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Ogiwara H, Liao YM, Wong TT. Pineal/germ cell tumors and pineal parenchymal tumors. Childs Nerv Syst 2023; 39:2649-2665. [PMID: 37831207 DOI: 10.1007/s00381-023-06081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Pineal region tumors (PRTs) are tumors arising from the pineal gland and the paraspinal structures. These tumors are rare and heterogeneous that account for 2.8-10.1% and 0.6-3.2% of tumors in children and in all ages, respectively. Almost all types and subtypes of CNS tumors may be diagnosed in this region. These tumors come from cells of the pineal gland (pinealocytes and neuroglial cells), ectopic primordial germ cells (PGC), and cells from adjacent structures. Hence, PRTs are consisted of pineal parenchyma tumors (PPTs), germ cell tumors (GCTs), neuroepithelial tumors (NETs), other miscellaneous types of tumors, cystic tumors (epidermoid, dermoid), and pineal cyst in addition. The symptoms of PRTs correlate to the increased intracranial cranial pressure due to obstructive hydrocephalus and dorsal midbrain compression. The diagnostic imaging studies are mainly MRI of brain (with and without gadolinium) along with a sagittal view of whole spine. Serum and/or CSF AFP/β-HCG helps to identify GCTs. The treatment of PRTs is consisted of the selection of surgical biopsy/resection, handling of hydrocephalus, neoadjuvant and/or adjuvant therapy according to age, tumor location, histopathological/molecular classification, grading of tumors, staging, and threshold value of markers (for GCTs) in addition. METHODS In this article, we review the following focus points: 1. Background of pineal region tumors. 2. Pineal GCTs and evolution of management. 3. Molecular study for GCTs and pineal parenchymal tumors. 4. Review of surgical approaches to the pineal region. 5. Contribution of endoscopy. 6. Adjuvant therapy (chemotherapy, radiotherapy, and combination). 7. FUTURE DIRECTION RESULTS In all ages, the leading three types of PRTs in western countries were PPTs (22.7-34.8%), GCTs (27.3-34.4%), and NETs (17.2-28%). In children and young adults, the leading PRTs were invariably in the order of GCTs (40-80.5%), PPTs (7.6-21.6%), NETs (2.4-37.5%). Surgical biopsy/resection of PRTs is important for precision diagnosis and therapy. Safe resection with acceptable low mortality and morbidity was achieved after 1970s because of the advancement of surgical approaches, CSF shunt and valve system, microscopic and endoscopic surgery. Following histopathological diagnosis and classification of types and subtypes of PRTs, in PPTs, through molecular profiling, four molecular groups of pineoblastoma (PB) and their oncogenic driver were identified. Hence, molecular stratified precision therapy can be achieved. CONCLUSION Modern endoscopic and microsurgical approaches help to achieve precise histopathological diagnosis and molecular classification of different types and subtypes of pineal region tumors for risk-stratified optimal, effective, and protective therapy. In the future, molecular analysis of biospecimen (CSF and blood) along with AI radiomics on tumor imaging integrating clinical and bioinformation may help for personalized and risk-stratified management of patients with pineal region tumors.
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Affiliation(s)
- Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, 157-8535, Tokyo, Japan
| | - Yu-Mei Liao
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Tai-Tong Wong
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, 252 Wuxing St, Taipei, 11031, Taiwan.
- Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan.
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2
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Knight TE, Ahn KW, Hebert KM, Atshan R, Wall DA, Chiengthong K, Rotz SJ, Fraint E, Rangarajan HG, Auletta JJ, Sharma A, Kitko CL, Hashem H, Williams KM, Wirk B, Dvorak CC, Myers KC, Pulsipher MA, Warwick AB, Lalefar NR, Schultz KR, Qayed M, Broglie L, Eapen M, Yanik GA. Effect of Autograft CD34 + Dose on Outcome in Pediatric Patients Undergoing Autologous Hematopoietic Stem Cell Transplant for Central Nervous System Tumors. Transplant Cell Ther 2023; 29:380.e1-380.e9. [PMID: 36990222 PMCID: PMC10247464 DOI: 10.1016/j.jtct.2023.03.024] [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: 01/25/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
Consolidation with autologous hematopoietic stem cell transplantation (HSCT) has improved survival for patients with central nervous system tumors (CNSTs). The impact of the autologous graft CD34+ dose on patient outcomes is unknown. We wanted to analyze the relationship between CD34+ dose, total nucleated cell (TNC) dose, and clinical outcomes, including overall survival (OS), progression-free survival (PFS), relapse, non-relapse mortality (NRM), endothelial-injury complications (EIC), and time to neutrophil engraftment in children undergoing autologous HSCT for CNSTs. A retrospective analysis of the CIBMTR database was performed. Children aged <10 years who underwent autologous HSCT between 2008 to 2018 for an indication of CNST were included. An optimal cut point was identified for patient age, CD34+ cell dose, and TNC, using the maximum likelihood method and PFS as an endpoint. Univariable analysis for PFS, OS, and relapse was described using the Kaplan-Meier estimator. Cox models were fitted for PFS and OS outcomes. Cause-specific hazards models were fitted for relapse and NRM. One hundred fifteen patients met the inclusion criteria. A statistically significant association was identified between autograft CD34+ content and clinical outcomes. Children receiving >3.6×106/kg CD34+ cells experienced superior PFS (p = .04) and OS (p = .04) compared to children receiving ≤3.6 × 106/kg. Relapse rates were lower in patients receiving >3.6 × 106/kg CD34+ cells (p = .05). Higher CD34+ doses were not associated with increased NRM (p = .59). Stratification of CD34+ dose by quartile did not reveal any statistically significant differences between quartiles for 3-year PFS (p = .66), OS (p = .29), risk of relapse (p = .57), or EIC (p = .87). There were no significant differences in patient outcomes based on TNC, and those receiving a TNC >4.4 × 108/kg did not experience superior PFS (p = .26), superior OS (p = .14), reduced risk of relapse (p = .37), or reduced NRM (p = .25). Children with medulloblastoma had superior PFS (p < .001), OS (p = .01), and relapse rates (p = .001) compared to those with other CNS tumor types. Median time to neutrophil engraftment was 10 days versus 12 days in the highest and lowest infused CD34+ quartiles, respectively. For children undergoing autologous HSCT for CNSTs, increasing CD34+ cell dose was associated with significantly improved OS and PFS, and lower relapse rates, without increased NRM or EICs.
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Affiliation(s)
- Tristan E Knight
- Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington; Division of Hematology and Oncology, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin; CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kyle M Hebert
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rasha Atshan
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Donna A Wall
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kanhatai Chiengthong
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Seth J Rotz
- Department of Pediatric Hematology, Oncology, and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, Ohio
| | - Ellen Fraint
- Division of Pediatric Hematology, Oncology, and Cellular Therapy, The Children's Hospital at Montefiore, Bronx, New York
| | - Hemalatha G Rangarajan
- Department of Pediatric Hematology, Oncology, Blood and Marrow Transplantation, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffery J Auletta
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Hematology/Oncology/BMT and Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio
| | - Akshay Sharma
- Department of Bone Marrow Transplantation and Cellular Therapy, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Carrie L Kitko
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hasan Hashem
- Division of Pediatric Hematology/Oncology and Bone Marrow Transplantation, King Hussein Cancer Center, Amman, Jordan
| | - Kirsten M Williams
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Baldeep Wirk
- Bone Marrow Transplant Program, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology & Bone Marrow Transplantation, Benioff Children's Hospital, University of California San Francisco, San Francisco, California
| | - Kasiani C Myers
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael A Pulsipher
- Intermountain Primary Children's Hospital Division of Hematology and Oncology, Huntsman Cancer Institute at the Spencer Eccles Fox School of Medicine at the University of Utah, Salt Lake City, Utah
| | - Anne B Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Nahal Rose Lalefar
- Division of Pediatric Hematology, UCSF Benioff Children's Hospital, Oakland, California
| | - Kirk R Schultz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Muna Qayed
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Larisa Broglie
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Mary Eapen
- CIBMTR® (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gregory A Yanik
- Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, Michigan
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Chadda KR, Solano-Páez P, Khan S, Llempén-López M, Phyu P, Horan G, Trotman J, Tarpey P, Erker C, Lindsay H, Addy D, Jacques TS, Allinson K, Pizer B, Huang A, Murray MJ. Embryonal tumor with multilayered rosettes: Overview of diagnosis and therapy. Neurooncol Adv 2023; 5:vdad052. [PMID: 37727849 PMCID: PMC10506690 DOI: 10.1093/noajnl/vdad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Affiliation(s)
- Karan R Chadda
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Palma Solano-Páez
- Department of Pediatric Hematology and Oncology, Hospital Infantil Virgen del Rocio, Seville, Spain
| | - Sara Khan
- Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Monash Children’s Cancer Centre, Monash Children’s Hospital, Monash Health, Melbourne, Victoria, Australia
- Center for Cancer Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Molecular and Translational Science, School of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Mercedes Llempén-López
- Department of Pediatric Hematology and Oncology, Hospital Infantil Virgen del Rocio, Seville, Spain
| | - Poe Phyu
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gail Horan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jamie Trotman
- East Genomics Laboratory Hub (GLH) Genetics Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Patrick Tarpey
- East Genomics Laboratory Hub (GLH) Genetics Laboratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Craig Erker
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Holly Lindsay
- Department of Pediatrics, Division of Hematology and Oncology, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
| | - Dilys Addy
- SIHMDS-Acquired Genomics Laboratory, NHS North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Department, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Kieren Allinson
- Department of Neuropathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Barry Pizer
- Department of Paediatric Oncology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Annie Huang
- Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Haematology/Oncology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew J Murray
- Department of Pathology, University of Cambridge, Cambridge, UK
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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4
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Hansford JR, Huang J, Endersby R, Dodgshun AJ, Li BK, Hwang E, Leary S, Gajjar A, Von Hoff K, Wells O, Wray A, Kotecha RS, Raleigh DR, Stoller S, Mueller S, Schild SE, Bandopadhayay P, Fouladi M, Bouffet E, Huang A, Onar-Thomas A, Gottardo NG. Pediatric Pineoblastoma: A pooled outcome study of North American and Australian therapeutic data. Neurooncol Adv 2022; 4:vdac056. [PMID: 35664557 PMCID: PMC9154333 DOI: 10.1093/noajnl/vdac056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Pineoblastoma is a rare brain tumor usually diagnosed in children. Given its rarity, no pineoblastoma specific trials have been conducted. Studies have included pineoblastoma accruing for other embryonal tumors over the past 30 years. These included only occasional children with pineoblastoma, making clinical features difficult to interpret and determinants of outcome difficult to ascertain.
Patients and Methods
Centrally or independently reviewed series with treatment and survival data from North American and Australian cases were pooled. To investigate associations between variables, Fisher’s exact tests, Wilcoxon-Mann-Whitney tests, and Spearman correlations were used. Kaplan-Meier plots, log-rank tests, and Cox proportional hazards models were used in survival analyses.
Results
We describe a pooled cohort of 178 pineoblastoma cases from Children’s Oncology Group (n=82) and institutional series (n=96) over 30 years. Children <3 years of age have significantly worse survival compared to older children, with 5-year progression free survival and overall survival estimates of 13.5±5.1% and 16.2±5.3% respectively compared with 60.8±5.6% and 67.3±5.0% for ≥3 years old (both p<0.0001). Multivariable analysis showed male sex was associated with worse PFS in children <3 years of age (Hazard Ratio 3.93, 95% CI 1.80-8.55; p=0.0006), suggestive of sex specific risks needing future validation. For children ≥3 years of age, disseminated disease at diagnosis was significantly associated with an inferior 5-year PFS of 39.2±9.7% (HR 2.88, 95% CI 1.52-5.45; p=0.0012) and 5-year OS of 49.8±9.1% (HR 2.87, 95% CI 1.49-5.53; p=0.0016).
Conclusion
Given the rarity of this tumor, prospective, collaborative international studies will be vital to improving the long-term survival of these patients.
