCID: PMC8573171 DOI: 10.3389/fonc.2021.718030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/08/2021] [Indexed: 01/06/2023] Open
Abstract
Despite decades of research, pediatric central nervous system (CNS) tumors remain the most debilitating, difficult to treat, and deadliest cancers. Current therapies, including radiation, chemotherapy, and/or surgery, are unable to cure these diseases and are associated with serious adverse effects and long-term impairments. Immunotherapy using chimeric antigen receptor (CAR) T cells has the potential to elucidate therapeutic antitumor immune responses that improve survival without the devastating adverse effects associated with other therapies. Yet, despite the outstanding performance of CAR T cells against hematologic malignancies, they have shown little success targeting brain tumors. This lack of efficacy is due to a scarcity of targetable antigens, interactions with the immune microenvironment, and physical and biological barriers limiting the homing and trafficking of CAR T cells to brain tumors. In this review, we summarize experiences with CAR T-cell therapy for pediatric CNS tumors in preclinical and clinical settings and focus on the current roadblocks and novel strategies to potentially overcome those therapeutic challenges.
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Affiliation(s)
| | | | - Giedre Krenciute
- Department of Bone Marrow Transplantation & Cellular Therapy, St. Jude Children’s Research Hospital, Memphis, TN, United States
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35
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Lim KY, Lee KH, Phi JH, Yun H, Won JK, Choi SH, Park SH. ZFTA-YAP1 fusion-positive ependymoma can occur in the spinal cord: Letter to the editor. Brain Pathol 2021; 32:e13020. [PMID: 34506076 PMCID: PMC8713521 DOI: 10.1111/bpa.13020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Ka Young Lim
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwang Hoon Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hongseok Yun
- Department of Precision Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Kyung Won
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Neuroscience, Seoul National University College of Medicine, Seoul, Republic of Korea
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36
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Qadeer ZA, Weiss WA. A SHHecret target of relapsed medulloblastoma: Astrocytes. J Exp Med 2021; 218:e20211141. [PMID: 34398189 PMCID: PMC8424466 DOI: 10.1084/jem.20211141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this issue of JEM, Guo et al. (2021. J. Exp. Med.https://doi.org/10.1084/jem.20202350) examine the importance of tumor-derived astrocytes in SHH-medulloblastoma recurrence. They show that tumor cells transdifferentiate to tumor-derived astrocytes via bone morphogenetic proteins and Sox9, which excitingly can be targeted by BMP inhibitors.
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Affiliation(s)
- Zulekha A Qadeer
- Department of Neurology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - William A Weiss
- Department of Neurology and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
- Department of Pediatrics, Neurosurgery and Brain Tumor Research Center, University of California, San Francisco, San Francisco, CA
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37
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Classification and Treatment of Pediatric Gliomas in the Molecular Era. CHILDREN-BASEL 2021; 8:children8090739. [PMID: 34572171 PMCID: PMC8464723 DOI: 10.3390/children8090739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/22/2021] [Accepted: 08/26/2021] [Indexed: 12/21/2022]
Abstract
The overall survival of pediatric gliomas varies over a wide spectrum depending on the tumor grade. Low-grade gliomas have an excellent long-term survival, with a possible burden of surgery, irradiation, and chemotherapy; in contrast, high-grade gliomas generally have a short-term, devastating lethal outcome. Recent advances in understanding their molecular background will transform the classification and therapeutic approaches of pediatric gliomas. Molecularly targeted treatments may acquire a leading role in the primary treatment of low-grade gliomas and may provide alternative therapeutic strategies for high-grade glioma cases in the attempt to avoid the highly unsuccessful conventional therapeutic approaches. This review aims to overview this progress.
