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Ronsley R, Triscott J, Stanek J, Rassekh SR, Lum A, Cheng S, Goddard K, McConnell D, Strahlendorf C, Singhal A, Finlay JL, Yip S, Dunham C, Hukin J. Outcomes of a radiation sparing approach in medulloblastoma by subgroup in young children: an institutional review. Childs Nerv Syst 2023:10.1007/s00381-023-05918-z. [PMID: 37022464 PMCID: PMC10390609 DOI: 10.1007/s00381-023-05918-z] [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: 10/04/2022] [Accepted: 03/12/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE To describe disease outcomes including overall survival and relapse patterns by subgroup in young pediatric patients treated for medulloblastoma with a radiation-sparing approach. METHODS Retrospective analysis of clinical outcomes includes treatment, relapse, and salvage therapy and late effects in children treated for medulloblastoma with a radiation-sparing approach at British Columbia Children's Hospital (BCCH) between 2000 and 2020. RESULTS There were 30 patients (median age 2.8 years, 60% male) treated for medulloblastoma with a radiation-sparing approach at BCCH. Subgroups included Sonic Hedgehog (SHH) (n = 14), group 3 (n = 7), group 4 (n = 6), and indeterminate status (n = 3). Three- and 5-year event-free survival (EFS) were 49.0% (30.2-65.4%) and 42.0% (24.2-58.9%) and overall survival (OS) 66.0% (95% CI 46.0-80.1%) and 62.5% (95% CI 42.5 and 77.2%), respectively, with a median follow-up of 9.5 years. Relapse occurred in 12/25 patients following a complete response, of whom six (group 4: n = 4; group 3: n = 1; unknown: n = 1) were successfully salvaged with craniospinal axis (CSA) RT and remain alive at a median follow-up of 7 years. Disease/treatment-related morbidity included endocrinopathies (n = 8), hearing loss n = 16), and neurocognitive abnormalities (n = 9). CONCLUSIONS This radiation sparing treatment approach for young patients with medulloblastoma resulted in a durable cure in most patients with SHH subgroup medulloblastoma. In those patients with groups 3 and 4 medulloblastoma, relapse rates were high; however, most group 4 patients were salvaged with RT.
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Affiliation(s)
- Rebecca Ronsley
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada
| | - Joanna Triscott
- Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - Joseph Stanek
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, Seattle Children's Hospital and the University of Washington, Seattle, WA, USA
| | - S Rod Rassekh
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada
| | - Amy Lum
- Department of Pathology, Vancouver General Hospital, Vancouver, Canada
| | - Sylvia Cheng
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada
| | - Karen Goddard
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Dina McConnell
- Department of Psychology, British Columbia Children's Hospital, Vancouver, Canada
| | - Caron Strahlendorf
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada
| | - Ash Singhal
- Division of Pediatric Neurosurgery, Department of Surgery, British Columbia Children's Hospital, Vancouver, Canada
| | - Jonathan L Finlay
- Departments of Pediatrics and Radiation Oncology, the Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephen Yip
- Department of Pathology, Vancouver General Hospital, Vancouver, Canada
| | - Christopher Dunham
- Department of Pathology, British Columbia Children's Hospital, Vancouver, Canada
| | - Juliette Hukin
- Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, 4480 Oak Street B318, Vancouver, BC V6H 3V4, Canada.
- Division of Neurology and Division of Hematology Oncology Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada.
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2
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Carter-Febres M, Sloan EA, Pekmezci M, Putnam AR, Linscott L, Cheshier S, Aldape K, Bruggers CS. Aggressive chemotherapy aimed at obviating radiation in two very young infants with disseminated anaplastic ependymoma. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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3
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Liu APY, Wu G, Orr BA, Lin T, Ashford JM, Bass JK, Bowers DC, Hassall T, Fisher PG, Indelicato DJ, Klimo P, Boop F, Conklin H, Onar-Thomas A, Merchant TE, Ellison DW, Gajjar A, Robinson GW. Outcome and molecular analysis of young children with choroid plexus carcinoma treated with non-myeloablative therapy: results from the SJYC07 trial. Neurooncol Adv 2020; 3:vdaa168. [PMID: 33506206 PMCID: PMC7813199 DOI: 10.1093/noajnl/vdaa168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Choroid plexus carcinoma (CPC) is a rare and aggressive tumor of infancy without a clear treatment strategy. This study describes the outcomes of children with CPC treated on the multi-institutional phase 2 SJYC07 trial and reports on the significance of clinical and molecular characteristics. Methods Eligible children <3 years-old with CPC were postoperatively stratified to intermediate-risk (IR) stratum if disease was localized or high-risk (HR) stratum, if metastatic. All received high-dose methotrexate-containing induction chemotherapy. IR-stratum patients received focal irradiation as consolidation whereas HR-stratum patients received additional chemotherapy. Consolidation was followed by oral antiangiogenic maintenance regimen. Survival rates and potential prognostic factors were analyzed. Results Thirteen patients (median age: 1.41 years, range: 0.21-2.93) were enrolled; 5 IR, 8 HR. Gross-total resection or near-total resection was achieved in ten patients and subtotal resection in 3. Seven patients had TP53-mutant tumors, including 4 who were germline carriers. Five patients experienced progression and died of disease; 8 (including 5 HR) are alive without progression. The 5-year progression-free survival (PFS) and overall survival rates were 61.5 ± 13.5% and 68.4 ± 13.1%. Patients with TP53-wild-type tumors had a 5-year PFS of 100% as compared to 28.6 ± 17.1% for TP53-mutant tumors (P = .012). Extent of resection, metastatic status, and use of radiation therapy were not significantly associated with survival. Conclusions Non-myeloablative high-dose methotrexate-containing therapy with maximal surgical resection resulted in long-term PFS in more than half of patients with CPC. TP53-mutational status was the only significant prognostic variable and should form the basis of risk-stratification in future trials.