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Affiliation(s)
- Jordan R Hansford
- Children’s Cancer Center, Royal Children’s Hospital; University of Melbourne, Department of Pediatrics; Murdoch Children’s Research Institute, Cell Biology and Cancer Division, Melbourne, VIC, Australia
- Michael Rice Cancer Center; South Australia Health and Medical Research Institute; South Australia Immunogenomics Cancer Institute, Faculty of Health and Medical Sciences University of Adelaide, Adelaide, SA, Australia
| | - Jie Huang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Raelene Endersby
- Brain Tumor Research Program, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Andrew J Dodgshun
- Christchurch Hospital, Children’s Hematology/Oncology Center, Christchurch, New Zealand
| | - Bryan K Li
- Division of Hematology/Oncology, Cell Biology Research Program, Arthur and Sonia Labatt Brain Tumor Research Institute, Hospital for Sick Children, Department of Pediatrics, Medical Biophysics, Lab Medicine and Pathobiology University of Toronto, ON, Canada
| | - Eugene Hwang
- Children’s National, Division of Oncology, Washington, USA
| | - Sarah Leary
- Seattle Children’s Hospital, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Amar Gajjar
- St Jude Children’s Research Hospital, Memphis, USA
| | - Katja Von Hoff
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Olivia Wells
- Children’s Cancer Center, Royal Children’s Hospital; University of Melbourne, Department of Pediatrics; Murdoch Children’s Research Institute, Cell Biology and Cancer Division, Melbourne, VIC, Australia
| | - Alison Wray
- Children’s Cancer Center, Royal Children’s Hospital; University of Melbourne, Department of Pediatrics; Murdoch Children’s Research Institute, Cell Biology and Cancer Division, Melbourne, VIC, Australia
- Royal Children’s Hospital, Department of Neurosurgery, Melbourne, Australia
| | - Rishi S Kotecha
- Department of Clinical Hematology, Oncology, Blood and Marrow Transplantation, Perth Children’s Hospital, Perth, WA, Australia
- Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - David R Raleigh
- Department of Radiation Oncology and Neurological Surgery, University of California San Francisco, San Francisco, CA
| | - Schuyler Stoller
- Department of Pediatric Oncology, University of California San Francisco, San Francisco, CA
| | - Sabine Mueller
- Department of Pediatric Oncology, University of California San Francisco, San Francisco, CA
| | | | | | - Maryam Fouladi
- Nationwide Children’s Hospital, Department of Neuro-Oncology, Columbus, OH Division of Hematology/Oncology
| | - Eric Bouffet
- Hospital for Sick Children, Department of Pediatrics, University of Toronto, Ontario, Canada
| | - Annie Huang
- Division of Hematology/Oncology, Cell Biology Research Program, Arthur and Sonia Labatt Brain Tumor Research Institute, Hospital for Sick Children, Department of Pediatrics, Medical Biophysics, Lab Medicine and Pathobiology University of Toronto, ON, Canada
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Nicholas G Gottardo
- Brain Tumor Research Program, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Department of Clinical Hematology, Oncology, Blood and Marrow Transplantation, Perth Children’s Hospital, Perth, WA, Australia
- Paediatrics, School of Medicine, University of Western Australia, Perth, Australia
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Elbaroody M, Abdullah A. Primary intracranial Ewing’s sarcoma/peripheral primitive neuroectodermal tumor in pediatric age group: A comprehensive review of literature. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_198_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Leary SES, Kilburn L, Geyer JR, Kocak M, Huang J, Smith KS, Hadley J, Ermoian R, MacDonald TJ, Goldman S, Phillips P, Young Poussaint T, Olson JM, Ellison DW, Dunkel IJ, Fouladi M, Onar-Thomas A, Northcott PA. Vorinostat and isotretinoin with chemotherapy in young children with embryonal brain tumors: A report from the Pediatric Brain Tumor Consortium (PBTC-026). Neuro Oncol 2021; 24:1178-1190. [PMID: 34935967 PMCID: PMC9248403 DOI: 10.1093/neuonc/noab293] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Embryonal tumors of the CNS are the most common malignant tumors occurring in the first years of life. This study evaluated the feasibility and safety of incorporating novel non-cytotoxic therapy with vorinostat and isotretinoin to an intensive cytotoxic chemotherapy backbone. METHODS PBTC-026 was a prospective multi-institutional clinical trial for children <48 months of age with newly diagnosed embryonal tumors of the CNS. Treatment included three 21-day cycles of induction therapy with vorinostat and isotretinoin, cisplatin, vincristine, cyclophosphamide, and etoposide; three 28-day cycles of consolidation therapy with carboplatin and thiotepa followed by stem cell rescue; and twelve 28-day cycles of maintenance therapy with vorinostat and isotretinoin. Patients with M0 medulloblastoma (MB) received focal radiation following consolidation therapy. Molecular classification was by DNA methylation array. RESULTS Thirty-one patients with median age of 26 months (range 6-46) received treatment on study; 19 (61%) were male. Diagnosis was MB in 20 and supratentorial CNS embryonal tumor in 11. 24/31 patients completed induction therapy within a pre-specified feasibility window of 98 days. Five-year progression-free survival (PFS) and overall survival (OS) for all 31 patients were 55 ± 15 and 61 ± 13, respectively. Five-year PFS was 42 ± 13 for group 3 MB (n = 12); 80 ± 25 for SHH MB (n = 5); 33 ± 19 for embryonal tumor with multilayered rosettes (ETMR, n = 6). CONCLUSION It was safe and feasible to incorporate vorinostat and isotretinoin into an intensive chemotherapy regimen. Further study to define efficacy in this high-risk group of patients is warranted.
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Affiliation(s)
- Sarah E S Leary
- Corresponding Author: Sarah E. S. Leary, MD, MS, Seattle Children’s Hospital, Mail Stop MB.8.501, 4800 Sand Point Way NE, Seattle, WA 98105, USA ()
| | - Lindsay Kilburn
- Center for Cancer and Blood Disorders, Children’s National Hospital, Washington, DC, USA
| | - J Russell Geyer
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mehmet Kocak
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jie Huang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Kyle S Smith
- Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Jennifer Hadley
- Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ralph Ermoian
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Tobey J MacDonald
- Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, Georgia, USA
| | - Stewart Goldman
- Department of Child Health, Phoenix Children’s Hospital, Phoenix, Arizona, USA
| | - Peter Phillips
- Department of Pediatric Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tina Young Poussaint
- Department of Radiology, Boston Children’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - James M Olson
- Cancer and Blood Disorders Center, Seattle Children’s Hospital, Seattle, Washington, USA,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - David W Ellison
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Maryam Fouladi
- Department of Pediatric Hematology & Oncology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Paul A Northcott
- Department of Developmental Neurobiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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7
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Low JT, Kirkpatrick JP, Peters KB. Pineal Parenchymal Tumors of Intermediate Differentiation Treated With Ventricular Radiation and Temozolomide. Adv Radiat Oncol 2021; 7:100814. [PMID: 34746517 PMCID: PMC8554459 DOI: 10.1016/j.adro.2021.100814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 07/30/2021] [Accepted: 08/27/2021] [Indexed: 01/04/2023] Open
Affiliation(s)
| | - John P. Kirkpatrick
- Radiation Oncology, Duke University School of Medicine, Durham, North Carolina
| | - Katherine B. Peters
- Departments of Neurosurgery
- Corresponding author: Katherine B. Peters, MD, PhD
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8
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Fries C, Girvin AR, Korones DN, Weintraub L, Fitzpatrick L, Andolina JR. Myeloablative Carboplatin and Thiotepa With Autologous Stem Cell Rescue for Nonmedulloblastoma High-risk CNS Tumors in Young Children. J Pediatr Hematol Oncol 2021; 43:e1223-e1227. [PMID: 34001790 DOI: 10.1097/mph.0000000000002198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 03/31/2021] [Indexed: 11/25/2022]
Abstract
Malignant central nervous system (CNS) tumors in young children have a poor prognosis and pose a therapeutic challenge. We describe 11 patients with high-risk CNS tumors (6 atypical teratoid/rhabdoid tumor, 4 nonmedulloblastoma CNS embryonal tumors, and 1 glioblastoma multiforme) who received 32 consolidation cycles of myeloablative carboplatin/thiotepa followed by autologous peripheral blood stem cell rescue. All patients underwent successful stem cell harvest without significant complications. Mean time to absolute neutrophil count ≥0.5×103/µL was 10.2±1.3 days and the mean length of hospital stay was 15.7±3.0 days. There were no regimen-related deaths. Five-year event-free survival and overall survival were 45.5±15.0% and 58.4±16.3%, respectively. Tandem carboplatin/thiotepa consolidation with autologous stem cell rescue is well-tolerated in young children with nonmedulloblastoma CNS tumors.
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Affiliation(s)
- Carol Fries
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Rochester, Rochester
| | - Angela R Girvin
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Rochester, Rochester
| | - David N Korones
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Rochester, Rochester
| | - Lauren Weintraub
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Albany Medical Center, Albany
| | - Lorna Fitzpatrick
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University at Buffalo, Buffalo, NY
| | - Jeffrey R Andolina
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Rochester, Rochester
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9
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von Hoff K, Haberler C, Schmitt-Hoffner F, Schepke E, de Rojas T, Jacobs S, Zapotocky M, Sumerauer D, Perek-Polnik M, Dufour C, van Vuurden D, Slavc I, Gojo J, Pickles JC, Gerber NU, Massimino M, Gil-da-Costa MJ, Garami M, Kumirova E, Sehested A, Scheie D, Cruz O, Moreno L, Cho J, Zeller B, Bovenschen N, Grotzer M, Alderete D, Snuderl M, Zheludkova O, Golanov A, Okonechnikov K, Mynarek M, Juhnke BO, Rutkowski S, Schüller U, Pizer B, Zezschwitz BV, Kwiecien R, Wechsung M, Konietschke F, Hwang EI, Sturm D, Pfister SM, von Deimling A, Rushing EJ, Ryzhova M, Hauser P, Łastowska M, Wesseling P, Giangaspero F, Hawkins C, Figarella-Branger D, Eberhart C, Burger P, Gessi M, Korshunov A, Jacques TS, Capper D, Pietsch T, Kool M. Therapeutic implications of improved molecular diagnostics for rare CNS-embryonal tumor entities: results of an international, retrospective study. Neuro Oncol 2021; 23:1597-1611. [PMID: 34077956 DOI: 10.1093/neuonc/noab136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Only few data are available on treatment-associated behavior of distinct rare CNS-embryonal tumor entities previously treated as "CNS-primitive neuroectodermal tumors" (CNS-PNET). Respective data on specific entities, including CNS neuroblastoma, FOXR2 activated (CNS NB-FOXR2), and embryonal tumor with multi-layered rosettes (ETMR) are needed for development of differentiated treatment strategies. METHODS Within this retrospective, international study, tumor samples of clinically well-annotated patients with the original diagnosis of CNS-PNET were analyzed using DNA methylation arrays (n=307). Additional cases (n=66) with DNA methylation pattern of CNS NB-FOXR2 were included irrespective of initial histological diagnosis. Pooled clinical data (n=292) were descriptively analyzed. RESULTS DNA methylation profiling of "CNS-PNET" classified 58(19%) cases as ETMR, 57(19%) as HGG, 36(12%) as CNS NB-FOXR2, and 89(29%) cases were classified into 18 other entities. Sixty-seven (22%) cases did not show DNA methylation patterns similar to established CNS tumor reference classes. Best treatment results were achieved for CNS NB-FOXR2 patients (5-year PFS: 63%±7%, OS: 85%±5%, n=63), with 35/42 progression-free survivors after upfront craniospinal irradiation (CSI) and chemotherapy. The worst outcome was seen for ETMR and HGG patients with 5-year PFS of 18%±6% and 22%±7%, and 5-year OS of 24%±6% and 25%±7%, respectively. CONCLUSION The historically reported poor outcome of CNS-PNET patients becomes highly variable when tumors are molecularly classified based on DNA methylation profiling. Patients with CNS NB-FOXR2 responded well to current treatments and a standard-risk-CSI based regimen may be prospectively evaluated. The poor outcome of ETMR across applied treatment strategies substantiates the necessity for evaluation of novel treatments.
