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Yankelevich M, Zaky W, Lafay-Cousin L, Osorio D, Adamski J, Kordes U, Finlay JL, Prados M, Mueller S. Marrow-ablative consolidation chemotherapy and molecular targeted therapy delivered in a risk-adapted manner for newly diagnosed children with choroid plexus carcinoma: A work in progress. Neurooncol Adv 2024; 6:vdae109. [PMID: 39036438 PMCID: PMC11259950 DOI: 10.1093/noajnl/vdae109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Choroid plexus carcinomas (CPC) are early childhood cancers characterized by loss of TP53 function and poor survival. We are analyzing data on TP53 status, survival, and second cancers from the largest cohort of CPC receiving chemotherapy followed by consolidation with marrow-ablative chemotherapy (HDCx). Additionally, we discuss the rationale for targeted therapies for CPC patients. Currently, 8 of the 13 with Li-Fraumeni Syndrome-associated CPC were treated and continued CPC-free, indicating that HDCx improves CPC-free survival in young children with TP53-mutated CPC. These data justify the inclusion of HDCx in the planned prospective international trial for children with TP53-mutated CPC.
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Affiliation(s)
- Maxim Yankelevich
- Division of Oncology, St. Cristopher’s Hospital for Children, Philadelphia, Pennsylvania, USA
| | - Wafik Zaky
- Department of Pediatrics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Lucie Lafay-Cousin
- Department of Pediatrics and Oncology, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Diana Osorio
- Department of Pediatrics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jenny Adamski
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jonathan L Finlay
- Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Michael Prados
- Departments of Pediatrics and Neurosurgery, University of California-San Francisco, San Francisco, California, USA
| | - Sabine Mueller
- Departments of Pediatrics and Neurosurgery, University of California-San Francisco, San Francisco, California, USA
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2
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Yeo KK, Macrae CB, Gampel B, Ahrendsen JT, Lidov H, Wright KD, Chi S, Fehnel K, Baird L, Clymer J, Aldape K, Alexandrescu S. Clinical utility of DNA methylation profiling for choroid plexus tumors. Neurooncol Adv 2024; 6:vdae097. [PMID: 38962753 PMCID: PMC11221062 DOI: 10.1093/noajnl/vdae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Background Choroid plexus tumors (CPTs) are rare, potentially aggressive CNS tumors with defined histologic criteria for grading. In recent years, several patients within our practice have demonstrated discordance between the histologic diagnosis and clinical behavior. DNA methylation profiling has emerged as a potential diagnostic adjunct for aiding the clinical approach. Methods We reviewed the clinical and pathologic data of all CPTs diagnosed at Boston Children's Hospital from 1995 to 2023. All cases with available material (38/48) underwent DNA methylation profiling at NIH/NCI, and the classifier results were correlated with the WHO histologic grade and patient outcomes. Survival information was analyzed using Kaplan-Meier curves. Results There was good correlation (11/12, 92%) between methylation class and WHO histologic grade for choroid plexus carcinomas (CPC); one histologic CPC grouped with choroid plexus papilloma (CPP) group pediatric (P). Five CPPs grouped with methylation class CPC (5/17, 29%). In the group of atypical CPPs (n = 9), there were two that grouped with methylation class CPC. Survival analysis showed utility of methylation classes in the prediction of biologic behavior. Conclusions Results indicated that methylation profiling may serve as a valuable tool in the clinical decision-making process for patients with CPTs, providing additional prognostic information compared to WHO histologic grade alone. The value of methylation array analysis is particularly important given the lack of consensus on treatment regimens for CPTs.