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Affiliation(s)
- Anthony P Y Liu
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gang Wu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Brent A Orr
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Tong Lin
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jason M Ashford
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Johnnie K Bass
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Daniel C Bowers
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tim Hassall
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Paul G Fisher
- Department of Neurology, Stanford University, Palo Alto, California, USA
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine-Jacksonville, Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Paul Klimo
- Department of Surgery, St. Jude Children's Research Hospital, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Frederick Boop
- Department of Surgery, St. Jude Children's Research Hospital, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Heather Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David W Ellison
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Giles W Robinson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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4
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Stadskleiv K, Stensvold E, Stokka K, Bechensteen AG, Brandal P. Neuropsychological functioning in survivors of childhood medulloblastoma/CNS-PNET: The role of secondary medical complications. Clin Neuropsychol 2020; 36:600-625. [PMID: 32729777 DOI: 10.1080/13854046.2020.1794045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the long-term cognitive consequences of malignant pediatric brain tumor and its treatment, and factors explaining variability in cognitive functioning among survivors. Method: A geographical cohort of survivors of pediatric medulloblastoma (MB) and supratentorial primitive neuroectodermal tumor (CNS-PNET), treated between 1974 and 2013, was invited to participate. Of the 63 surviving patients, 50 (79%) consented to participation. The participants were tested with a battery of neuropsychological tests covering a wide age range. Verbal cognition, nonverbal cognition, processing speed, attention, memory, executive functioning, and manual dexterity were assessed. The participants were between 5:5 and 51:11 years of age at time of assessment. Assessments took place on average 19 years after primary tumor resective surgery. Results: One participant had a severe intellectual disability. For the rest, IQ varied from 52 to 125, with a mean score of 88.0 (SD 19.7). Twenty-eight (56%) of the participants had full-scale IQ scores in the age-average range or above. Gender, age at operation, time since operation, the presence of secondary medical complications, and treatment variables explained 46% of the variability in IQ scores, F(4,44) = 9.5, p<.001. The presence of endocrine insufficiency in combination with either epilepsy and/or hydrocephalus was associated with lowered IQ, lowered processing speed, and memory impairments. Conclusion: Patients treated for childhood MB and CNS-PNET have a lifelong risk of medical sequelae, including impaired cognitive functioning. This study adds to the literature by demonstrating the importance of following neuropsychological functioning closely, especially processing speed, learning, and memory, in survivors who have multiple secondary medical complications.
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Affiliation(s)
- Kristine Stadskleiv
- Department of Special Needs Education, University of Oslo, Oslo, Norway.,Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Einar Stensvold
- The Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pediatric Research, Oslo University Hospital, Oslo, Norway.,Department of Pediatrics, Oslo University Hospital, Oslo, Norway
| | - Kjersti Stokka
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway.,Centre for Cancer Biomedicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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5
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Guidi M, Giunti L, Buccoliero AM, Santi M, Spacca B, De Masi S, Genitori L, Sardi I. Use of High-Dose Chemotherapy in Front-Line Therapy of Infants Aged Less Than 12 Months Treated for Aggressive Brain Tumors. Front Pediatr 2020; 8:135. [PMID: 32328470 PMCID: PMC7160729 DOI: 10.3389/fped.2020.00135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/10/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction: Malignant brain tumors in infants less than 12 months of age are extremely rare, and they have poor prognosis. We evaluated genetic characteristics and response rates of infants with congenital brain tumors subjected to high-dose chemotherapy and autologous stem cell transplant after gross total tumor resection. Materials and Methods: In total, 10 infants, aged less than 12 months, were enrolled in this study. The median age was 56 days (range: 1-279 days). Pathological examination demonstrated the following: four anaplastic astrocytomas, two glioblastomas, two central nervous system (CNS) embryonal tumors, not otherwise specified (NOS), and two atypical teratoid/rhabdoid tumors. Results: All patients were exposed to induction chemotherapy regimen, two high-dose chemotherapy courses, and autologous stem cell transplant after maximal surgery. At 1-3-5 years, the global overall survival (OS) was 90, 70, and 70% and the progression-free survival (PFS) was 80-60 and 60%. In all the patients, the copy number variants (CNVs) profile was analyzed using the SNP/CGH array approach. To investigate the clinical relevance of germline SMARCB1 mutation in AT/RT patients, we performed sequence analysis of the coding regions. The two patients with AT/RT were found to have germline SMARCB1 mutations. No BRAF mutations were found, and only NTRK gene fusion was present in one patient. We also have examined the association with OS and PFS and different histological subtypes of infant CNS proving that high-grade astrocytoma has better overall survival than other tumor types (p: 0.007 and p: 0.0590). Conclusion: High-dose chemotherapy regimen represents a valid therapeutic approach for congenital brain tumors with a high rate of response. The molecular analysis has to be analyzed in all infants' brain tumor types. High-grade gliomas are characterized by a better prognosis than other histologies of infant CNS.