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Affiliation(s)
- Katja von Hoff
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - Felix Schmitt-Hoffner
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, Heidelberg, Germany
| | - Elizabeth Schepke
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Teresa de Rojas
- Pediatric OncoGenomics Unit, Children's University Hospital Niño Jesús, Madrid, Spain
| | - Sandra Jacobs
- Department of Pediatrics, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Michal Zapotocky
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - David Sumerauer
- Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Marta Perek-Polnik
- Department of Oncology, The Children's Memorial Health Institute, University of Warsaw, Warsaw, Poland
| | - Christelle Dufour
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Villejuif, France.,Paris-Saclay University, INSERM, Molecular predictors and New targets in Oncology, Villejuif, France
| | | | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine and Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Jessica C Pickles
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital, Zurich, Switzerland
| | - Maura Massimino
- Pediatric Unit, Fondazione IRCCS Istituto Nazionale die Tumori, Milan, Italy
| | | | - Miklos Garami
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Ella Kumirova
- Department of Neuro-Oncology, Dmitry Rogachev National Medical Research Center for Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Astrid Sehested
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - David Scheie
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Frederik Vs vej 11, 2100 Copenhagen, Denmark
| | - Ofelia Cruz
- Pediatric Oncology Department. Hospital Sant Joan de Deu. Barcelona, Spain
| | - Lucas Moreno
- Paediatric Haematology & Oncology Division, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jaeho Cho
- Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Bernward Zeller
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Niels Bovenschen
- Department of Pathology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michael Grotzer
- Department of Oncology, University Children's Hospital, Zurich, Switzerland
| | - Daniel Alderete
- Service of Hematology/Oncology, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health and School of Medicine, New York, NY, USA
| | - Olga Zheludkova
- Department of Neurooncology, Russian Scientific Center of Radiology, Moscow, Russia
| | - Andrey Golanov
- Department of Neuroradiology, Burdenko Neurosurgical Institute, Moscow, Russia
| | - Konstantin Okonechnikov
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - B Ole Juhnke
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, Hamburg, Germany
| | - Barry Pizer
- Institute of Translational Research, University of Liverpool, UK
| | - Barbara V Zezschwitz
- Department of Pediatric Oncology and Hematology, Charité University Medicine, Berlin, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Maximilian Wechsung
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine and Berlin Institute of Health, Berlin, Germany
| | - Frank Konietschke
- Institute of Biometry and Clinical Epidemiology, Charité University Medicine and Berlin Institute of Health, Berlin, Germany
| | - Eugene I Hwang
- Department of Pediatric Hematology-Oncology, Center for Cancer and Immunology Research and Neuroscience Research, Children's National Medical Center, Washington DC, USA
| | - Dominik Sturm
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabeth J Rushing
- Institute of Neuropathology, University Medical Center Zurich, Zurich, Switzerland
| | - Marina Ryzhova
- Department of Neuropathology, Burdenko Neurosurgical Institute, Moscow, Russia
| | - Peter Hauser
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Maria Łastowska
- Department of Pathomorphology, Children's Memorial Health Institute, Warsaw, Poland
| | - Pieter Wesseling
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.,Amsterdam University Medical Center / VUmc, Amsterdam, The Netherlands
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli (IS), Italy
| | - Cynthia Hawkins
- Division of Pathology, The Hospital for Sick Children, Toronto, Canada
| | - Dominique Figarella-Branger
- Aix-Marseille Univ, APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France
| | - Charles Eberhart
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Peter Burger
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Marco Gessi
- Neuropathology Unit, Division of Pathology, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Università Cattolica S.Cuore, Rome, Italy
| | - Andrey Korshunov
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tom S Jacques
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - David Capper
- Department of Neuropathology, Charité University Medicine, and Berlin Institute of Health, Berlin, Germany.,German Cancer Consortium (DKTK), partner site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn, DZNE German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Marcel Kool
- Hopp Children´s Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany.,Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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10
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Early signs of metabolic syndrome in pediatric central nervous system tumor survivors after high-dose chemotherapy and autologous stem-cell transplantation and radiation. Childs Nerv Syst 2021; 37:1087-1094. [PMID: 33205297 DOI: 10.1007/s00381-020-04971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Cancer survivors treated with stem-cell transplant (SCT) and radiation therapy are at a high risk for late effects including the metabolic syndrome. This study reviewed the prevalence of the metabolic syndrome in pediatric central nervous system (CNS) tumor survivors treated with autologous SCT and craniospinal radiation. METHODS A prospective, cross-sectional study in pediatric CNS tumor patients, who underwent a one-time evaluation at least 18 months post-autologous SCT for the presence of components of metabolic syndrome: obesity, hypertension, hyperlipidemia, and abnormal glucose levels. RESULTS Twelve patients were evaluated, and two (16%) met full criteria for the metabolic syndrome. Seven patients (58%) had at least one component of metabolic syndrome: elevated glucose levels in 8% (1/12), obesity 17% (2/12), hypertriglyceridemia 17% (2/12), and reduced HDL cholesterol in 25% (3/12). None had hypertension. Nine patients (75%) demonstrated abnormal fasting lipid profiles with elevated total cholesterol levels, although only 25% (3/12) fulfilled criteria for a diagnosis of dyslipidemia. CONCLUSION Pediatric CNS tumor survivors treated with autologous SCT and craniospinal radiation are at risk for early signs of metabolic syndrome, most commonly hyperlipidemia. Further studies evaluating the progression of these early signs to full criteria for the metabolic syndrome diagnosis are required.
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11
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Lambo S, von Hoff K, Korshunov A, Pfister SM, Kool M. ETMR: a tumor entity in its infancy. Acta Neuropathol 2020; 140:249-266. [PMID: 32601913 PMCID: PMC7423804 DOI: 10.1007/s00401-020-02182-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 12/18/2022]
Abstract
Embryonal tumor with Multilayered Rosettes (ETMR) is a relatively rare but typically deadly type of brain tumor that occurs mostly in infants. Since the discovery of the characteristic chromosome 19 miRNA cluster (C19MC) amplification a decade ago, the methods for diagnosing this entity have improved and many new insights in the molecular landscape of ETMRs have been acquired. All ETMRs, despite their highly heterogeneous histology, are characterized by specific high expression of the RNA-binding protein LIN28A, which is, therefore, often used as a diagnostic marker for these tumors. ETMRs have few recurrent genetic aberrations, mainly affecting the miRNA pathway and including amplification of C19MC (embryonal tumor with multilayered rosettes, C19MC-altered) and mutually exclusive biallelic DICER1 mutations of which the first hit is typically inherited through the germline (embryonal tumor with multilayered rosettes, DICER1-altered). Identification of downstream pathways affected by the deregulated miRNA machinery has led to several proposed potential therapeutical vulnerabilities including targeting the WNT, SHH, or mTOR pathways, MYCN or chromosomal instability. However, despite those findings, treatment outcomes have only marginally improved, since the initial description of this tumor entity. Many patients do not survive longer than a year after diagnosis and the 5-year overall survival rate is still lower than 30%. Thus, there is an urgent need to translate the new insights in ETMR biology into more effective treatments. Here, we present an overview of clinical and molecular characteristics of ETMRs and the current progress on potential targeted therapies.
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Affiliation(s)
- Sander Lambo
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Katja von Hoff
- Department of Pediatric Oncology/Hematology, Charité University Medicine, Berlin, Germany
| | - Andrey Korshunov
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
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12
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AbdelBaki MS, Abu-Arja MH, Davidson TB, Fangusaro JR, Stanek JR, Dunkel IJ, Dhall G, Gardner SL, Finlay JL. Pineoblastoma in children less than six years of age: The Head Start I, II, and III experience. Pediatr Blood Cancer 2020; 67:e28252. [PMID: 32187454 PMCID: PMC8428681 DOI: 10.1002/pbc.28252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/03/2020] [Accepted: 02/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND We report the outcomes of patients with pineoblastoma and trilateral retinoblastoma syndrome enrolled on the Head Start (HS) I-III trials. METHODS Twenty-three children were enrolled prospectively between 1991 and 2009. Treatment included maximal surgical resection followed by five cycles of intensive chemotherapy and consolidation with marrow-ablative chemotherapy and autologous hematopoietic cell rescue (HDCx/AuHCR). Irradiation following consolidation was reserved for children over six years of age or those with residual tumor at the end of induction. RESULTS Median age was 3.12 years (range, 0.44-5.72). Three patients withdrew from the study treatment and two patients experienced chemotherapy-related death. Eight patients experienced progressive disease (PD) during induction chemotherapy and did not proceed to HDCx/AuHCR. Ten patients received HDCx/AuHCR; eight experienced PD post-consolidation. Seven patients received craniospinal irradiation (CSI) with a median dose of 20.7 Gy (range, 18-36 Gy) with boost(s) (median dose 27 Gy; range, 18-36 Gy); three received CSI as adjuvant therapy (two post-HDCx/AuHCR) and four upon progression/recurrence. The five-year progression-free survival (PFS) and overall survival (OS) were 9.7% (95% confidence intervals [CI]: 2.6%-36.0%) and 13% (95% CI: 4.5%-37.5%), respectively. Only three patients survived beyond five years. Favorable OS prognostic factors were CSI (hazard ratio [HR] = 0.30 [0.11-0.86], P = 0.025) and HDCx/AuHCR (HR = 0.40 [0.16-0.99], P = 0.047). CONCLUSIONS Within the HS I-III trials, CSI and HDCx/AuHCR were statistically associated with improved survival. The high PD rate during later induction cycles and following consolidation chemotherapy warrants consideration of fewer induction cycles prior to consolidation and the potential intensification of consolidation with multiple cycles of marrow-ablative chemotherapy and irradiation.
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Affiliation(s)
- Mohamed S. AbdelBaki
- The Division of Hematology, Oncology and Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Mohammad H. Abu-Arja
- The Department of Pediatrics, New York-Presbyterian Brooklyn Methodist Hospital, Weill-Cornell College of Medicine, Brooklyn, NY, USA
| | - Tom B. Davidson
- The Division of Hematology, Oncology and Blood & Marrow Transplantation, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | - Jason R. Fangusaro
- The Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Joseph R. Stanek
- The Division of Hematology, Oncology and Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Ira J. Dunkel
- The Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Girish Dhall
- The Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation at the University of Alabama at Birmingham, AL, USA
| | - Sharon L. Gardner
- The Stephen D. Hassenfeld Children’s Center for Cancer & Blood Disorders, New York University, New York City, NY, USA
| | - Jonathan L. Finlay
- The Division of Hematology, Oncology and Blood and Marrow Transplant, Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, USA
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13
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Yeo KK, Margol AS, Kennedy RJ, Hung L, Robison NJ, Dhall G, Asgharzadeh S. Prognostic significance of molecular subgroups of medulloblastoma in young children receiving irradiation-sparing regimens. J Neurooncol 2019; 145:375-383. [PMID: 31621042 PMCID: PMC7543681 DOI: 10.1007/s11060-019-03307-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Irradiation-avoiding strategies have been used with relative success in the treatment of infants and young children with medulloblastoma. While advances in cancer genomics have significantly improved our understanding of the tumor biology of medulloblastoma allowing for improved prognostication and risk-stratification, the molecular subgroup-specific outcomes of infants and young children with medulloblastoma treated with irradiation-avoiding strategies remains unknown. METHODS Molecular and clinical features of children with medulloblastoma treated with irradiation-avoiding strategies at Children's Hospital Los Angeles were analyzed. Molecular subgrouping of these patients was determined using a 31-gene TaqMan Low Density Array signature. Survival analyses were conducted based on 3 molecular subgroups (SHH, Group 3, and Group 4). RESULTS Twenty-eight patients with medulloblastoma received irradiation-sparing regimens and were included in this analysis. Patients were divided into SHH (n = 16), Group 3 (n = 3) and Group 4 subgroups (n = 9). Subgroup specific 5-year progression-free and overall survival was 81.2% (95% CI 52.5-93.5) and 93.7% (95% CI 63.2-99.1) for SHH, 0% and 0% for Group 3 and 0% and 44.4% (95% CI 13.6-71.9) for Group 4. CONCLUSION The majority of young children with SHH-subgroup medulloblastoma can be treated effectively with irradiation-sparing regimens. Our results support the use of chemotherapy-only strategies for upfront treatment of young children with SHH medulloblastoma, while demonstrating the urgent need for intensification/augmentation of treatment for patients with group 3/4 medulloblastoma.
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Affiliation(s)
- Kee Kiat Yeo
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, USA
| | - Ashley S Margol
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA.
| | - Rebekah J Kennedy
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
| | - Long Hung
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
| | - Nathan J Robison
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
| | - Girish Dhall
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
- The Alabama Center for Childhood Cancer and Blood Disorders at Children's of Alabama, University of Alabama at Birmingham (UAB), Birmingham, USA
| | - Shahab Asgharzadeh
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA
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14
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Choi JY, Kang HJ, Hong KT, Hong CR, Lee YJ, Park JD, Phi JH, Kim SK, Wang KC, Kim IH, Park SH, Choi YH, Cheon JE, Park KD, Shin HY. Tandem high-dose chemotherapy with topotecan-thiotepa-carboplatin and melphalan-etoposide-carboplatin regimens for pediatric high-risk brain tumors. Int J Clin Oncol 2019; 24:1515-1525. [PMID: 31352632 DOI: 10.1007/s10147-019-01517-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 07/20/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND High-dose chemotherapy (HDC) and autologous stem-cell transplantation (auto-SCT) are used to improve the survival of children with high-risk brain tumors who have a poor outcome with the standard treatment. This study aims to evaluate the outcome of HDC/auto-SCT with topotecan-thiotepa-carboplatin and melphalan-etoposide-carboplatin (TTC/MEC) regimens in pediatric brain tumors. METHODS We retrospectively analyzed the data of 33 children (median age 6 years) who underwent HDC/auto-SCT (18 tandem and 15 single) with uniform conditioning regimens. RESULTS Eleven patients aged < 3 years at diagnosis were eligible for HDC/auto-SCT to avoid or defer radiotherapy. In addition, nine patients with high-risk medulloblastoma (presence of metastasis and/or postoperative residual tumor ≥ 1.5 cm2), eight with other high-risk brain tumor (six CNS primitive neuroectodermal tumor, one CNS atypical teratoid/rhabdoid tumor, and one pineoblastoma), and five with relapsed brain tumors were enrolled. There were three toxic deaths, and two of which were due to pulmonary complications. The main reason for not performing tandem auto-SCT was due to toxicities and patient refusal. The event-free survival (EFS) and overall survival (OS) rates of all patients were 59.4% and 80.0% at a median follow-up with 49.1 months from the first HDC/auto-SCT, respectively. The EFS/OS rates of patients aged < 3 years at diagnosis, high-risk medulloblastoma, other high-risk brain tumor, and relapsed tumors were 50.0/81.8%, 87.5/85.7%, 66.7/88.9%, and 20.0/60.0%, respectively. CONCLUSIONS Although tandem HDC/auto-SCT with TTC/MEC regimens showed promising survival rates, treatment modifications are warranted to reduce toxicities. The survival rates with relapsed brain tumors were unsatisfactory despite HDC/auto-SCT, and further study is needed.