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Affiliation(s)
- Kee Kiat Yeo
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts, USA
| | - Cassie B Macrae
- Department of Pathology, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Forensic Pathology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Bradley Gampel
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts, USA
- Department of Pediatrics, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Jared T Ahrendsen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Hart Lidov
- Department of Pathology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Karen D Wright
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts, USA
| | - Susan Chi
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts, USA
| | - Katie Fehnel
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Lissa Baird
- Department of Neurosurgery, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Jessica Clymer
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, Massachusetts, USA
- Department of Pediatrics, New York University Lagone Medical Center, New York, New York, USA
| | - Kenneth Aldape
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Sanda Alexandrescu
- Department of Pathology, Boston Children’s Hospital, Boston, Massachusetts, USA
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3
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Adamski J, Langford V, Finlay JL. Approaches to Minimise the Neurodevelopmental Impact of Choroid Plexus Carcinoma and Its Treatment. Life (Basel) 2023; 13:1855. [PMID: 37763259 PMCID: PMC10533047 DOI: 10.3390/life13091855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
Choroid plexus carcinomas (CPC) are rare aggressive tumours that primarily affect very young children. Treatment for CPC typically involves a combination of surgery, chemotherapy, and radiation therapy. Whilst considered necessary for a cure, these therapies have significant neurocognitive consequences for patients, negatively impacting cognitive function including memory, attention, executive functioning, and full-scale intelligence quotients (FSIQ). These challenges significantly impact the quality of life and ultimately socioeconomic parameters such as the level of educational attainment, marital status, and socioeconomic status. This review looks at the tumour- and treatment-related causes of neurocognitive damage in CPC patients and the progress made in finding strategies to reduce these. Opportunities to mitigate the neurodevelopmental consequences of surgery, chemotherapy, and radiation therapy are explored in the context of CPC treatment. Evaluation of the pathological and biological mechanisms of injury has identified innovative approaches to neurocognitive protection and neurorehabilitation, which aim to limit the neurocognitive damage. This review aims to highlight multiple approaches physicians can use when treating young children with CPC, to focus on neurocognitive outcomes as a measure of success.
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Affiliation(s)
- Jenny Adamski
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Vikki Langford
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Jonathan L. Finlay
- Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
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4
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Martin B, Garman T, Laramee M, Wang A, Zhang X, Beck E, Wilson K, Klumpp-Thomas C, McKnight C, Xu X, Hagen N, Holland D, Dahmane N, Thomas CJ, Souweidane M. Preclinical validation of a novel therapeutic strategy for choroid plexus carcinoma. J Control Release 2023; 357:580-590. [PMID: 37054779 PMCID: PMC10174050 DOI: 10.1016/j.jconrel.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
Choroid plexus carcinoma (CPC) is a rare infantile brain tumor with an aggressive clinical course that often leaves children with debilitating side effects due to aggressive and toxic chemotherapies. Development of novel therapeutical strategies for this disease have been extremely limited owing to the rarity of the disease and the paucity of biologically relevant substrates. We conducted the first high-throughput screen (HTS) on a human patient-derived CPC cell line (Children Cancer Hospital Egypt, CCHE-45) and identified 427 top hits highlighting key molecular targets in CPC. Furthermore, a combination screen with a wide variety of targets revealed multiple synergistic combinations that may pave the way for novel therapeutical strategies against CPC. Based on in vitro efficiency, central nervous system (CNS) penetrance ability and feasible translational potential, two combinations using a DNA alkylating or topoisomerase inhibitors in combination with an ataxia telangiectasia mutated and rad3 (ATR) inhibitor (topotecan/elimusertib and melphalan/elimusertib respectively) were validated in vitro and in vivo. Pharmacokinetic assays established increased brain penetrance with intra-arterial (IA) delivery over intra-venous (IV) delivery and demonstrated a higher CNS penetrance for the combination melphalan/elimusertib. The mechanisms of synergistic activity for melphalan/elimusertib were assessed through transcriptome analyses and showed dysregulation of key oncogenic pathways (e.g. MYC, mammalian target of rapamycin mTOR, p53) and activation of critical biological processes (e.g. DNA repair, apoptosis, hypoxia, interferon gamma). Importantly, IA administration of melphalan combined with elimusertib led to a significant increase in survival in a CPC genetic mouse model. In conclusion, this study is, to the best of our knowledge, the first that identifies multiple promising combinatorial therapeutics for CPC and emphasizes the potential of IA delivery for the treatment of CPC.