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Affiliation(s)
- Milena Guidi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Laura Giunti
- Medical Genetics Unit, Meyer Children's Hospital, Florence, Italy
| | | | - Mariarita Santi
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Barbara Spacca
- Neurosurgery Unit, Meyer Children's Hospital, Florence, Italy
| | | | | | - Iacopo Sardi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
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6
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Koschmann C, Wu YM, Kumar-Sinha C, Lonigro R, Vats P, Kasaian K, Cieslik M, Cao X, Anderson B, Frank K, Zhao L, Prensner JR, Zureick AH, Everett J, Mullan B, Marini B, Camelo-Piragua S, Venneti S, McKeever P, McFadden K, Lieberman AP, Leonard M, Maher CO, Garton H, Muraszko K, Robertson P, Robinson D, Chinnaiyan AM, Mody R. Clinically Integrated Sequencing Alters Therapy in Children and Young Adults With High-Risk Glial Brain Tumors. JCO Precis Oncol 2018; 2. [PMID: 32832832 DOI: 10.1200/po.17.00133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Brain tumors have become the leading cause of cancer-related mortality in young patients. Novel effective therapies on the basis of the unique biology of each tumor are urgently needed. The goal of this study was to evaluate the feasibility, utility, and clinical impact of integrative clinical sequencing and genetic counseling in children and young adults with high-risk brain tumors. Patients and Methods Fifty-two children and young adults with brain tumors designated by the treating neuro-oncologist to be high risk (> 25% chance for treatment failure; mean age, 10.2 years; range, 0 to 39 years) were enrolled in a prospective, observational, consecutive case series, in which participants underwent integrative clinical exome (tumor and germline DNA) and transcriptome (tumor RNA) sequencing and genetic counseling. Results were discussed in a multi-institutional brain tumor precision medicine teleconference. Results Sequencing revealed a potentially actionable germline or tumor alteration in 25 (63%) of 40 tumors with adequate tissue, of which 21 (53%) resulted in an impact on treatment or change of diagnosis. Platelet-derived growth factor receptor or fibroblast growth factor receptor pathway alterations were seen in nine of 20 (45%) glial tumors. Eight (20%) sequenced tumors harbored an oncogenic fusion isolated on RNA sequencing. Seventeen of 20 patients (85%) with glial tumors were found to have a potentially actionable result, which resulted in change of therapy in 14 (70%) patients. Patients with recurrent brain tumors receiving targeted therapy had a median progression-free survival (from time on therapy) of 4 months. Conclusion Selection of personalized agents for children and young adults with highrisk brain tumors on the basis of integrative clinical sequencing is feasible and resulted in a change in therapy in more than two thirds of children and young adults with high-risk glial tumors.
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Affiliation(s)
- Carl Koschmann
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Yi-Mi Wu
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Robert Lonigro
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Pankaj Vats
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Marcin Cieslik
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Xuhong Cao
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Kevin Frank
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Lili Zhao
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | | | | | - Brendan Mullan
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Bernard Marini
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Sriram Venneti
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Paul McKeever
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | | | - Marcia Leonard
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Cormac O Maher
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Hugh Garton
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Karin Muraszko
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Dan Robinson
- University of Michigan School of Medicine, Ann Arbor, MI
| | | | - Rajen Mody
- University of Michigan School of Medicine, Ann Arbor, MI
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7
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High-grade glioma in very young children: a rare and particular patient population. Oncotarget 2017; 8:64564-64578. [PMID: 28969094 PMCID: PMC5610026 DOI: 10.18632/oncotarget.18478] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/17/2017] [Indexed: 01/05/2023] Open
Abstract
In the past years, pediatric high-grade gliomas (HGG) have been the focus of several research articles and reviews, given the recent discoveries on the genetic and molecular levels pointing out a clinico-biological uniqueness of the pediatric population compared to their adult counterparts with HGG. On the other hand, there are only scarce data about HGG in very young children (below 3 years of age at diagnosis) due to their relatively low incidence. However, the few available data suggest further distinction of this very rare subgroup from older children and adults at several levels including their molecular and biological characteristics, their treatment management, as well as their outcome. This review summarizes and discusses the current available knowledge on the epidemiological, neuropathological, genetic and molecular data of this subpopulation. We discuss these findings and differences compared to older patients suffering from the same histologic disease. In addition, we highlight the particular clinical and neuro-radiological findings in this specific subgroup of patients as well as their current management approaches and treatment outcomes.
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8
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Lafay-Cousin L, Smith A, Chi SN, Wells E, Madden J, Margol A, Ramaswamy V, Finlay J, Taylor MD, Dhall G, Strother D, Kieran MW, Foreman NK, Packer RJ, Bouffet E. Clinical, Pathological, and Molecular Characterization of Infant Medulloblastomas Treated with Sequential High-Dose Chemotherapy. Pediatr Blood Cancer 2016; 63:1527-34. [PMID: 27145464 PMCID: PMC5031363 DOI: 10.1002/pbc.26042] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/04/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND High-dose chemotherapy (HDC) strategies were developed to avoid unacceptable neurotoxicity associated with craniospinal irradiation in infants with embryonal brain tumors. However, the impact of molecular and pathological characterizations in such approaches and long-term outcome have not been widely described in young children. METHODS We retrospectively collected information from seven North American institutions, on young children with medulloblastoma (MB) treated with sequential HDC, as per the CCG 99703 protocol. Data collection included clinical presentation, histology, molecular subgroup, irradiation, ototoxicity, and neurocognitive evaluations. RESULTS The cohort included 53 patients diagnosed at a median age of 24 months (2.9-63.2). Seventeen patients (32.1%) had nodular desmoplatic MB, all belonging to the sonic Hedgehog (SHH) subgroup, as did 30% of classic MB. The 5-year progression-free survival (PFS) and overall survival (OS) was 69.6% (±6·9%) and 76.1% (±6.5%), respectively. Seventeen (32.1%) patients received irradiation (nine adjuvant radiotherapy [RT]). Patients with SHH and group 3 MB had a 5-year PFS of 86·2% (±7.4%) and 49·1% (±14%), respectively (P = 0.03). The 5-year PFS radiation free for group 3 MB was 46.4%. Patients with macroscopic metastasis (M2 and M3) had a worst survival. Fifteen (45.5%) patients had significant ototoxicity. Mean Full Scale Intellectual Quotient (FSIQ) for 24 survivors was 91.6 (range 52-119). CONCLUSIONS This HDC strategy led to an encouraging OS while only 20% of the patients received adjuvant RT. SHH MB, irrespective of histological subgroup, had an excellent outcome. Such intensive therapy may not be needed for this subgroup. Patients with classic histology or group 3 had an encouraging PFS of 58% and 46.4%, respectively, in the absence of adjuvant RT. The neurocognitive profile of the survivors appears to be within the normal range.