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Douyère M, Chastagner P, Boura C. Neuropilin-1: A Key Protein to Consider in the Progression of Pediatric Brain Tumors. Front Oncol 2021; 11:665634. [PMID: 34277411 PMCID: PMC8281001 DOI: 10.3389/fonc.2021.665634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022] Open
Abstract
Neuropilins are transmembrane glycoproteins that play important roles in cardiovascular and neuronal development, as well as in immunological system regulations. NRP1 functions as a co-receptor, binding numerous ligands, such as SEMA 3 or VEGF and, by doing so, reinforcing their signaling pathways and can also interface with the cytoplasmic protein synectin. NRP1 is expressed in many cancers, such as brain cancers, and is associated with poor prognosis. The challenge today for patients with pediatric brain tumors is to improve their survival rate while minimizing the toxicity of current treatments. The aim of this review is to highlight the involvement of NRP1 in pediatric brain cancers, focusing essentially on the roles of NRP1 in cancer stem cells and in the regulation of the immune system. For this purpose, recent literature and tumor databases were analyzed to show correlations between NRP1 and CD15 (a stem cancer cells marker), and between NRP1 and PDL1, for various pediatric brain tumors, such as high- and low-grade gliomas, medulloblastomas, and ependymomas. Finally, this review suggests a relevant role for NRP1 in pediatric brain tumors progression and identifies it as a potential diagnostic or therapeutic target to improve survival and life quality of these young patients.
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Affiliation(s)
| | - Pascal Chastagner
- Université de Lorraine, CNRS, CRAN, Nancy, France.,Service d'Onco-Hématologie Pédiatrique, CHRU-Nancy, Nancy, France
| | - Cédric Boura
- Université de Lorraine, CNRS, CRAN, Nancy, France
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Abstract
Central nervous system (CNS) tumors are the most common solid tumor in pediatrics and represent the largest cause of childhood cancer-related mortality. With advances in molecular characterization of tumors, considerable developments have occurred impacting diagnosis and management, and refined prognostication. Advances in management have led to better survival, but mortality remains high and significant morbidity persists. Novel therapeutic approaches targeting the biology of these tumors are being investigated to improve overall survival and decrease treatment-related morbidity. Further molecular understanding of pediatric CNS tumors will lead to continued refinement of tumor classification, management, and prognostication.
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Affiliation(s)
- Fatema Malbari
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neurosciences, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin Street, Suite 1250, Houston, TX 77030, USA.
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40
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Zhou J, Wang P, Zhang R, Huang X, Dai H, Yuan L, Ruan J. Association of HMGA2 Polymorphisms with Glioma Susceptibility in Chinese Children. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:601-607. [PMID: 34079335 PMCID: PMC8164710 DOI: 10.2147/pgpm.s310780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
Background Glioma is a malignant central nervous system tumor in children, with poor outcomes and prognosis. HMGA2 is a proto-oncogene with increased expression in various malignancies. Methods We explored the association of HMGA2 polymorphisms with glioma susceptibility in Chinese children using a case-control study (191 cases, 248 controls). HMGA2 single nucleotide polymorphisms (rs6581658 A>G; rs8756 A>C; rs968697 T>C) were genotyped using PCR-based TaqMan. Results Increased glioma susceptibility was associated with rs6581658 A>G; AG (adjusted odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.13–2.58, P = 0.010) or GG (adjusted OR = 3.12, 95% CI = 1.26–7.74, P = 0.014) genotype carriers had significantly raised glioma risk compared with AA genotype carriers. The rs6581658 AG/GG (adjusted OR = 1.85, 95% CI = 1.25–2.73, P = 0.002) and AA/GG (adjusted OR = 2.58, 95% CI = 1.05–6.33, P = 0.038) genotypes were associated with an increased risk of glioma relative to the AA genotype. Subjects with 2–3 risk genotypes had a significantly elevated risk (adjusted OR = 1.93, 95% CI = 1.31–2.84, P = 0.001) relative to those with 0–1 risk genotype. Conclusion HMGA2 rs6581658 A>G is associated with glioma susceptibility in Chinese children.