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Affiliation(s)
- Jung Yoon Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Seoul National University Cancer Research Institute, Seoul, Republic of Korea.
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Che Ry Hong
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Il Han Kim
- Seoul National University Cancer Research Institute, Seoul, Republic of Korea.,Department of Radiation Oncology, 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
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Duk Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Seoul National University Cancer Research Institute, Seoul, Republic of Korea
| | - Hee Young Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.,Seoul National University Cancer Research Institute, Seoul, Republic of Korea
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15
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Koo J, Silverman S, Nuechterlein B, Keating AK, Verneris MR, Foreman NK, Mulcahy Levy JM. Safety and feasibility of outpatient autologous stem cell transplantation in pediatric patients with primary central nervous system tumors. Bone Marrow Transplant 2019; 54:1605-1613. [PMID: 30783209 PMCID: PMC6957458 DOI: 10.1038/s41409-019-0479-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 11/09/2022]
Abstract
High-dose chemotherapy with autologous hematopoietic stem cell transplantation (autoHSCT) is a well-established treatment for pediatric central nervous system (CNS) tumors. Given the risks of toxicity and infection, pediatric autoHSCT has been historically performed on hospitalized children. As our practice evolved, some patients were transplanted as outpatients. We performed a retrospective cohort analysis of 37 patients who received 90 transplant procedures (49 outpatient and 41 inpatient) at Children’s Hospital Colorado. The most common primary diagnosis was medulloblastoma (51.4%). Of the patients transplanted as outpatients, 69.4% were admitted for fever and neutropenia and had a median time to hospitalization of day +6, with fever and neutropenia being the most common reasons for admission. The median time to neutrophil engraftment was the same in both cohorts, 11 days. Median time to platelet engraftment was 13 days (8–82 days) vs 16 days (8–106 days) (p = 0.0008). At day +100, the transplant-related mortality (TRM) was 0% for both the cohorts. At a median follow-up of 1.7 years, overall survival (OS) for all patients was 66.1% and TRM was 0% for both the cohorts. Outpatient autoHSCT for properly selected children with CNS tumors is safe and effective.
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Affiliation(s)
- Jane Koo
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA.
| | - Stacy Silverman
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Brandon Nuechterlein
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Amy K Keating
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Michael R Verneris
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Nicholas K Foreman
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA.,The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, CO, USA
| | - Jean M Mulcahy Levy
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA.,The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, CO, USA
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16
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Elshahoubi A, Khattab E, Halalsheh H, Khaleifeh K, Bouffet E, Amayiri N. Feasibility of high-dose chemotherapy protocols to treat infants with malignant central nervous system tumors: Experience from a middle-income country. Pediatr Blood Cancer 2019; 66:e27464. [PMID: 30251335 DOI: 10.1002/pbc.27464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 08/18/2018] [Accepted: 08/26/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Results of high-dose chemotherapy (HDCT) protocols for the management of malignant central nervous system (CNS) tumors in infants are mostly reported in high-income countries. We evaluated the feasibility and results of such protocols in a middle-income country (Jordan). METHODS A retrospective study of infants' charts with CNS tumors between 2006 and 2015 who were treated according to HeadStart (HS) protocols. Data included patients' demographics, chemotherapy complications, and cost. RESULTS We identified 18 patients with median age 29 months (range, 9-62 months) at diagnosis (12 HS-I and six HS-II). Distribution according to pathology was: atypical teratoid rhabdoid tumors (ATRT) (nine), primitive neuoroectodermal tumors (PNET)/pineoblastoma (five), and medulloblastoma (four). Six patients (33%) had metastatic disease, and 14 (78%) had an incomplete resection. Eleven patients achieved partial or complete remission, two stabilized, and five progressed. Ten patients did not proceed to HDCT due to progression (five), financial reasons (two), failure to collect stem cells (one), and undocumented reasons (two). Seventy-eight chemotherapy cycles were administered (median interval 26 days). Main complications during induction and consolidation were febrile neutropenia (73% and 100%), documented infections (8% and 13%), and mucositis (12% and 88%), respectively. Three patients developed moderate hearing loss. No protocol-related mortality was reported. At the last follow-up, five patients were alive: three with medulloblastoma (19, 29, and 89 months) and two with ATRT (18 and 42 months). Three survivors received focal/craniospinal radiation. The median cost of a complete HS protocol, excluding surgery/radiotherapy, was $103 500 per patient; 39% of the median cost was related to pharmacy expenses. CONCLUSIONS These protocols were manageable in our context of limited health care resources. However, considering the significant costs and the modest survival rate, better selection criteria need to be used to identify patients likely to benefit from this approach.
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Affiliation(s)
- Alya Elshahoubi
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Eman Khattab
- Pediatric Stem Cell Transplantation Unit, King Hussein Cancer Center, Amman, Jordan
| | - Hadeel Halalsheh
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Kawther Khaleifeh
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Nisreen Amayiri
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
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17
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Embryonal Tumors of the Central Nervous System in Children: The Era of Targeted Therapeutics. Bioengineering (Basel) 2018; 5:bioengineering5040078. [PMID: 30249036 PMCID: PMC6315657 DOI: 10.3390/bioengineering5040078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/12/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023] Open
Abstract
Embryonal tumors (ET) of the central nervous system (CNS) in children encompass a wide clinical spectrum of aggressive malignancies. Until recently, the overlapping morphological features of these lesions posed a diagnostic challenge and undermined discovery of optimal treatment strategies. However, with the advances in genomic technology and the outpouring of biological data over the last decade, clear insights into the molecular heterogeneity of these tumors are now well delineated. The major subtypes of ETs of the CNS in children include medulloblastoma, atypical teratoid rhabdoid tumor (ATRT), and embryonal tumors with multilayered rosettes (ETMR), which are now biologically and clinically characterized as different entities. These important developments have paved the way for treatments guided by risk stratification as well as novel targeted therapies in efforts to improve survival and reduce treatment burden.
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18
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Sung KW, Lim DH, Shin HJ. Tandem High-dose Chemotherapy and Autologous Stem Cell Transplantation in Children with Brain Tumors : Review of Single Center Experience. J Korean Neurosurg Soc 2018; 61:393-401. [PMID: 29742883 PMCID: PMC5957321 DOI: 10.3340/jkns.2018.0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/02/2018] [Accepted: 03/08/2018] [Indexed: 11/27/2022] Open
Abstract
The prognosis of brain tumors in children has improved for last a few decades. However, the prognosis remains dismal in patients with recurrent brain tumors. The outcome for infants and young children in whom the use of radiotherapy (RT) is very limited because of unacceptable long-term adverse effect of RT remains poor. The prognosis is also not satisfactory when a large residual tumor remains after surgery or when leptomeningeal seeding is present at diagnosis. In this context, a strategy using high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) has been explored to improve the prognosis of recurrent or high-risk brain tumors. This strategy is based on the hypothesis that chemotherapy dose escalation might result in improvement in survival rates. Recently, the efficacy of tandem HDCT/auto-SCT has been evaluated in further improving the outcome. This strategy is based on the hypothesis that further dose escalation might result in further improvement in survival rates. At present, the number of studies employing tandem HDCT/auto-SCT for brain tumors is limited. However, results of these pilot studies suggest that tandem HDCT/auto-SCT may further improve the outcome. In this review, we will summarize our single center experience with tandem HDCT/auto-SCT for recurrent or high-risk brain tumors.
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Affiliation(s)
- Ki Woong Sung
- Department of Pediatrics, Radiation Oncology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Pediatrics, Neurosurgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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19
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Lim DH. Radiation Therapy against Pediatric Malignant Central Nervous System Tumors : Embryonal Tumors and Proton Beam Therapy. J Korean Neurosurg Soc 2018; 61:386-392. [PMID: 29742879 PMCID: PMC5957314 DOI: 10.3340/jkns.2018.0004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/04/2018] [Accepted: 02/14/2018] [Indexed: 11/27/2022] Open
Abstract
Radiation therapy is highly effective for the management of pediatric malignant central nervous system (CNS) tumors including embryonal tumors. With the increment of long-term survivors from malignant CNS tumors, the radiation-related toxicities have become a major concern and we need to improve the treatment strategies to reduce the late complications without compromising the treatment outcomes. One of such strategies is to reduce the radiation dose to craniospinal axis or radiation volume and to avoid or defer radiation therapy until after the age of three. Another strategy is using particle beam therapy such as proton beams instead of photon beams. Proton beams have distinct physiologic advantages over photon beams and greater precision in radiation delivery to the tumor while preserving the surrounding healthy tissues. In this review, I provide the treatment principles of pediatric CNS embryonal tumors and the strategic improvements of radiation therapy to reduce treatment-related late toxicities, and finally introduce the increasing availability of proton beam therapy for pediatric CNS embryonal tumors compared with photon beam therapy.
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Affiliation(s)
- Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Richardson EA, Ho B, Huang A. Atypical Teratoid Rhabdoid Tumour : From Tumours to Therapies. J Korean Neurosurg Soc 2018; 61:302-311. [PMID: 29742888 PMCID: PMC5957315 DOI: 10.3340/jkns.2018.0061] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 12/29/2022] Open
Abstract
Atypical teratoid rhabdoid tumours (ATRTs) are the most common malignant central nervous system tumours in children ≤1 year of age and represent approximately 1–2% of all pediatric brain tumours. ATRT is a primarily monogenic disease characterized by the bi-allelic loss of the SMARCB1 gene, which encodes the hSNF5 subunit of the SWI/SNF chromatin remodeling complex. Though conventional dose chemotherapy is not effective in most ATRT patients, high dose chemotherapy with autologous stem cell transplant, radiotherapy and/or intrathecal chemotherapy all show significant potential to improve patient survival. Recent epigenetic and transcriptional studies highlight three subgroups of ATRT, each with distinct clinical and molecular characteristics with corresponding therapeutic sensitivities, including epigenetic targeting, and inhibition of tyrosine kinases or growth/lineage specific pathways.
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Affiliation(s)
- Elizabeth Anne Richardson
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Canada.,Department of Cell Biology, Hospital for Sick Children, Toronto, Canada
| | - Ben Ho
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Canada.,Department of Cell Biology, Hospital for Sick Children, Toronto, Canada
| | - Annie Huang
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Canada.,Department of Cell Biology, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Canada
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21
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Mynarek M, Pizer B, Dufour C, van Vuurden D, Garami M, Massimino M, Fangusaro J, Davidson T, Gil-da-Costa MJ, Sterba J, Benesch M, Gerber N, Juhnke BO, Kwiecien R, Pietsch T, Kool M, Clifford S, Ellison DW, Giangaspero F, Wesseling P, Gilles F, Gottardo N, Finlay JL, Rutkowski S, von Hoff K. Evaluation of age-dependent treatment strategies for children and young adults with pineoblastoma: analysis of pooled European Society for Paediatric Oncology (SIOP-E) and US Head Start data. Neuro Oncol 2017; 19:576-585. [PMID: 28011926 DOI: 10.1093/neuonc/now234] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Pineoblastoma is a rare pineal region brain tumor. Treatment strategies have reflected those for other malignant embryonal brain tumors. Patients and Methods Original prospective treatment and outcome data from international trial groups were pooled. Cox regression models were developed considering treatment elements as time-dependent covariates. Results Data on 135 patients with pineoblastoma aged 0.01-20.7 (median 4.9) years were analyzed. Median observation time was 7.3 years. Favorable prognostic factors were age ≥4 years (hazard ratio [HR] for progression-free survival [PFS] 0.270, P < .001) and administration of radiotherapy (HR for PFS 0.282, P < .001). Metastatic disease (HR for PFS 2.015, P = .006), but not postoperative residual tumor, was associated with unfavorable prognosis. In 57 patients <4 years old, 5-year PFS/overall survival (OS) were 11 ± 4%/12 ± 4%. Two patients survived after chemotherapy only, while 3 of 16 treated with craniospinal irradiation (CSI) with boost, and 3 of 5 treated with high-dose chemotherapy (HDCT) and local radiotherapy survived. In 78 patients aged ≥4 years, PFS/OS were 72 ± 7%/73 ± 7% for patients without metastases, and 50 ± 10%/55 ± 10% with metastases. Seventy-three patients received radiotherapy (48 conventionally fractionated CSI, median dose 35.0 [18.0-45.0] Gy, 19 hyperfractionated CSI, 6 local radiotherapy), with (n = 68) or without (n = 6) chemotherapy. The treatment sequence had no impact; application of HDCT had weak impact on survival in older patients. Conclusion Survival is poor in young children treated without radiotherapy. In these patients, combination of HDCT and local radiotherapy may warrant further evaluation in the absence of more specific or targeted treatments. CSI combined with chemotherapy is effective for older non-metastatic patients.