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Affiliation(s)
- Lucie Lafay-Cousin
- Department of Pediatrics and Oncology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Amy Smith
- Arnold Palmer Hospital, Orlando, Florida
| | - Susan N Chi
- Dana-Farber Cancer Institute, Pediatric Neuro-Oncology, Boston, Massachusetts
| | - Elizabeth Wells
- Department of Pediatrics, Neurology & Integrative Systems Biology Brain Tumor Institute, Children's National Health System, Washington, District of Colombia
| | - Jennifer Madden
- Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Ashley Margol
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Vijay Ramaswamy
- Division of Pediatric Hematology Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jonathan Finlay
- Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio
| | - Michael D Taylor
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Girish Dhall
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Douglas Strother
- Department of Pediatrics and Oncology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Mark W Kieran
- Dana-Farber Cancer Institute, Pediatric Neuro-Oncology, Boston, Massachusetts
| | | | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute Children's National Health System, Washington, District of Colombia
| | - Eric Bouffet
- Division of Pediatric Hematology Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
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9
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High-dose Chemotherapy With Autologous Stem Cell Rescue in Saudi Children Less Than 3 Years of Age With Embryonal Brain Tumors. J Pediatr Hematol Oncol 2015; 37:204-8. [PMID: 25551668 DOI: 10.1097/mph.0000000000000301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
High-dose chemotherapy with autologous stem cell rescue (HDC/ASCR) has been used in children under the age of 3 years with embryonal brain tumors to avoid or delay the use of radiation. We reviewed the medical records of 10 Saudi children less than 3 years of age with embryonal brain tumors who underwent HDC/ASCR. All 10 patients underwent surgical resection followed by 3 to 5 cycles of induction chemotherapy and 1 to 3 cycles of HDC/ASCR using carboplatin and thiotepa. Isotretinoin was used as a maintenance therapy in 4 patients. Five patients had medulloblastoma, 3 had atypical teratoid/rhabdoid tumors, 1 had an embryonal tumor with abundant neuropil and true rosettes, and 1 had pineoblastoma. The median age of the patients was 1.9 years. A total of 19 HDC/ASCR procedures were performed. Radiotherapy (RT) was administered to 5 patients after HDC/ASCR and as a salvage therapy in 1 patient. The progression-free survival rate was 50% at 1 year and at 2 years, with a median follow-up of 24 months. All 5 patients with medulloblastoma are still alive without evidence of disease, but the other patients died secondary to tumor progression. This experience suggests that strategies combining myeloablative chemotherapy and autologous stem cell rescue appear to be feasible for children with embryonal brain tumors in the Middle East.
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10
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Finkel M, Goldstein A, Steinberg Y, Granowetter L, Trachtman H. Cisplatinum nephrotoxicity in oncology therapeutics: retrospective review of patients treated between 2005 and 2012. Pediatr Nephrol 2014; 29:2421-4. [PMID: 25171948 DOI: 10.1007/s00467-014-2935-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/22/2014] [Accepted: 07/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cisplatinum (CP) is associated with acute kidney injury. The aim of this study was to define the spectrum of CP-induced nephrotoxicity in current practice. CASE-DIAGNOSIS/TREATMENT A single-center, retrospective chart review was performed on children who received CP for treatment of a malignancy at the Hassenfeld Children's Center for Blood and Cancer Disorders of NYU Langone Medical Center between 2005 and 2012. Patients were considered to have nephrotoxicity if they had: (1) a decrease in estimated glomerular filtration rate (eGFR) of ≥30 % or (2) a decline in serum magnesium of ≥0.2 meq/L or (3) a decline in serum potassium of ≥0.2 meq/L. Thirty-two patients (mean age 8.0 ± 7.0 years) were included in this review, of whom 21 had a brain tumor (BT) and 11 had an osteosarcoma (OS); 31 (97 %) of the patients had a disturbance in renal function. The mean reduction in eGFR, serum magnesium and potassium was 37 ± 17, 30 ± 16 and 25 ± 14 %, respectively. The decline in eGFR, hypomagnesemia and hypokalemia was persistent in 38, 60 and 40 % of cases, respectively, through the short-term follow-up period. No patients required dialysis. CONCLUSIONS Nearly all patients receiving CP in current care experience modest glomerular and tubular injury. The abnormalities persist in 40-60 % of cases during the short-term recovery period after CP treatment.