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Affiliation(s)
- Jingying Zhou
- Department of Hematology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, People's Republic of China
| | - Pan Wang
- Department of Hematology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, People's Republic of China
| | - Ran Zhang
- Sydney School of Public Health, The University of Sydney, Camperdown, Sydney, NSW, 2006, Australia
| | - Xiaokai Huang
- Department of Hematology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, People's Republic of China
| | - Hanqi Dai
- Department of Hematology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, People's Republic of China
| | - Li Yuan
- Department of Pathology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, People's Republic of China
| | - Jichen Ruan
- Department of Hematology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, People's Republic of China
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Wang Y, Zhou C, Luo H, Cao J, Ma C, Cheng L, Yang Y. Prognostic implications of immune-related eight-gene signature in pediatric brain tumors. ACTA ACUST UNITED AC 2021; 54:e10612. [PMID: 34008756 PMCID: PMC8130135 DOI: 10.1590/1414-431x2020e10612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/04/2021] [Indexed: 02/14/2023]
Abstract
Genomic studies have provided insights into molecular subgroups and oncogenic drivers of pediatric brain tumors (PBT) that may lead to novel therapeutic strategies. Participants of the cohort Pediatric Brain Tumor Atlas: CBTTC (CBTTC cohort), were randomly divided into training and validation cohorts. In the training cohort, Kaplan-Meier analysis and univariate Cox regression model were applied to preliminary screening of prognostic genes. The LASSO Cox regression model was implemented to build a multi-gene signature, which was then validated in the validation and CBTTC cohorts through Kaplan-Meier, Cox, and receiver operating characteristic curve (ROC) analyses. Also, gene set enrichment analysis (GSEA) and immune infiltrating analyses were conducted to understand function annotation and the role of the signature in the tumor microenvironment. An eight-gene signature was built, which was examined by Kaplan-Meier analysis, revealing that a significant overall survival difference was seen, either in the training or validation cohorts. The eight-gene signature was further proven to be independent of other clinic-pathologic parameters via the Cox regression analyses. Moreover, ROC analysis demonstrated that this signature owned a better predictive power of PBT prognosis. Furthermore, GSEA and immune infiltrating analyses showed that the signature had close interactions with immune-related pathways and was closely related to CD8 T cells and monocytes in the tumor environment. Identifying the eight-gene signature (CBX7, JADE2, IGF2BP3, OR2W6P, PRAME, TICRR, KIF4A, and PIMREG) could accurately identify patients' prognosis and the signature had close interactions with the immunodominant tumor environment, which may provide insight into personalized prognosis prediction and new therapies for PBT patients.
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Affiliation(s)
- Yi Wang
- Department of Neonatology and Neonatal Intensive Care, Zhumadian Central Hospital, Zhumadian, China
| | - Chuan Zhou
- Neonatal Intensive Care Unit, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huan Luo
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Jing Cao
- Department of Anatomy, College of Basic Medicine, Zhengzhou University, Zhengzhou, China
| | - Chao Ma
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and the Berlin Institute of Health, Berlin, Germany
| | - Lulu Cheng
- Digital Medical Laboratory, Zhumadian Central Hospital, Zhumadian, China
| | - Yang Yang
- Digital Medical Laboratory, Zhumadian Central Hospital, Zhumadian, China
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Zhang L, Zhang B, Dou Z, Wu J, Iranmanesh Y, Jiang B, Sun C, Zhang J. Immune Checkpoint-Associated Locations of Diffuse Gliomas Comparing Pediatric With Adult Patients Based on Voxel-Wise Analysis. Front Immunol 2021; 12:582594. [PMID: 33815356 PMCID: PMC8010651 DOI: 10.3389/fimmu.2021.582594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/23/2021] [Indexed: 01/22/2023] Open
Abstract
Objective: Pediatric diffuse gliomas (pDGs) are relatively rare and molecularly distinct from pediatric pilocytic astrocytoma and adult DGs. Immunotherapy is a promising therapeutic strategy, requiring a deep understanding of tumor immune profiles. The spatial locations of brain tumors might be related to the molecular profiles. We aimed to analyze the relationship between the immune checkpoint molecules with the locations of DGs comparing pediatric with adult patients. Method: We studied 20 pDGs patients (age ≤ 21 years old), and 20 paired adult patients according to gender and histological types selected from 641 adult patients with DGs. Immune checkpoint molecules including B7-H3, CD47, and PD-L1, as well as tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs), were manifested by immunohistochemical staining. Expression difference analyses and Spearman's correlation were performed. MRI data were voxel-wise normalized, segmented, and analyzed by Fisher's exact test to construct the tumor frequency and p value heatmaps. Survival analyses were conducted by Log-rank tests. Result: The median age of pediatric patients was 16 years. 55% and 30% of patients were WHO II and III grades, respectively. The left frontal lobe and right cerebellum were the statistically significant locations for pDGs, while the anterior horn of ventricles for adult DGs. A potential association between the expression of PD-L1 and TAMs was found in pDGs (p = 0.002, R = 0.670). The right posterior external capsule and the lateral side of the anterior horn of the left ventricle were predominant locations for the adult patients with high expression of B7-H3 and low expression of PD-L1 compared to pediatric ones, respectively. Pediatric patients showed significantly improved overall survival compared with adults. The prognostic roles of immune checkpoint molecules and TILs/TAMs were not significantly different between the two groups. Conclusion: Immune checkpoint-associated locations of diffuse gliomas comparing pediatric with adult patients could be helpful for the immunotherapy decisions and design of clinical trials.