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Affiliation(s)
- Martin Mynarek
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barry Pizer
- Oncology Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Christelle Dufour
- Brain Tumor Programme, Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Dannis van Vuurden
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, Netherlands
| | - Miklos Garami
- Second Department of Pediatrics, School of Medicine, Semmelweis University, Budapest, Hungary
| | - Maura Massimino
- Department of Pediatrics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Jason Fangusaro
- Department of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Tom Davidson
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | | | - Jaroslav Sterba
- Pediatric Oncology Department, University Hospital Brno, Brno, Czech Republic
| | - Martin Benesch
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical University of Graz, Graz, Austria
| | - Nicolas Gerber
- Department of Oncology, University Children's Hospital Zurich, Zurich, Switzerland
| | - B Ole Juhnke
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Marcel Kool
- Division of Pediatric Neurooncology, German Cancer Research Center, Heidelberg, Germany
| | - Steve Clifford
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - David W Ellison
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Pieter Wesseling
- Department of Pathology, VU University Medical Center, Amsterdam, Netherlands.,Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Floyd Gilles
- Department of Pathology (Neuropathology), Children's Hospital Los Angeles and the University of Southern California, Los Angeles, California, USA
| | | | - Jonathan L Finlay
- Department of Pediatrics, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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22
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de Rojas T, Bautista F, Flores M, Igual L, Rubio R, Bardón E, Navarro L, Murillo L, Hladun R, Cañete A, Garcia-Ariza M, Garrido C, Fernández-Teijeiro A, Quiroga E, Calvo C, Llort A, de Prada I, Madero L, Cruz O, Moreno L. Management and outcome of children and adolescents with non-medulloblastoma CNS embryonal tumors in Spain: room for improvement in standards of care. J Neurooncol 2017; 137:205-213. [PMID: 29248974 DOI: 10.1007/s11060-017-2713-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/11/2017] [Indexed: 02/07/2023]
Abstract
Non-medulloblastoma CNS embryonal tumors (former PNET/Pineoblastomas) are aggressive malignancies with poor outcome that have been historically treated with medulloblastoma protocols. The purpose of this study is to present a tumor-specific, real-world data cohort of patients with CNS-PNET/PB to analyze quality indicators that can be implemented to improve the outcome of these patients. Patients 0-21 years with CNS-PNET treated in eight large institutions were included. Baseline characteristics, treatment and outcome [progression-free and overall survival (PFS and OS respectively)] were analyzed. From 2005 to 2014, 43 patients fulfilled entry criteria. Median age at diagnosis was 3.6 years (range 0.0-14.7). Histology was pineoblastoma (9%), ependymoblastoma (5%), ETANTR (7%) and PNET (77%). Median duration of the main symptom was 2 weeks (range 0-12). At diagnosis, 28% presented with metastatic disease. Seventeen different protocols were used on frontline treatment; 44% had gross total resection, 42% craniospinal radiotherapy, 86% chemotherapy, and 33% autologous hematopoietic stem cell transplantation (aHSCT). Median follow-up for survivors was 3.5 years (range 1.7-9.3). 3-year PFS was 31.9% (95% CI 17-47%) and OS 35.1% (95% CI 20-50%). Age, extent of resection and radiotherapy were prognostic of PFS and OS in univariate analysis (p < 0.05). Our series shows a dismal outcome for CNS-PNET, especially when compared to patients included in clinical trials. Establishing a common national strategy, implementing referral circuits and collaboration networks, and incorporating new molecular knowledge into routine clinical practice are accessible measures that can improve the outcome of these patients.
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Affiliation(s)
- Teresa de Rojas
- Pediatric Oncology Department, Hospital Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Francisco Bautista
- Pediatric Oncology Department, Hospital Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain
| | - Miguel Flores
- Pediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lucía Igual
- Pediatric Oncology Department, Hospital La Fe, Valencia, Spain
| | - Raquel Rubio
- Pediatric Oncology Department, Hospital Cruces, Bilbao, Spain
| | - Eduardo Bardón
- Pediatric Oncology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Lucía Navarro
- Pediatric Oncology Department, Hospital Virgen del Rocío, Sevilla, Spain
| | - Laura Murillo
- Pediatric Oncology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Raquel Hladun
- Pediatric Oncology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | - Adela Cañete
- Pediatric Oncology Department, Hospital La Fe, Valencia, Spain
| | | | - Carmen Garrido
- Pediatric Oncology Department, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eduardo Quiroga
- Pediatric Oncology Department, Hospital Virgen del Rocío, Sevilla, Spain
| | - Carlota Calvo
- Pediatric Oncology Department, Hospital Miguel Servet, Zaragoza, Spain
| | - Anna Llort
- Pediatric Oncology Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Luis Madero
- Pediatric Oncology Department, Hospital Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain
| | - Ofelia Cruz
- Pediatric Oncology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lucas Moreno
- Pediatric Oncology Department, Hospital Niño Jesús, Av. Menéndez Pelayo, 65, 28009, Madrid, Spain. .,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.
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23
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Wong KK, All S, Waxer J, Olch AJ, Venkatramani R, Dhall G, Davidson TB, Zaky W, Finlay JL. Radiotherapy after high-dose chemotherapy with autologous hematopoietic cell rescue: Quality assessment of Head Start III. Pediatr Blood Cancer 2017; 64. [PMID: 28379644 DOI: 10.1002/pbc.26529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/21/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND The use of high-dose chemotherapy with autologous hematopoietic cell rescue (AuHCR) in Head Start III is a potentially curative approach for the management of young children with central nervous system neoplasms. We report the potential influence of quality and timing of radiation therapy on the survival of patients treated on the study. PROCEDURE Between 2003 and 2009, 220 children with newly diagnosed central nervous system neoplasms were enrolled on the study. Radiation therapy was indicated following AuHCR for children between 6 and 10 years old or those younger than 6 years with residual tumor preconsolidation. Records were received for 42 patients and reviewed to determine adherence to protocol treatment volume and dose guidelines. Of these patients, seven were irradiated prior to consolidation, and additional four patients who initially avoided radiation therapy after AuHCR were subsequently treated at relapse. RESULTS Of the 31 patients who were fully evaluable, 2 refused radiation therapy until recurrence and 4 progressed between recovery from AuHCR and radiation therapy. Of the remaining 25 patients, 8 had violations in their indication, dose, or treatment volume. All violations occurred in patients under 6 years of age. Two patients could have avoided radiation therapy. There were 6 violations in the 23 patients who received radiation therapy for guideline indications. CONCLUSION All protocol violations occurred in patients under 6 years of age and were associated with decreased overall survival as was the time to start radiotherapy of greater than 11 weeks. When indicated, starting radiation therapy soon after neutrophil and platelet recovery may improve the outcome for these high-risk children.
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Affiliation(s)
- Kenneth K Wong
- Children's Hospital Los Angeles, Los Angeles, California.,Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Sean All
- University of Central Florida College of Medicine, Orlando, Florida
| | - Jonathan Waxer
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Arthur J Olch
- Children's Hospital Los Angeles, Los Angeles, California.,Department of Radiation Oncology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Rajkumar Venkatramani
- Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Girish Dhall
- Children's Hospital Los Angeles, Los Angeles, California
| | - Tom Belle Davidson
- Division of Hematology/Oncology, University of California Los Angeles, Pediatrics, Los Angeles, California
| | - Wafik Zaky
- MD Anderson Cancer Center, Pediatrics Neuro-oncology Program, Houston, Texas
| | - Jonathan L Finlay
- Department of Pediatrics, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
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24
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Guerra JA, Dhall G, Marachelian A, Castillo E, Malvar J, Wong K, Sposto R, Finlay JL. Marrow-ablative chemotherapy followed by tandem autologous hematopoietic cell transplantation in pediatric patients with malignant brain tumors. Bone Marrow Transplant 2017; 52:1543-1548. [PMID: 28783147 DOI: 10.1038/bmt.2017.166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 04/29/2017] [Accepted: 06/18/2017] [Indexed: 11/09/2022]
Abstract
To improve survival in young children with malignant brain tumors, irradiation-avoiding or -minimizing marrow-ablative chemotherapy (HDCx) with autologous hematopoietic cell transplantation (AuHCT) has been investigated. We evaluated the outcome of 44 children with malignant brain tumors treated with HDCx and tandem AuHCT at Children's Hospital Los Angeles between June 1999 and July 2012. Forty-four children with malignant brain tumors were studied. Twenty-one had medulloblastoma/primitive neuro-ectodermal tumor, eight atypical teratoid/rhabdoid tumor (ATRT), five high-grade glioma, four malignant germ cell tumor, three ependymoma and three choroid plexus carcinoma. Twenty-nine patients received three tandem transplants and 15 received two tandem transplants, respectively. The 5-year PFS and overall survivals (OS) for all patients were 46.3±8.2% and 51.7±8.5%, respectively. The PFS and OS for 27 newly diagnosed patients were 68.9±9.9% and 73.5±9.3%, respectively, compared with 17 transplanted at relapse 11.8±9.8% (P<0.001) and 15.1±12.3% (P=0.0231), respectively. The 5-year PFS and OS in 13 previously unirradiated patients were 74±13% and 74±13% versus 33.2±9.8% and 40.2±10.6% in 31 irradiated patients (P=0.11 and P=0.239), respectively. One patient died of transplant-related toxicity. HDCx with tandem AuHCT is feasible and safe in children with malignant brain tumors with encouraging irradiation-free survival in newly diagnosed children.
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Affiliation(s)
- J A Guerra
- Sections of Pediatric Hematology-Oncology-BMT and Neuro-oncology, Department of Pediatrics, HIMA San Pablo Oncology Hospital, Caguas, Puerto Rico
| | - G Dhall
- The Neuro-oncology Program, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Marachelian
- The Neuro-oncology Program, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - E Castillo
- Bone Marrow Transplant Division, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles,Los Angeles, California, USA
| | - J Malvar
- Bone Marrow Transplant Division, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles,Los Angeles, California, USA
| | - K Wong
- The Neuro-oncology and Radiation Oncology Programs, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Sposto
- Children's Center for Cancer and Blood Diseases, Department of Statistics, Children's Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - J L Finlay
- Division of Hematology, Oncology and BMT, Neuro-oncology Program, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
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Lee JW, Lim DH, Sung KW, Lee HJ, Yi ES, Yoo KH, Koo HH, Suh YL, Shin HJ. Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for High-Grade Gliomas in Children and Adolescents. J Korean Med Sci 2017; 32:195-203. [PMID: 28049229 PMCID: PMC5219984 DOI: 10.3346/jkms.2017.32.2.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/20/2016] [Indexed: 11/20/2022] Open
Abstract
With the aim to investigate the outcome of tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) for high-grade gliomas (HGGs), we retrospectively reviewed the medical records of 30 patients with HGGs (16 glioblastomas, 7 anaplastic astrocytomas, and 7 other HGGs) between 2006 and 2015. Gross or near total resection was possible in 11 patients. Front-line treatment after surgery was radiotherapy (RT) in 14 patients and chemotherapy in the remaining 16 patients including 3 patients less than 3 years of age. Eight of 12 patients who remained progression free and 5 of the remaining 18 patients who experienced progression during induction treatment underwent the first HDCT/auto-SCT with carboplatin + thiotepa + etoposide (CTE) regimen and 11 of them proceeded to the second HDCT/auto-SCT with cyclophosphamide + melphalan (CyM) regimen. One patient died from hepatic veno-occlusive disease (VOD) during the second HDCT/auto-SCT; otherwise, toxicities were manageable. Four patients in complete response (CR) and 3 of 7 patients in partial response (PR) or second PR at the first HDCT/auto-SCT remained event free: however, 2 patients with progressive tumor experienced progression again. The probabilities of 3-year overall survival (OS) after the first HDCT/auto-SCT in 11 patients in CR, PR, or second PR was 58.2% ± 16.9%. Tumor status at the first HDCT/auto-SCT was the only significant factor for outcome after HDCT/auto-SCT. There was no difference in survival between glioblastoma and other HGGs. This study suggests that the outcome of HGGs in children and adolescents after HDCT/auto-SCT is encouraging if the patient could achieve CR or PR before HDCT/auto-SCT.
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Affiliation(s)
- Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, 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
| | - Hyeong Jin Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sang Yi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Infinger LK, Stevenson CB. Re-Examining the Need for Tissue Diagnosis in Pediatric Diffuse Intrinsic Pontine Gliomas: A Review. Curr Neuropharmacol 2017; 15:129-133. [PMID: 27109746 PMCID: PMC5327458 DOI: 10.2174/1570159x14666160425114024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/18/2014] [Accepted: 02/08/2016] [Indexed: 01/24/2023] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a malignant brain tumor of childhood that carries an extremely poor prognosis. There are ~200-300 new cases diagnosed each year, [1, 2] and little progress has been made in changing the prognosis and outcome of the tumor since it was first documented in the literature in 1926 [3]. The median overall survival is 8-11 months [4], with an overall survival rate of 30% at 1 year, and less than 10% at 2 years [4]. This review will provide background information on DIPGs, a historical look at the trends in caring for DIPG, and current trends in diagnosis and treatment. By changing the way we care for these terminal tumors, we can work towards having a better understanding of the underlying molecular biology, and attempt to develop better chemotherapeutic tools to combat the disease.