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Affiliation(s)
- Morgan Finkel
- Division of Nephrology, Department of Pediatrics, NYU Langone Medical Center, New York, NY, USA
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11
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Toxicity of tandem high-dose chemotherapy and autologous stem cell transplantation using carboplatin-thiotepa-etoposide and cyclophosphamide-melphalan regimens for malignant brain tumors in children and young adults. J Neurooncol 2014; 120:507-13. [DOI: 10.1007/s11060-014-1576-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 08/03/2014] [Indexed: 11/24/2022]
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Treatment Options for Medulloblastoma and CNS Primitive Neuroectodermal Tumor (PNET). Curr Treat Options Neurol 2013; 15:593-606. [PMID: 23979905 DOI: 10.1007/s11940-013-0255-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OPINION STATEMENT Medulloblastoma and central nervous system (CNS) primitive neuroectodermal tumor (PNET) are primary pediatric brain tumors that require multidisciplinary therapies. Although often treated similarly in clinical trials, they are biologically different diseases. Even within medulloblastomas and CNS PNETs, there are molecularly distinct subgroups with differing presentations and prognoses. Overall, prognosis is better for medulloblastomas. Specific treatments for these types of cancer are continuously evolving to maximize survival and minimize long-term sequelae of treatment. Patients should be treated on a clinical trial, if eligible, as they may gain benefit with minimal risk over current standard of care. The amount of residual disease after surgery better correlates with survival for medulloblastomas than for CNS PNETs. Maximal surgical resection of tumor should be done, only if additional permanent, neurologic deficits can be spared. Patients should have a staging work-up to assess the extent of disease. This includes postoperative magnetic resonance imaging (MRI) of the brain, MRI of the entire spine and lumbar cerebrospinal fluid (CSF) sampling for cytological examination, if deemed safe. Radiation therapy to the entire CNS axis is required, with a greater dose (boost) given to the region of the primary site or any bulky residual disease for older children. Adjuvant chemotherapy must be given even if no evidence of disease after radiation therapy exists, as the risk of relapse is substantial after radiation alone. Subsets of younger children with medulloblastoma, arbitrarily defined as those younger than 3 years of age in some studies and 4 or even 5 years in other studies, can be effectively treated with chemotherapy alone. Recent genomic studies have revealed further subtypes of disease than previously recognized. Clinical trials to exploit these biologic differences are required to assess potential efficacy of targeted agents. The treatment of medulloblastoma and CNS PNET can cause significant impairment in neurologic function. Evaluations by physical therapy, occupational therapy, speech therapy and neurocognitive assessments should be obtained, as needed. After therapy is completed, survivors need follow-up of endocrine function, surveillance scans and psychosocial support.
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Determining factors predictive of CD34+ cell collection efficiency in an effort to avoid extended and repeated apheresis sessions. J Clin Apher 2013; 28:404-10. [DOI: 10.1002/jca.21292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 07/01/2013] [Accepted: 07/11/2013] [Indexed: 11/07/2022]
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Dubrovsky L, McCarter RJ, Fry TJ, Wong E, Cheng Y, Perez-Albuerne ED. Analysis of pediatric autologous PBSC apheresis and transplant: age is a major factor affecting post-transplant toxicity. Pediatr Blood Cancer 2012; 59:301-5. [PMID: 22180259 DOI: 10.1002/pbc.24026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 11/07/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND High-dose chemotherapy followed by autologous hematopoietic cell transplantation (HCT) is used in many therapeutic protocols for pediatric intra- and extra-cranial solid tumors. HCT can be curative, but is associated with significant toxicity. PROCEDURE Between January 2001 and June 2009, 92 solid tumor patients (age 6 months to 27 years) underwent 94 autologous apheresis procedures at Children's National Medical Center. Out of that group, 71 patients, who underwent 162 autologous HCT, were analyzed for transplant outcomes. Multiple variable modeling was used to identify independent variables related to transplant toxicity outcome measures, such as bacteremia, intensive care admission, and death. Other outcome measures (time to pre-apheresis peripheral blood CD34+ count, product yield, and time to engraftment) were also analyzed. Independent variables included patient-specific variables (age, weight, tumor type, chemotherapy administered, and primary vs. relapsed disease) and harvest or transplant-related variables (total white blood cell and CD34+ cell counts prior to transplant, and quantity of total nucleated cells and CD34+ cells infused during transplant). RESULTS Transplant toxicity was significantly greater in younger patients (P = 0.001) and in neuroblastoma patients (P = 0.003). The time to neutrophil engraftment, controlling for weight, age, and chemotherapy, was positively related to absolute CD34+ cells/kg infused (P = 0.01). The time to CD34+ recovery pre-apheresis was affected by patient diagnosis (P = 0.05). CONCLUSIONS Younger patients had increased transplant toxicity, with infants <1 year of age at highest risk for fever, bacteremia, admission to intensive care, and death. Infants would likely benefit from hospitalization after autologous HCT until neutrophil recovery.
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Affiliation(s)
- Leonid Dubrovsky
- Pediatric Residency Program, Children's National Medical Center, Washington, District of Columbia, USA.
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Abstract
PURPOSE OF REVIEW Most children diagnosed with cancer today are expected to be cured. Medulloblastoma, the most common pediatric malignant brain tumor, is an example of a disease that has benefitted from advances in diagnostic imaging, surgical techniques, radiation therapy and combination chemotherapy over the past decades. It was an incurable disease 50 years ago, but approximately 70% of children with medulloblastoma are now cured of their disease. However, the pace of increasing the cure rate has slowed over the past 2 decades, and we have likely reached the maximal benefit that can be achieved with cytotoxic therapy and clinical risk stratification. Long-term toxicity of therapy also remains significant. To increase cure rates and decrease long-term toxicity, there is great interest in incorporating biologic 'targeted' therapy into treatment of medulloblastoma, but this will require a paradigm shift in how we classify and study disease. RECENT FINDINGS Using genome-based high-throughput analytic techniques, several groups have independently reported methods of molecular classification of medulloblastoma within the past year. This has resulted in a working consensus to view medulloblastoma as four molecular subtypes, including wingless-type murine mammary tumor virus integration site (WNT) pathway subtype, Sonic Hedgehog pathway subtype and two less well defined subtypes (groups C and D). SUMMARY Novel classification and risk stratification based on biologic subtypes of disease will form the basis of further study in medulloblastoma and identify specific subtypes that warrant greater research focus.