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Affiliation(s)
- Li Zhang
- Department of Oncology, Daqing Oilfield General Hospital, Daqing, China
| | - Buyi Zhang
- Department of Pathology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhangqi Dou
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jiawei Wu
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yasaman Iranmanesh
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Biao Jiang
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Chongran Sun
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jianmin Zhang
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Alvarez-Arellano L, Salazar-García M, Corona JC. Neuroprotective Effects of Quercetin in Pediatric Neurological Diseases. Molecules 2020; 25:E5597. [PMID: 33260783 PMCID: PMC7731313 DOI: 10.3390/molecules25235597] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 02/07/2023] Open
Abstract
Oxidative stress is a crucial event underlying several pediatric neurological diseases, such as the central nervous system (CNS) tumors, autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Neuroprotective therapy with natural compounds used as antioxidants has the potential to delay, ameliorate or prevent several pediatric neurological diseases. The present review provides an overview of the most recent research outcomes following quercetin treatment for CNS tumors, ASD and ADHD as well as describes the potential in vitro and in vivo ameliorative effect on oxidative stress of bioactive natural compounds, which seems like a promising future therapy for these diseases. The neuroprotective effects of quercetin against oxidative stress can also be applied in the management of several neurodegenerative disorders with effects such as anti-cancer, anti-inflammatory, anti-viral, anti-obesity and anti-microbial. Therefore, quercetin appears to be a suitable adjuvant for therapy against pediatric neurological diseases.
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Affiliation(s)
| | - Marcela Salazar-García
- Laboratorio de Investigación en Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico;
| | - Juan Carlos Corona
- Laboratory of Neurosciences, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico
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Y-Box Binding Protein-1: A Neglected Target in Pediatric Brain Tumors? Mol Cancer Res 2020; 19:375-387. [DOI: 10.1158/1541-7786.mcr-20-0655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/21/2020] [Accepted: 11/20/2020] [Indexed: 11/16/2022]
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Ebert LM, Yu W, Gargett T, Toubia J, Kollis PM, Tea MN, Ebert BW, Bardy C, van den Hurk M, Bonder CS, Manavis J, Ensbey KS, Oksdath Mansilla M, Scheer KG, Perrin SL, Ormsby RJ, Poonnoose S, Koszyca B, Pitson SM, Day BW, Gomez GA, Brown MP. Endothelial, pericyte and tumor cell expression in glioblastoma identifies fibroblast activation protein (FAP) as an excellent target for immunotherapy. Clin Transl Immunology 2020; 9:e1191. [PMID: 33082953 PMCID: PMC7557106 DOI: 10.1002/cti2.1191] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/07/2020] [Accepted: 09/14/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives Targeted immunotherapies such as chimeric antigen receptor (CAR)-T cells are emerging as attractive treatment options for glioblastoma, but rely on identification of a suitable tumor antigen. We validated a new target antigen for glioblastoma, fibroblast activation protein (FAP), by undertaking a detailed expression study of human samples. Methods Glioblastoma and normal tissues were assessed using immunostaining, supported by analyses of published transcriptomic datasets. Short-term cultures of glioma neural stem (GNS) cells were compared to cultures of healthy astrocytes and neurons using flow cytometry. Glioblastoma tissues were dissociated and analysed by high-parameter flow cytometry and single-cell transcriptomics (scRNAseq). Results Compared to normal brain, FAP was overexpressed at the gene and protein level in a