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Affiliation(s)
| | - Charles B. Stevenson
- Cincinnati Children’s Hospital Medical Center, Division of Pediatric Neurosurgery, USA
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Nazemi KJ, Shen V, Finlay JL, Boyett J, Kocak M, Lafond D, Gardner SL, Packer RJ, Nicholson HS. High Incidence of Veno-Occlusive Disease With Myeloablative Chemotherapy Following Craniospinal Irradiation in Children With Newly Diagnosed High-Risk CNS Embryonal Tumors: A Report From the Children's Oncology Group (CCG-99702). Pediatr Blood Cancer 2016; 63:1563-70. [PMID: 27203542 PMCID: PMC4955719 DOI: 10.1002/pbc.26074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/18/2016] [Accepted: 04/28/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The outcomes with high-risk central nervous system (CNS) embryonal tumors remain relatively poor despite aggressive treatment. The purposes of this study using postirradiation myeloablative chemotherapy with autologous hematopoietic stem cell rescue (ASCR) were to document feasibility and describe toxicities of the regimen, establish the appropriate dose of thiotepa, and estimate the overall survival (OS) and event-free survival (EFS). PROCEDURE The Children's Cancer Group conducted this pilot study in children and adolescents with CNS embryonal tumors. The treatment consisted of induction chemotherapy to mobilize hematopoietic stem cells, chemoradiotherapy, and myeloablative consolidation chemotherapy with ASCR. RESULTS The study accrued 25 subjects in 40 months and was closed early due to toxicity, namely, veno-occlusive disease (VOD) of the liver, more recently termed sinusoidal obstructive syndrome (SOS). Of 24 eligible subjects, three of 11 (27%) receiving thiotepa Dose Level 1 (150 mg/m(2) /day × 3 days) and three of 12 (25%) receiving de-escalated Dose Level 0 (100 mg/m(2) /day × 3 days) experienced VOD/SOS. One additional subject experienced toxic death attributed to septic shock; postmortem examination revealed clinically undiagnosed VOD/SOS. The 2-year EFS and OS were 54 ± 10% and 71 ± 9%, respectively. The 5-year EFS and OS were 46 ± 11% and 50 ± 11%. CONCLUSIONS The treatment regimen was deemed to have an unacceptable rate of VOD/SOS. There was complete recovery in all six cases. The overall therapeutic strategy using a regimen less likely to cause VOD/SOS may merit further evaluation for the highest risk patients.
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Affiliation(s)
- Kellie J. Nazemi
- Oregon Health & Science University, Doernbecher Children's Hospital, Department of Pediatrics, Division of Pediatric Hematology-Oncology, 3181 SW Sam Jackson Park Road, CDRC-P, Portland, Oregon 97239
| | - Violet Shen
- Children's Hospital of Orange County, Cancer Institute, 1201 West LaVeta, Orange, California 92868
| | | | - James Boyett
- Saint Jude Children's Research Hospital, Biostatistics, 262 Danny Thomas Place, MS763, Memphis, Tennessee 38105-3678
| | - Mehmet Kocak
- University of Tennessee Health Science Center, Department of Preventive Medicine, 66 N. Pauline Street, Suite 633, Memphis, Tennessee 38103
| | - Deborah Lafond
- Children's National Health System, Department of Hematology-Oncology, 111 Michigan Avenue NW, Washington, DC 20010-2970
| | - Sharon L. Gardner
- New York University Langone Medical Center, Hassenfeld Children's Center, 160 East 32 Street, 2 Floor, New York, NY 10016
| | - Roger J. Packer
- Children's National Health System, Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute, 111 Michigan Avenue NW, Washington, DC 20010-2970
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Choi SH, Kim SH, Shim KW, Han JW, Choi J, Kim DS, Lyu CJ, Kim JW, Suh CO, Cho J. Treatment Outcome and Prognostic Molecular Markers of Supratentorial Primitive Neuroectodermal Tumors. PLoS One 2016; 11:e0153443. [PMID: 27074032 PMCID: PMC4830607 DOI: 10.1371/journal.pone.0153443] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/29/2016] [Indexed: 11/19/2022] Open
Abstract
Background To identify prognostic factors and define the optimal management of patients with supratentorial primitive neuroectodermal tumors (sPNETs), we investigated treatment outcomes and explored the prognostic value of specific molecular markers. Methods A total of 47 consecutive patients with pathologically confirmed sPNETs between May 1985 and June 2012 were included. Immunohistochemical analysis of LIN28, OLIG2, and Rad51 expression was performed and correlated with clinical outcome. Results With a median follow-up of 70 months, 5-year overall survival (OS) and progression-free survival (PFS) was 55.5% and 40%, respectively, for all patients. Age, surgical extent, and radiotherapy were significant prognostic factors for OS and PFS. Patients who received initially planned multimodal treatment without interruption (i.e., radiotherapy and surgery (≥subtotal resection), with or without chemotherapy) showed significantly higher 5-year OS (71.2%) and PFS (63.1%). In 29 patients with available tumor specimens, tumors with high expression of either LIN28 or OLIG2 or elevated level of Rad51 were significantly associated with poorer prognosis. Conclusions We found that multimodal treatment improved outcomes for sPNET patients, especially when radiotherapy and ≥subtotal resection were part of the treatment regimen. Furthermore, we confirmed the prognostic significance of LIN28 and OLIG2 and revealed the potential role of Rad51 in sPNETs.
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Affiliation(s)
- Seo Hee Choi
- Departments of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Departments of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Won Shim
- Departments of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Han
- Departments of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Junjeong Choi
- Department of Pharmacy, College of Pharmacy, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Seok Kim
- Departments of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Chuhl Joo Lyu
- Departments of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Departments of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeho Cho
- Departments of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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Sung KW, Lim DH, Yi ES, Choi YB, Lee JW, Yoo KH, Koo HH, Kim JH, Suh YL, Joung YS, Shin HJ. Tandem High-Dose Chemotherapy and Autologous Stem Cell Transplantation for Atypical Teratoid/Rhabdoid Tumor. Cancer Res Treat 2016; 48:1408-1419. [PMID: 27034140 PMCID: PMC5080816 DOI: 10.4143/crt.2015.347] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022] Open
Abstract
Purpose We prospectively evaluated the effectiveness of tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) in improving the survival of patients with atypical teratoid/rhabdoid tumors while reducing the risks of late adverse effects from radiotherapy (RT). Materials and Methods For young children (< 3 years old), tandem HDCT/auto-SCT was administered after six cycles of induction chemotherapy. RT was deferred until after 3 years of age unless the tumor showed relapse or progression. For older patients (> 3 years old), RT including reduced-dose craniospinal RT (23.4 or 30.6 Gy) was administered either after two cycles of induction chemotherapy or after surgery, and tandem HDCT/auto-SCT was administered after six cycles of induction chemotherapy. Results A total of 13 patients (five young and eight older) were enrolled from November 2004 to June 2012. Eight patients, including all five young patients, had metastatic disease at diagnosis. Six patients (four young and two older) experienced progression before initiation of RT, and seven were able to proceed to HDCT/auto-SCT without progression during induction treatment. Three of six patients who experienced progression during induction treatment underwent HDCT/auto-SCT as salvage treatment. All five young patients died from disease progression. However, four of the eight older patients remain progression-freewith a median follow-up period of 64 months (range, 39 to 108 months). Treatment-related late toxicities were acceptable. Conclusion The required dose of craniospinal RT might be reduced in older patients if the intensity of chemotherapy is increased. However, early administration of RT should be considered to prevent early progression in young patients.
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Affiliation(s)
- Ki Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Sang Yi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bae Choi
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon-Lim Suh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo Sook Joung
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Altshuler C, Haley K, Dhall G, Vasquez L, Gardner SL, Stanek J, Finlay JL. Decreased morbidity and mortality of autologous hematopoietic transplants for children with malignant central nervous system tumors: the ‘Head Start’ trials, 1991–2009. Bone Marrow Transplant 2016; 51:945-8. [DOI: 10.1038/bmt.2016.45] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/08/2016] [Indexed: 11/09/2022]
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Orgel E, O'Neil SH, Kayser K, Smith B, Softley TL, Sherman-Bien S, Counts PA, Murphy D, Dhall G, Freyer DR. Effect of Sensorineural Hearing Loss on Neurocognitive Functioning in Pediatric Brain Tumor Survivors. Pediatr Blood Cancer 2016; 63:527-34. [PMID: 26529035 PMCID: PMC4724248 DOI: 10.1002/pbc.25804] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/18/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intensified therapy with platinum-based regimens for pediatric brain tumors has dramatically increased the number of pediatric brain tumor survivors (PBTS) but frequently causes permanent sensorineural hearing loss (SNHL). Although neurocognitive decline in PBTS is known to be associated with radiation therapy (RT), SNHL represents a potential additional contributor whose long-term impact has yet to be fully determined. METHODS The neurocognitive impact of significant SNHL (Chang scale ≥ 2b) in PBTS was assessed through a retrospective cohort study of audiograms and neurocognitive testing. Scores for neurocognitive domains and subtest task performance were analyzed to identify specific strengths and weakness for PBTS with SNHL. RESULTS In a cohort of PBTS (n = 58) treated with platinum therapy, significant SNHL was identified in more than half (55%, n = 32/58), of which the majority required hearing aids (72%, 23/32). RT exposure was approximately evenly divided between those with and without SNHL. PBTS were 6.7 ± 0.6 and 11.3 ± 0.7 years old at diagnosis and neurocognitive testing, respectively. In multivariate analyses adjusted for RT dose, SNHL was independently associated with deficits in intelligence, executive function, and verbal reasoning skills. Subtests revealed PBTS with SNHL to have poor learning efficiency but intact memory and information acquisition. CONCLUSIONS SNHL in PBTS increases the risk for severe therapy-related intellectual and neurocognitive deficits. Additional prospective investigation in malignant brain tumors is necessary to validate these findings through integration of audiology and neurocognitive assessments and to identify appropriate strategies for neurocognitive screening and rehabilitation specific to PBTS with and without SNHL.
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Affiliation(s)
- Etan Orgel
- Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach, Long Beach, California.,Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA.,Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Sharon H O'Neil
- Keck School of Medicine of University of Southern California, Los Angeles, California.,Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA.,Clinical Translational Science Institute, Children's Hospital Los Angeles, Los Angeles, CA
| | - Kimberly Kayser
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA.,Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Bea Smith
- Division of Rehabilitative Medicine at the Children's Hospital Los Angeles, Los Angeles, California
| | - Teddi L Softley
- Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach, Long Beach, California
| | - Sandra Sherman-Bien
- Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach, Long Beach, California
| | - Pamela A Counts
- Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach, Long Beach, California
| | - Devin Murphy
- Jonathan Jaques Children's Cancer Center, Miller Children's Hospital Long Beach, Long Beach, California
| | - Girish Dhall
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA.,Keck School of Medicine of University of Southern California, Los Angeles, California
| | - David R Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, CA.,Keck School of Medicine of University of Southern California, Los Angeles, California
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Biswas A, Mallick S, Purkait S, Gandhi A, Sarkar C, Singh M, Julka PK, Rath GK. Treatment outcome and patterns of failure in patients of pinealoblastoma: review of literature and clinical experience from a regional cancer centre in north India. Childs Nerv Syst 2015; 31:1291-304. [PMID: 26040934 DOI: 10.1007/s00381-015-2751-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/15/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Pinealoblastoma is a highly malignant embryonal tumour of the pineal region affecting children and young adults. We herein intend to report the clinical features and treatment outcome of patients of pinealoblastoma treated at our institute. METHODS Clinical data was collected by retrospective chart review from 2003-2012. Histopathology slides were reviewed, and relevant immunohistochemistry stains were done. Overall survival (OS) and recurrence-free survival (RFS) were analysed by Kaplan-Meier product-limit method. Univariate and multivariate analyses of prognostic factors were done by log rank test and Cox proportional hazard regression model, respectively. RESULTS Seventeen patients met the study criterion (male:female = 11:6). Median age at presentation was 14 years (range 4-47 years). Surgical resection was gross total in 6 (35.29%), near-total in 2 (11.76%), sub-total in 2 (11.76%), and limited to biopsy in 7 (41.18 %) patients. At presentation, 4 patients had leptomeningeal dissemination. Radiation therapy was delivered in all patients-craniospinal irradiation in 15 (88.24%), whole brain irradiation in 1 (5.88%), and whole ventricular irradiation followed by boost in 1 (5.88%) patient. Systemic chemotherapy (median 6 cycles) was given in 14 (82.35%) patients. The most common regimen was a combination of carboplatin and etoposide, used in 10 (58.82%) patients. After a median follow-up of 30.3 months (mean 32.01 months), death and disease recurrences were noted in 3 (17.65%) and 7 (41.18%) patients. Amongst the patients with recurrent disease, 4 had spinal drop metastases and 3 had local recurrence along with spinal drop metastases. Median OS was not reached, and estimated median RFS was noted to be 5.49 years. The actuarial rates of OS and RFS at 2 years were 85.6 and 73.1%, respectively. On univariate analysis, age more than 8 years (P = 0.0071) and M0 stage (P = 0.0483) were significant predictors of improved RFS. Age retained significance on multivariate analysis of RFS (P = 0.02932). CONCLUSION Maximal safe resection followed by craniospinal irradiation and systemic chemotherapy with 6 cycles of carboplatin-etoposide regimen is a reasonable treatment strategy in patients of pinealoblastoma more than 8 years of age in a developing nation. However, the same strategy is less effective in younger children and innovative study designs of intensification of post-operative treatment must be explored in this age group.