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Lee SH, Sung KW. High-dose chemotherapy and autologous stem cell transplantation for pediatric brain tumors. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2012. [DOI: 10.5124/jkma.2012.55.5.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Soo Hyun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Blakeley J, Grossman SA. Chemotherapy with cytotoxic and cytostatic agents in brain cancer. HANDBOOK OF CLINICAL NEUROLOGY 2012; 104:229-54. [PMID: 22230447 DOI: 10.1016/b978-0-444-52138-5.00017-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Medulloblastoma is the most common malignant brain tumor in children. The treatment strategy in this tumor mainly includes surgery and radiotherapy, but chemotherapy has been successfully applied in medulloblastoma. The survival rates have improved over the last decade with chemotherapy. The most important prognostic factors were the amount and the extent of metastases, surgery and age. Risk factors have been defined in recent years, but chemotherapy has not been planned according to these defined risk factors on a worldwide basis. The aim of this article was to examine the use of chemotherapy in childhood medulloblastoma according to risk group. A secondary aim was to examine high-dose chemotherapy with autologous stem cell transplantation and the treatment of infant medulloblastoma.
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Affiliation(s)
- Ali Varan
- Department of Pediatric Oncology, Hacettepe University, Institute of Oncology, 06100 Ankara, Turkey.
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Gilman AL, Jacobsen C, Bunin N, Levine J, Goldman F, Bendel A, Joyce M, Anderson P, Rozans M, Wall DA, Macdonald TJ, Simon S, Kadota RP. Phase I study of tandem high-dose chemotherapy with autologous peripheral blood stem cell rescue for children with recurrent brain tumors: a Pediatric Blood and MarrowTransplant Consortium study. Pediatr Blood Cancer 2011; 57:506-13. [PMID: 21744474 DOI: 10.1002/pbc.22899] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 10/08/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND High-dose chemotherapy with autologous stem cell rescue (HDC/SCR) has produced responses and prolonged survival for some children with recurrent brain tumors, but is associated with considerable morbidity and mortality. A Phase I trial of two cycles of HDC/SCR for recurrent brain tumors in children was performed to determine the maximum tolerated doses for a novel regimen. PROCEDURES Two cycles of HDC/SCR were given. Cycle 1 included thiotepa and carmustine given on days -5, -4, and -3. Four to six weeks later, patients received cycle 2 which included thiotepa and carboplatin given on days -5, -4, and -3. Autologous peripheral blood stem cells (PBSC) were infused on day 0 of each cycle. RESULTS Thirty-two patients were treated and 25 patients received both cycles of HDC/SCR. Common toxicities included mucositis, emesis, diarrhea, anorexia, and pancytopenia. Eight of 32 (25%) assessable children died from regimen-related toxicity. Pulmonary failure occurred in seven patients. Seven patients had grade 3-4 neurotoxicity. The 3-year event-free survival (EFS) was 25%. CONCLUSIONS We determined the maximum tolerated regimen to be thiotepa 600 mg/m(2) and carmustine 300 mg/m(2) followed by thiotepa 600 mg/m(2) and carboplatin 1,200 mg/m(2) . Pulmonary toxicity was considerable. The toxic death rate was similar to other trials of HDC/SCR for children with recurrent brain tumors performed during the same time period. The regimen resulted in prolonged time to progression for a significant number of patients and long-term survival for some patients with recurrent medulloblastoma and rhabdoid tumor.
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Phi JH, Wang KC, Park SH, Kim IH, Kim IO, Park KD, Ahn HS, Lee JY, Son YJ, Kim SK. Pediatric infratentorial ependymoma: prognostic significance of anaplastic histology. J Neurooncol 2011; 106:619-26. [PMID: 21863401 DOI: 10.1007/s11060-011-0699-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 08/12/2011] [Indexed: 10/17/2022]
Abstract
Pediatric infratentorial ependymomas are difficult to cure. Despite the availability of advanced therapeutic modalities for brain tumors, total surgical resection remains the most important prognostic factor. Recently, histological grade emerged as an independent prognostic factor for intracranial ependymoma. We retrospectively reviewed the treatment outcome of 33 pediatric patients with infratentorial ependymoma. Progression-free survival (PFS) and overall survival (OS) rates were calculated and relevant prognostic factors were analyzed. Fourteen patients (42%) were under the age of 3 at diagnosis. Gross total resection was achieved in 16 patients (49%). Anaplastic histology was found in 13 patients (39%). Adjuvant therapies were delayed until progression in 12 patients (36%). Actuarial PFS rates were 64% in the first year and 29% in the fifth year. Actuarial OS rates were 91% in the first year and 71% in the fifth year. On univariate analysis, brainstem invasion (P = 0.047), anaplastic histology (P = 0.004), higher mitotic count (P = 0.001), and higher Ki-67 index (P = 0.004) were significantly related to a shorter PFS. Gross total resection (P = 0.029) and a greater age at diagnosis (P = 0.033) were significantly related to a longer PFS. On multivariate analysis, anaplastic histology alone was significantly related to a shorter PFS (P = 0.023). Gross total resection (P = 0.039) was significantly related to a longer overall survival (OS) on multivariate analysis. Anaplastic histology and gross total resection were the most important clinical factors affecting PFS and OS, respectively. Anaplastic histology, mitotic count, and Ki-67 index can be used as universal and easily available prognostic parameters in infratentorial ependymomas.