large percentage of glioblastoma tissues, with highest levels of expression associated with poorer prognosis. FAP was also overexpressed in several paediatric brain cancers. FAP was commonly expressed by cultured GNS cells but absent from normal neurons and astrocytes. Within glioblastoma tissues, the strongest expression of FAP was around blood vessels. In fact, almost every tumor vessel was highlighted by FAP expression, whereas normal tissue vessels and cultured endothelial cells (ECs) lacked expression. Single-cell analyses of dissociated tumors facilitated a detailed characterisation of the main cellular components of the glioblastoma microenvironment and revealed that vessel-localised FAP is because of expression on both ECs and pericytes. Conclusion Fibroblast activation protein is expressed by multiple cell types within glioblastoma, highlighting it as an ideal immunotherapy antigen to target destruction of both tumor cells and their supporting vascular network.
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Affiliation(s)
- Lisa M Ebert
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia.,Adelaide Medical School University of Adelaide Adelaide Australia
| | - Wenbo Yu
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia
| | - Tessa Gargett
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia.,Adelaide Medical School University of Adelaide Adelaide Australia
| | - John Toubia
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia
| | - Paris M Kollis
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia.,Adelaide Medical School University of Adelaide Adelaide Australia
| | - Melinda N Tea
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia
| | - Brenton W Ebert
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia
| | - Cedric Bardy
- South Australian Health and Medical Research Institute (SAHMRI) Adelaide Australia.,College of Medicine & Public Health Flinders University Adelaide Australia
| | - Mark van den Hurk
- South Australian Health and Medical Research Institute (SAHMRI) Adelaide Australia.,College of Medicine & Public Health Flinders University Adelaide Australia
| | - Claudine S Bonder
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia.,Adelaide Medical School University of Adelaide Adelaide Australia
| | - Jim Manavis
- Adelaide Medical School University of Adelaide Adelaide Australia
| | - Kathleen S Ensbey
- Department of Cell and Molecular Biology Sid Faithfull Brain Cancer Laboratory QIMR Berghofer Medical Research Institute Brisbane QLD Australia
| | | | - Kaitlin G Scheer
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia.,Clinical and Health Sciences University of South Australia Adelaide Australia
| | - Sally L Perrin
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia.,Clinical and Health Sciences University of South Australia Adelaide Australia
| | - Rebecca J Ormsby
- College of Medicine & Public Health Flinders University Adelaide Australia
| | - Santosh Poonnoose
- College of Medicine & Public Health Flinders University Adelaide Australia.,Department of Neurosurgery Flinders Medical Centre Bedford Park Australia
| | - Barbara Koszyca
- Department of Anatomical Pathology SA Pathology Adelaide Australia
| | - Stuart M Pitson
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia.,Adelaide Medical School University of Adelaide Adelaide Australia
| | - Bryan W Day
- Department of Cell and Molecular Biology Sid Faithfull Brain Cancer Laboratory QIMR Berghofer Medical Research Institute Brisbane QLD Australia.,Faculty of Health Queensland University of Technology Brisbane QLD Australia.,Faculty of Medicine The University of Queensland Brisbane QLD Australia
| | - Guillermo A Gomez
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia
| | - Michael P Brown
- Centre for Cancer Biology SA Pathology and University of South Australia Adelaide Australia.,Adelaide Medical School University of Adelaide Adelaide Australia.,Cancer Clinical Trials Unit Royal Adelaide Hospital Adelaide Australia
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