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Affiliation(s)
- Ahitagni Biswas
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India, 110029,
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Treatment outcome and patterns of failure in patients of non-pineal supratentorial primitive neuroectodermal tumor: review of literature and clinical experience form a regional cancer center in north India. Acta Neurochir (Wien) 2015; 157:1251-66. [PMID: 25990846 DOI: 10.1007/s00701-015-2444-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/05/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Supra-tentorial primitive neuroectodermal tumors (SPNET) are high-grade, hemispheric tumors, which account for around 2-3 % of pediatric brain tumors. We herein intend to report the clinical features and treatment outcome of patients with nonpineal SPNET treated at our institute. METHODS Clinical data were collected by retrospective chart review from 2006 to 2012. Histopathology slides were reviewed, and relevant immunohistochemistry stains were done. Overall survival (OS), recurrence-free survival (RFS) and event-free survival (EFS) were analyzed by the Kaplan-Meier product-limit method. RESULTS Fifteen patients met the study criterion (male: female = 2:1). Median age at presentation was 11 years (range 3-49 years). Surgical resection was gross total in 6 (40%) and subtotal in 8 (53.33%) patients. At presentation, two patients had leptomeningeal dissemination. Radiation therapy was delivered in 11 (73.33%) patients: craniospinal irradiation in 8 (36 Gy/20 fractions/4 weeks to the craniospinal axis followed by a local boost of 20 Gy/10 fractions/2 weeks) and focal RT in 3 patients. Systemic chemotherapy (median 6 cycles; range 1-16 cycles), given in 13 (86.67%) patients, included the VAC regimen (vincristine, adriamycin, cyclophosphamide) alternating with IE (ifosfamide,etoposide). After a median follow-up of 22.6 months (mean, 24.47 months), complete response and progressive disease were noted in 8 (53.33%) and 7 (46.67%) patients, respectively. Median OS was not reached, and estimated median EFS was noted to be 4.12 years (actuarial rate of EFS at 2 years, 55.2%). CONCLUSION Maximal safe resection followed by craniospinal irradiation and systemic chemotherapy with 6-12 cycles of an alternating regimen of VAC and IE is a reasonable treatment strategy in patients with nonpineal SPNET.
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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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Wang ZJ, Rao L, Bhambhani K, Miller K, Poulik J, Altinok D, Sood S. Diffuse intrinsic pontine glioma biopsy: a single institution experience. Pediatr Blood Cancer 2015; 62:163-5. [PMID: 25263768 DOI: 10.1002/pbc.25224] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/20/2014] [Indexed: 11/11/2022]
Abstract
Tumor biopsy is rarely performed in diffuse intrinsic pontine glioma (DIPG) due to the presumed risk of surgical complications, although data on the surgery related morbidity of DIPG biopsy is sparse. We performed a retrospective review on 22 consecutive cases of DIPG diagnosed from 2002 to 2012 at Children's Hospital of Michigan, 15 of which underwent biopsy. Transient new or worsening neurological deficits were observed in three of 15 cases following surgery. No surgery related mortality or permanent deficit was observed, and the mean overall survival was 10.4 ± 3.8 months. Undergoing biopsy did not adversely affect the outcome.
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Affiliation(s)
- Zhihong J Wang
- Pediatric Hematology Oncology, The Carman and Ann Adams Department of Pediatrics, Wayne State University, 3901 Beaubien Street, Detroit, Michigan, 48201
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Wright KD, Panetta JC, Onar-Thomas A, Reddick WE, Patay Z, Qaddoumi I, Broniscer A, Robinson G, Boop FA, Klimo P, Ward D, Gajjar A, Stewart CF. Delayed methotrexate excretion in infants and young children with primary central nervous system tumors and postoperative fluid collections. Cancer Chemother Pharmacol 2014; 75:27-35. [PMID: 25342291 DOI: 10.1007/s00280-014-2614-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 10/15/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE High-dose methotrexate (HD-MTX) has been used to treat children with central nervous system tumors. Accumulation of MTX within pleural, peritoneal, or cardiac effusions has led to delayed excretion and increased risk of systemic toxicity. This retrospective study analyzed the association of intracranial post-resection fluid collections with MTX plasma disposition in infants and young children with brain tumors. METHODS Brain MRI findings were analyzed for postoperative intracranial fluid collections in 75 pediatric patients treated with HD-MTX and for whom serial MTX plasma concentrations (MTX) were collected. Delayed plasma excretion was defined as (MTX) ≥1 μM at 42 hours (h). Leucovorin was administered at 42 h and then every 6 h until (MTX) <0.1 μM. Population and individual MTX pharmacokinetic parameters were estimated by nonlinear mixed-effects modeling. RESULTS Fifty-eight patients had intracranial fluid collections present. Population average (inter-individual variation) MTX clearance was 96.0 ml/min/m² (41.1 CV %) and increased with age. Of the patients with intracranial fluid collections, 24 had delayed excretion; only 2 of the 17 without fluid collections (P < 0.04) had delayed excretion. Eleven patients had grade 3 or 4 toxicities attributed to HD-MTX. No significant difference was observed in intracranial fluid collection, total leucovorin dosing, or hydration fluids between those with and without toxicity. CONCLUSIONS Although an intracranial fluid collection is associated with delayed MTX excretion, HD-MTX can be safely administered with monitoring of infants and young children with intracranial fluid collections. Infants younger than 1 year may need additional monitoring to avoid toxicity.
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Affiliation(s)
- Karen D Wright
- Division of Neuro-oncology, Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 260, Memphis, TN, 38105, USA,
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Saha A, Salley CG, Saigal P, Rolnitzky L, Goldberg J, Scott S, Olshefski R, Hukin J, Sands SA, Finlay J, Gardner SL. Late effects in survivors of childhood CNS tumors treated on Head Start I and II protocols. Pediatr Blood Cancer 2014; 61:1644-52; quiz 1653-72. [PMID: 24789527 PMCID: PMC4714700 DOI: 10.1002/pbc.25064] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/21/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Due to the devastating late effects associated with cranial irradiation in young children with central nervous system (CNS) tumors, treatment for these patients has evolved to include the use of intensive chemotherapy to either avoid or postpone irradiation. While survival outcomes have improved, late effects data in survivors treated on such regimens are needed. OBJECTIVE This multi-institutional study comprehensively describes late effects in survivors treated on the Head Start I/II protocols. METHODS Survivors of CNS tumors treated on Head Start I/II protocols were enrolled. Late effects data were collected using a validated parent-report questionnaire. Social, emotional, and behavioral functioning and quality of life were assessed using parent-report on the BASC-2 and CHQ-PF50 questionnaires. RESULTS Twenty-one survivors (medulloblastoma = 13, sPNET = 4, ATRT = 1, ependymoma = 3) were enrolled. Ten (48%) were irradiation-free. Late effects (frequency; median time of onset since diagnosis) included ≥ grade III hearing loss (67%; 3.9 years), vision (67%; 4.1 years), hypothyroidism (33%; 4 years), growth hormone (GH) deficiency (48%; 4.7 years), dental (52%; 7.1 years), and no cases of secondary leukemia. Irradiation-free (vs. irradiated) survivors reported low rates of hypothyroidism (0/10 vs. 7/11; P = 0.004) and GH deficiency (2/10 vs. 8/11; P = 0.03). The BASC-2 and CHQPF-50 mean composite scores were within average ranges relative to healthy comparison norms. Neither age at diagnosis nor irradiation was associated with these scores. CONCLUSIONS Irradiation-free Head Start survivors have lower risk of hypothyroidism and GH deficiency. Secondary leukemias are not reported. With extended follow-up, survivors demonstrate quality of life, social, emotional, and behavioral functioning within average ranges.
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Affiliation(s)
- Aniket Saha
- New York University Langone Medical Center, New York, NY
| | | | - Preeti Saigal
- New York University Langone Medical Center, New York, NY
| | | | | | | | | | | | | | | | - Sharon L. Gardner
- New York University Langone Medical Center, New York, NY,Address for correspondence Sharon Gardner, MD, Stephen D. Hassenfeld Children’s Center for Cancer and Blood Disorders, 160 East 32 Street, L3 (Medical Floor), New York, NY 10016, Phone: 212-263-8400, Fax: 212-263-8410
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Lester RA, Brown LC, Eckel LJ, Foote RT, NageswaraRao AA, Buckner JC, Parney IF, Wetjen NM, Laack NN. Clinical outcomes of children and adults with central nervous system primitive neuroectodermal tumor. J Neurooncol 2014; 120:371-9. [DOI: 10.1007/s11060-014-1561-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/21/2014] [Indexed: 02/02/2023]
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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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Adamski J, Ramaswamy V, Huang A, Bouffet E. Advances in managing medulloblastoma and intracranial primitive neuro-ectodermal tumors. F1000PRIME REPORTS 2014; 6:56. [PMID: 25184046 PMCID: PMC4108954 DOI: 10.12703/p6-56] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Medulloblastoma and central nervous system (CNS)-primitive neuro-ectodermal tumors (PNETs) are a diverse group of entities which encompasses different pathological and clinical pictures. Initially divided based on histology and location, molecular insight is leading to new definitions and a change in the borders delineating these diseases, such that they become more divergent. Current treatment approaches consist of surgical resection, radiotherapy and intensive chemotherapy, dependent on age. Stratification is one risk factor shown to be prognostic and is divided into high- and average-risks. Outcomes with modern treatment regimens are good, particularly in average-risk medulloblastoma patients, but the cost of cure is high, with high rates of neurocognitive, endocrine and social dysfunction. The changing biological landscape, however, may allow for clearer prediction of tumor behavior, to better identify "good" and "bad" players within these groups. Discovery of subgroups with changes in dependent molecular pathways will also lead to the development of new specific targeted therapies. Presenting exciting opportunities, these advances may transform the treatment for some patients, revolutionizing therapy in the future. Several challenges, however, are yet to be faced and caution is needed not to abandon previously defined prognostic factors on the strength of thus far retrospective evidence. We are witnessing a new era of trials with biological stratification involving multiple subgroups and treatment arms, based on specific tumor-related targets. This review discusses the changing face of medulloblastoma and CNS-PNETs and how we move molecular advances into clinical trials that benefit patients.
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Affiliation(s)
- Jenny Adamski
- Division of Haematology/Oncology, The Hospital for Sick Children555 University Avenue Toronto, Ontario M5G 1X8Canada
| | - Vijay Ramaswamy
- Arthur and Sonia Labatt Brain Tumour Research Centre, Brain Tumour Research Centre, TMDT101 College St., 11-701 Toronto, Ontario M5G 1L7Canada
| | - Annie Huang
- Division of Haematology/Oncology, The Hospital for Sick Children555 University Avenue Toronto, Ontario M5G 1X8Canada
- Arthur and Sonia Labatt Brain Tumour Research Centre, Brain Tumour Research Centre, TMDT101 College St., 11-701 Toronto, Ontario M5G 1L7Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, The Hospital for Sick Children555 University Avenue Toronto, Ontario M5G 1X8Canada
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Frappaz D, Conter CF, Szathmari A, Valsijevic A, Mottolese C. The management of pineal tumors as a model for a multidisciplinary approach in neuro-oncology. Neurochirurgie 2014; 61:208-11. [PMID: 24863688 DOI: 10.1016/j.neuchi.2014.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 03/03/2014] [Accepted: 03/05/2014] [Indexed: 12/11/2022]
Abstract
The management of pineal tumors is a model for multidisciplinarity. Apart from an emergency situation that requires immediate shunting of cerebrospinal fluid (CSF), the initial discussion should involve at least a radiologist, a surgeon, a neurologist and an oncologist. The initial decision is whether obtaining a histological proof is obligatory. It depends on age and ethnicity, site (mono- or bifocality), presence of markers in serum as well as CSF, and/or of malignant cells in the CSF. In cases of marker elevation indicating a germ cell tumor, front line chemotherapy can avoid dangerous immediate surgery. When histological proof is required, the extent of surgery should be discussed, aiming either only at obtaining tissue or removal. If a germ cell tumor is detected, treatment will include a cisplatin-containing chemotherapy followed by focal or ventricular irradiation. Tumors of the pineal parenchyma will be treated according to grade, either by surgery alone (pinealocytoma) or chemo-radiotherapy (pinealoblastomas). Similarly, gliomas will be treated depending on their grade with several different possible lines in low grade, and usually radio-chemotherapy in high grade. A careful balance between improved survival rates and decreased long-term side effects will guide the decisions of all these specialists.