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Affiliation(s)
- Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea
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Lafay-Cousin L, Bouffet E, Hawkins C, Amid A, Huang A, Mabbott DJ. Impact of radiation avoidance on survival and neurocognitive outcome in infant medulloblastoma. ACTA ACUST UNITED AC 2011; 16:21-8. [PMID: 20016743 PMCID: PMC2794676 DOI: 10.3747/co.v16i6.435] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Concerns about radiotherapy-related neurocognitive sequelae in young children have led to deferral or avoidance of radiation in contemporary treatment for this fragile group of patients. We compared survival and neurocognitive outcome in two groups of infants with medulloblastoma who received adjuvant conventional craniospinal irradiation (csi) or reduced or no radiotherapy during an era of change in the philosophy of infant medulloblastoma treatment. Patients and Methods From 1985 to 2007, 29 patients 3 years of age or younger were diagnosed and treated with curative intent in our institution. Children treated before 1994 received adjuvant radiation with chemotherapy; subsequently, radiation was prescribed essentially for disease progression or relapse. Results Median age at diagnosis was 24 months (range: 1–36 months); 15 patients (52%) presented with metastatic disease at diagnosis. As part of initial treatment, 8 children received adjuvant radiotherapy with chemotherapy, and 21 children received postoperative chemotherapy only. Five children treated with chemotherapy alone are in prolonged remission. The 5-year event-free and overall survivals were 35.9% ± 9.8% and 50.2% ± 9.6% respectively. Extent of resection, metastatic status, and desmoplastic histology were not found to be significant prognostic factors. On serial neurocognitive evaluations, patients treated with chemotherapy with or without reduced radiotherapy demonstrated improvement of intellectual function over time. Patients treated with conventional csi exhibited significantly lower intelligence quotient scores and academic performance, with the exception of receptive vocabulary. Conclusions Avoidance of conventional csi in treatment of very young children with medulloblastoma appears to be associated with a preserved neurocognitive profile. Neurocognitive evaluation should be integrated into the primary objectives of future infant protocols.
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Affiliation(s)
- L Lafay-Cousin
- Department of Pediatric Oncology and Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, AB.
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Dubrovsky L, Wong EC, Perez-Albuerne E, Loechelt B, Kamani N, Sande J, Mintz K, Paul W, Luban NL, Rood BR, Fry T. CD34+ collection efficiency as a function of blood volumes processed in pediatric autologous peripheral blood stem cell collection. J Clin Apher 2011; 26:131-7. [DOI: 10.1002/jca.20281] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 12/02/2010] [Indexed: 11/08/2022]
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Leary SES, Zhou T, Holmes E, Geyer JR, Miller DC. Histology predicts a favorable outcome in young children with desmoplastic medulloblastoma: a report from the children's oncology group. Cancer 2011; 117:3262-7. [PMID: 21246528 DOI: 10.1002/cncr.25856] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 11/16/2010] [Accepted: 11/17/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Contemporary therapy for medulloblastoma results in adverse neurocognitive effects on young children, particularly those under the age of 3. Stratification of patients by risk group may allow toxic treatment to be avoided. METHODS Seventy-six patients diagnosed with medulloblastoma and enrolled on CCG-9921 underwent central review of pathology, and histologic subtype was designated as desmoplastic or nondesmoplastic. Nonparametric event-free survival (EFS) and survival (OS) curves were computed using the product limit (Kaplan-Meier) estimates, and the log-rank test was used to compare survival according to histologic subtype. RESULTS Patients with desmoplastic medulloblastoma experienced a favorable EFS of 77% ± 9% and OS of 85% ± 8% compared with EFS of 17% ± 5% and OS of 29% ± 6% for patients with tumors in the nondesmoplastic group (P < .0001 for both EFS and OS comparisons). Patients without disease progression did not receive radiation therapy. CONCLUSIONS Children less than 3 with desmoplastic histology of medulloblastoma represent a lower-risk group for whom reduction of therapy, including elimination of radiation therapy, is an appropriate strategy.
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Affiliation(s)
- Sarah E S Leary
- Division of Hematology/Oncology, Seattle Children's, Seattle, Washington, USA.
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Toledano H, Yahel A, Cohen IJ, Yaniv I, Stein J. Successful mobilization, harvest and transplant of peripheral blood stem cells using AMD3100 and G-CSF following high dose craniospinal irradiation for medulloblastoma in a young child. Pediatr Blood Cancer 2010; 54:613-5. [PMID: 19998469 DOI: 10.1002/pbc.22370] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Contemporary protocols for the treatment of malignant brain tumors such as medulloblastoma (MB) in children, often involve craniospinal irradiation (CSI) at diagnosis followed by serial courses of high dose chemotherapy and autologous hematopoietic stem cell support. Patients often require several pheresis procedures in order to collect sufficient stem cells for this type of treatment, particularly if they have already had CSI. We describe the successful mobilization, collection and subsequent transplant of a 7-year-old female with medulloblastoma after recent CSI using granulocyte colony stimulating factor (G-CSF) and the CXCR4 antagonist AMD3100 after a failed previous mobilization attempt using G-CSF alone.
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Affiliation(s)
- Helen Toledano
- Department of Pediatric Hematology Oncology, Petach Tikva, Israel.
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Danner-Koptik K, Jacobsohn DA, Dilley KJ. Late effects of stem cell transplantation in brain tumor survivors. Cancer Treat Res 2009; 150:67-79. [PMID: 19834662 DOI: 10.1007/b109924_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Karina Danner-Koptik
- Hematology/Oncology/Stem Cell Transplant, Children's Memorial Medical Center, Chicago, IL 60614-3394, USA.
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Abstract
Embryonal tumors are the most common brain tumors in infants less than 36 months. Histologically characterized as undifferentiated small, round cell tumors with divergent patterns of differentiation, these include medulloblastoma, the most common form of embryonal tumor, as well as supratentorial primitive neuroectodermal tumor, medulloepithelioma, ependymoblastoma, medullomyoblastoma, melanotic medulloblastoma, and atypical teratoid/rhabdoid tumor. All are similarly aggressive and have a tendency to disseminate throughout the central nervous system. Because of efforts to avoid craniospinal irradiation in an attempt to lessen treatment-related neurotoxicity, management of these tumors in infants is unique. Outcomes remain similarly poor among all the tumor types and, therefore, identification of specific molecular targets that have prognostic and therapeutic implications is crucial. The molecular and clinical aspects of the 3 most common aggressive infantile embryonal tumors, medulloblastoma, supratentorial primitive neuroectodermal tumor, and atypical teratoid/rhabdoid tumor, are the focus of this review.