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Affiliation(s)
- D Frappaz
- Neuro-oncologie, centre Léon-Bérard, 28, rue Laennec, 69673 Lyon, France.
| | - C Faure Conter
- Institut d'hématologie et d'oncologie pédiatriques, 69673 Lyon, France
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Robison NJ, Kieran MW. Diffuse intrinsic pontine glioma: a reassessment. J Neurooncol 2014; 119:7-15. [PMID: 24792486 DOI: 10.1007/s11060-014-1448-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/13/2014] [Indexed: 11/25/2022]
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a disease of childhood whose abysmal prognosis has remained unchanged for over 50 years. Biologic investigation has been stymied by lack of pretreatment tissue, as biopsy has been reserved for atypical cases. Recent advances in surgical and molecular-analytic techniques have increased the safety and potential utility of biopsy; brainstem biopsy has now been incorporated into several prospective clinical trials. These and other recent efforts have yielded new insights into DIPG molecular pathogenesis, and opened new avenues for investigation.
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Affiliation(s)
- Nathan J Robison
- Pediatric Neuro-Oncology Program, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 W Sunset Blvd, MS#54, Los Angeles, CA, 90027, USA,
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Glass T, Cochrane DD, Rassekh SR, Goddard K, Hukin J. Growing teratoma syndrome in intracranial non-germinomatous germ cell tumors (iNGGCTs): a risk for secondary malignant transformation—a report of two cases. Childs Nerv Syst 2014; 30:953-7. [PMID: 24122016 DOI: 10.1007/s00381-013-2295-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE About 5% of pediatric intracranial germ cell tumors and 20% of non-germinomatous germ cell tumors (NGGCT) progress to growing teratoma syndrome (GTS) following chemoradiotherapy. The growing teratoma is thought to arise from the chemotherapy-resistant, teratomatous portion of a germ cell tumor and is commonly benign but may undergo malignant transformation. METHODS Two pediatric patients whose intracranial NGGCTs progressed to growing teratomas during chemotherapy and later transformed to secondary malignant tumors after partial resection and radiation therapy (RT). RESULTS Both tumors were diagnosed by MRI scans and elevated serum and CSF markers. Following normalization of tumor markers with chemotherapy and initial decrease in tumor volume, subsequent imaging showed regrowth during chemotherapy with pathology revealing benign teratoma. RT was administered. Several years following this treatment, further growth was seen with pathology indicating malignant carcinoma in one patient and malignant rhabdomyosarcoma in the other. The patient with carcinoma received palliative care while the patient with the sarcoma received further resection, intensive chemotherapy, and an autologous stem cell transplant and is currently in remission, 36 months since malignant transformation. CONCLUSION Malignant transformation of presumed residual teratoma has been seldom reported. Treatment of NGGCT involves platinum-based chemotherapy with craniospinal RT and boost to the primary site, with cure rates of around 80%. Teratomas are characteristically chemotherapy and RT resistant and are treated surgically. In the event that residual or growing teratoma is suspected, a complete resection should be considered early in the management as there is a risk of malignant transformation of residual teratoma.
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Liu Z, Zhao X, Wang Y, Mao H, Huang Y, Kogiso M, Qi L, Baxter PA, Man TK, Adesina A, Su JM, Picard D, Ching Ho K, Huang A, Perlaky L, Lau CC, Chintagumpala M, Li XN. A patient tumor-derived orthotopic xenograft mouse model replicating the group 3 supratentorial primitive neuroectodermal tumor in children. Neuro Oncol 2014; 16:787-99. [PMID: 24470556 DOI: 10.1093/neuonc/not244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Supratentorial primitive neuroectodermal tumor (sPNET) is a malignant brain tumor with poor prognosis. New model systems that replicate sPNET's molecular subtype(s) and maintain cancer stem cell (CSC) pool are needed. METHODS A fresh surgical specimen of a pediatric sPNET was directly injected into the right cerebrum of Rag2/SCID mice. The xenograft tumors were serially sub-transplanted in mouse brains, characterized histopathologically, and subclassified into molecular subtype through qRT-PCR and immunohistochemical analysis. CSCs were identified through flow cytometric profiling of putative CSC markers (CD133, CD15, CD24, CD44, and CD117), functional examination of neurosphere forming efficiency in vitro, and tumor formation capacity in vivo. To establish a neurosphere line, neurospheres were propagated in serum-free medium. RESULTS Formation of intracerebral xenograft tumors was confirmed in 4 of the 5 mice injected with the patient tumor. These xenograft tumors were sub-transplanted in vivo 5 times. They replicated the histopathological features of the original patient tumor and expressed the molecular markers (TWIST1 and FOXJ1) of group 3 sPNET. CD133(+) and CD15(+) cells were found to have strong neurosphere-forming efficiency in vitro and potent tumor-forming capacity (with as few as 100 cells) in vivo. A neurosphere line BXD-2664PNET-NS was established that preserved stem cell features and expressed group 3 markers. CONCLUSION We have established a group 3 sPNET xenograft mouse model (IC-2664PNET) with matching neurosphere line (BXD-2664PNET-NS) and identified CD133(+) and CD15(+) cells as the major CSC subpopulations. This novel model system should facilitate biological studies and preclinical drug screenings for childhood sPNET.
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Affiliation(s)
- Zhigang Liu
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Xiumei Zhao
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Yue Wang
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Hua Mao
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Yulun Huang
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Mari Kogiso
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Lin Qi
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Patricia A Baxter
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Tsz-Kwong Man
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Adekunle Adesina
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Jack M Su
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Daniel Picard
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - King Ching Ho
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Annie Huang
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Laszlo Perlaky
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Ching C Lau
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Murali Chintagumpala
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
| | - Xiao-Nan Li
- Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (Z.L., X.N.L); Laboratory of Molecular Neuro-Oncology, Texas Children's Cancer Center, Houston, Texas (Z.L., X.Z., Y.W., H.M., M.K., L.Q., X.N.L.); Texas Children's Cancer Center, Houston, Texas (P.A.B., T.K.M., J.M.S., L.P., C.C.L., M.C.); Department of Pathology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas (A.A.); Division of Hematology-Oncology, Arthur and Sonia Labatt Brain Tumor Research Center, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada (D.P., K.C. H., A.H.)
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Muzumdar D, Ventureyra ECG. Treatment of posterior fossa tumors in children. Expert Rev Neurother 2014; 10:525-46. [DOI: 10.1586/ern.10.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Watanabe T, Mizowaki T, Arakawa Y, Iizuka Y, Ogura K, Sakanaka K, Miyamoto S, Hiraoka M. Pineal parenchymal tumor of intermediate differentiation: Treatment outcomes of five cases. Mol Clin Oncol 2013; 2:197-202. [PMID: 24649332 DOI: 10.3892/mco.2013.231] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 12/12/2013] [Indexed: 11/05/2022] Open
Abstract
Pineal parenchymal tumor of intermediate differentiation (PPTID) is a rare disease, first classified by the World Health Organization in 2000. The number of available studies on the treatment of PPTID is currrently limited and the optimal management for this disease has not yet been determined. We retrospectively evaluated the treatment outcomes for PPTID at our institute and analyzed the roles of radiation therapy and chemotherapy for this disease. The clinical data on five patients diagnosed with PPTID since 2000 were retrospectively reviewed. Patients with cerebrospinal dissemination at diagnosis received biopsy-only surgery, craniospinal and whole-ventricular irradiation and chemotherapy. Patients with locally limited disease at diagnosis received local or whole-ventricular irradiation after surgery. The median relapse-free and overall survival were 72.9 and 94.1 months, respectively. Two of the five patients developed a relapse of cerebrospinal dissemination after treatment and succumbed to the disease. All the patients who received both craniospinal and whole-ventricular irradiation exhibited evidence of cerebral white matter abnormalities in magnetic resonance imaging and developed neurocognitive disorders after treatment. Although PPTID may be aggressive and has cerebrospinal fluid seeding potential, PPTID patients may survive long-term, even after recurrence. Considering the long survival time and the late adverse effects due to intensive treatment, the irradiation field and usage of chemotherapy after surgery require optimization.
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Affiliation(s)
- Tsubasa Watanabe
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yusuke Iizuka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kengo Ogura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Katsuyuki Sakanaka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
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Massimino M, Gandola L, Biassoni V, Spreafico F, Schiavello E, Poggi G, Pecori E, Vajna De Pava M, Modena P, Antonelli M, Giangaspero F. Evolving of therapeutic strategies for CNS-PNET. Pediatr Blood Cancer 2013; 60:2031-5. [PMID: 23852767 DOI: 10.1002/pbc.24540] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/26/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND A protocol for the intensive treatment of non-cerebellar PNET (CNS-PNET) combining chemotherapy and radiotherapy was launched in 2000. Efforts were subsequently made to improve the prognosis and to de-escalate the treatment for selected patient groups. PROCEDURE Twenty-eight consecutive patients were enrolled for a high-dose drug schedule (methotrexate, etoposide, cyclophosphamide, and carboplatin ± vincristine), followed by hyperfractionated accelerated CSI (HART-CSI) at total doses of 31-39 Gy, depending on the patient's age, with two high-dose thiotepa courses following CSI. After the first 15 patients had been treated, craniospinal irradiation (CSI) was replaced with focal radiotherapy (RT) for selected cases (non-metastatic and not progressing during induction chemotherapy). Eight of the 28 children received the same chemotherapy but conventionally fractionated focal RT at 54 Gy. RESULTS The 5-year progression-free survival (PFS), event-free survival (EFS), and overall survival (OS) rates were 62%, 53%, and 52%, respectively, for the whole series, and 70%, 70%, and 87% for the eight focally irradiated children. Residual disease and metastases were not prognostically significant. In children with residual disease, response to RT was significant (5-year PFS 59% vs. 20%, P = 0.01), while the total dose of CSI was not. There were three treatment-related toxic events. Relapses were local in seven cases (including two of the eight focally irradiated patients), and both local and disseminated in 2. CONCLUSIONS This intensive schedule enabled treatment stratification for the purposes of radiation, thereby sparing some children full-dose CSI. Local control is the main goal of treatment for CNS-PNET.
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Affiliation(s)
- Maura Massimino
- Department of Pediatrics, Fond. IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Tandem high-dose chemotherapy and auto-SCT for malignant brain tumors in children under 3 years of age. Bone Marrow Transplant 2013; 48:932-8. [PMID: 23318534 DOI: 10.1038/bmt.2012.263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 11/22/2012] [Accepted: 11/22/2012] [Indexed: 11/08/2022]
Abstract
In an effort to improve survival and reduce late adverse effects of radiation therapy (RT), 25 children <3 years of age with malignant brain tumors received tandem high-dose chemotherapy (HDCT) and auto-SCT following six cycles of induction chemotherapy. RT was either not given or deferred until 3 years of age if the patient was in CR after tandem HDCT/auto-SCT. Tumors relapsed or progressed in nine patients (five during induction treatment), and two of these patients survived after receiving salvage treatment, including RT. Two patients died due to toxicities during tandem HDCT/auto-SCT. A total of 16 patients survived to a median follow-up period of 52 months (range 18-96) from the time of diagnosis. Four of these patients did not receive RT, two received local RT (L-RT), three received craniospinal RT (CSRT), and seven received both L-RT and CSRT. The 5-year OS and EFS rates were 67.8±9.4% and 55.5±10.0%, respectively. Neuroendocrine and neurocognitive functions evaluated 3 years after tandem HDCT/auto-SCT were acceptable. Our results indicate that tandem HDCT/auto-SCT may improve survival in young children with malignant brain tumors with an acceptable level of risk of long-term toxicity.
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Abstract
Central nervous system tumors are the most frequent malignant tumor in children and the main cause of death in this age group after traffic accidents. The current estimates are that one adult in 2500 is a survivor of a brain tumor that occurred during childhood. These tumors are particularly heterogeneous in terms of histology/biology, treatment, and outcome. They share, however, a high risk of neurological and cognitive morbidity due to the disease itself and the treatment modalities (radiotherapy, surgery, and chemotherapy). Diagnosis is frequently delayed because symptoms are usually nonspecific at the beginning of the evolution. Posterior fossa is the most frequent site and the tumors present most frequently with signs of intracranial hypertension. Supratentorial tumors are more frequent in infants and in adolescents; seizures are not uncommon, especially for benign tumors. When adjuvant treatment is needed, radiotherapy is usually the mainstay apart from some histologies where chemotherapy may be sufficient: low-grade gliomas, desmoplastic medulloblastomas, malignant glial tumors in infants. Multidisciplinary care is best performed in tertiary care centers and should include early rehabilitation programs soon after surgery.
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Affiliation(s)
- Grill Jacques
- Brain Tumor Program, Department of Pediatric and Adolescent Oncology, Gustave Roussy Cancer Institute, Villejuif, France.
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