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Affiliation(s)
- Tobey J. MacDonald
- Division of Oncology, Center for Cancer and Blood Disorders, Center for Cancer and Immunology Research, Children’s Research Institute, Children’s National Medical Center, Washington, DC, and The George Washington University School of Medicine and Health Sciences, Washington, DC
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Minicucci EM, Ribeiro DA, de Camargo B, Costa MC, Ribeiro LR, Favero Salvadori DM. DNA damage in lymphocytes and buccal mucosa cells of children with malignant tumours undergoing chemotherapy. Clin Exp Med 2008; 8:79-85. [PMID: 18618217 DOI: 10.1007/s10238-008-0161-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 12/11/2007] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to evaluate DNA damage (micronucleus) in cytokinesis-blocked lymphocytes and exfoliated buccal mucosa cells from children with malignant tumours and under chemotherapy. Micronucleated cells (MNCs) were assessed from children before and during chemotherapy. A total of 21 healthy children (controls), matched for gender and age, were used as control. The results pointed out higher frequencies of micronucleated lymphocytes in children with malignant tumour before any therapy when compared to healthy probands. Furthermore an increase of micronucleated lymphocytes during chemotherapy was detected when compared to the data obtained before chemotherapy. No statistically significant increases of MNCs were noticed in buccal mucosa cells at any of the timepoints evaluated. Taken together, these data indicate that the presence of malignant tumours may increase the frequency of DNA damage in circulating lymphocytes, these cells being more sensitive for detecting chromosome aberrations caused by anti-cancer drugs.
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Affiliation(s)
- E M Minicucci
- Department of Pathology, Faculty of Medicine, Botucatu Medical School, UNESP, 18618-000, Botucatu, SP, Brazil
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Abstract
Umbilical cord blood gifted to non-profit public cord blood banks is now routinely used as an alternative source of haematopoietic stem cells for allogeneic transplantation for children and adults with cancer, bone marrow failure syndromes, haemoglobinopathies and many genetic metabolic disorders. Because of the success and outcomes of public cord banking, many companies now provide private cord banking services. However, in the absence of any published transplant evidence to support autologous and non-directed family banking, commercial cord banks currently offer a superfluous service.
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Affiliation(s)
- Michael J Sullivan
- Department of Paediatrics, Children's Cancer Research Group, Children's Haematology Oncology Centre, Christchurch School of Medicine, University of Otago, 2 Riccarton Ave, Christchurch 8005, New Zealand.
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Choi LMR, Rood B, Kamani N, La Fond D, Packer RJ, Santi MR, Macdonald TJ. Feasibility of metronomic maintenance chemotherapy following high-dose chemotherapy for malignant central nervous system tumors. Pediatr Blood Cancer 2008; 50:970-5. [PMID: 17941070 DOI: 10.1002/pbc.21381] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Children less than 5 years of age with malignant central nervous system (CNS) tumors, continue to have a high rate of morbidity and mortality following administration of conventional therapy. In an attempt to avoid the neurologic sequelae associated with craniospinal radiation, strategies such as high-dose chemotherapy (HDCT) followed by peripheral stem cell rescue have been used successfully. Metronomic chemotherapy has also been reported as a potential new treatment strategy in solid tumors, particularly in adults. PROCEDURE A retrospective chart analysis was performed on 10 patients less than 5 years of age with CNS tumors treated with metronomic chemotherapy shortly after HDCT as part of their clinical care. RESULTS Metronomic chemotherapy was associated with minimal toxicity and all patients maintained a good quality of life. At the time of this report, all 10 patients are alive. Two patients have relapsed, and the remaining eight, including six patients with metastatic disease, continue to have stable clinical and radiographic disease at a mean of 20 months from the time of diagnosis. CONCLUSIONS Metronomic chemotherapy in this patient population is feasible and shows encouraging preliminary results, especially in patients with metastatic disease who have not received craniospinal radiation. Further investigation of this strategy in newly diagnosed patients with CNS tumors is warranted.
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Affiliation(s)
- L Mi Rim Choi
- Division of Hematology and Oncology, Children's National Medical Center, Washington, District of Columbia, USA
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Abstract
PURPOSE OF REVIEW Chemotherapy has gained a larger importance in the management of brain tumours, especially in children. RECENT FINDINGS Converging results were presented in 2005 by the German, French and North-American cooperative groups indicating that a subgroup of young children with medulloblastoma (i.e. those with desmoplastic histology) could be cured with chemotherapy only strategies. The usefulness of high-dose chemotherapy followed by stem-cell transplant was shown not only as salvage strategy but also upfront in high-risk patients with medulloblastoma. Diffuse pontine glioma remains a devastating disease despite numerous attempts to improve on the standard radiotherapy. Targeted therapies have entered the paediatric neuro-oncology field as well. SUMMARY In the most frequent paediatric brain tumors (medulloblastoma and low grade gliomas), the improvements have been impressive in recent years. These patients still await new targeted therapies to lower the burden of treatments and their related side-effects. Most of the brain tumours, however, are rare and the development of specific protocols too slow. Likely, they may have very specific biologic abnormalities that could be efficiently targeted in the near future.
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Affiliation(s)
- Jacques Grill
- Department of Paediatric and Adolescent Oncology, Gustave Roussy Cancerology Institute, Villejuif, France.
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