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Affiliation(s)
- Brice Martin
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Tyler Garman
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Madeline Laramee
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Amy Wang
- Division of National Toxicology, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA; Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Xiaohu Zhang
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Erin Beck
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Kelli Wilson
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Carleen Klumpp-Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Crystal McKnight
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Xin Xu
- Division of National Toxicology, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA; Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Natalie Hagen
- Division of National Toxicology, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - David Holland
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA; Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nadia Dahmane
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Craig J Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA; Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mark Souweidane
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Spennato P, De Martino L, Russo C, Errico ME, Imperato A, Mazio F, Miccoli G, Quaglietta L, Abate M, Covelli E, Donofrio V, Cinalli G. Tumors of Choroid Plexus and Other Ventricular Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:175-223. [PMID: 37452939 DOI: 10.1007/978-3-031-23705-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Tumors arising inside the ventricular system are rare but represent a difficult diagnostic and therapeutic challenge. They usually are diagnosed when reaching a big volume and tend to affect young children. There is a wide broad of differential diagnoses with significant variability in anatomical aspects and tumor type. Differential diagnosis in tumor type includes choroid plexus tumors (papillomas and carcinomas), ependymomas, subependymomas, subependymal giant cell astrocytomas (SEGAs), central neurocytomas, meningiomas, and metastases. Choroid plexus tumors, ependymomas of the posterior fossa, and SEGAs are more likely to appear in childhood, whereas subependymomas, central neurocytomas, intraventricular meningiomas, and metastases are more frequent in adults. This chapter is predominantly focused on choroid plexus tumors and radiological and histological differential diagnosis. Treatment is discussed in the light of the modern acquisition in genetics and epigenetics of brain tumors.
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Affiliation(s)
- Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy.
| | - Lucia De Martino
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Carmela Russo
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Maria Elena Errico
- Department of Pathology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Alessia Imperato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Federica Mazio
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Giovanni Miccoli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Massimo Abate
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Eugenio Covelli
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Vittoria Donofrio
- Department of Pathology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
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6
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Alshaghel MM, Mayo W, Sakkal N, Alali K, Wereeki M. Asymptomatic choroid plexus carcinoma in an infant: Report of one case. Ann Med Surg (Lond) 2022; 78:103755. [PMID: 35592824 PMCID: PMC9110975 DOI: 10.1016/j.amsu.2022.103755] [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] [Received: 04/12/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Choroid Plexus Carcinomas (CPC) are rare malignant brain neoplasms of choroid plexus epithelium, with a tendency to occur in infants and children, especially those who are under two years of age. The Main symptoms of CPC include nausea, vomiting, headache, irritability, blurred vision, and seizures. Few studies discuss the therapeutic methods to treat this tumor. However, most of these studies confirmed the poor prognosis of it. Case presentation A two-year-old girl presented with a headache due to head trauma, normal consciousness, GCS 15/15, and without intracranial hypertension symptoms. Computed Tomography (CT) has shown a large heterogeneous lesion in the region of the right lateral ventricle. Magnetic resonance imaging (MRI) showed a large poorly-defined mass in the right lateral ventricle with mild dilatation of the ipsilateral lateral ventricle, and midline shift and marked edema surrounding it. In this case, the mass has been discovered by accident. The histological diagnosis was choroid plexus carcinoma (WHO grade 3), curettage of the right lateral ventricle was performed. Discussion and conclusion CPC is a serious condition with a poor prognosis. Early diagnosis and appropriate approaches are required in order to reduce mortality and morbidity rates. Diagnosis difficulties of Choroid Plexus carcinoma make it an important case. Correct diagnosis is often delayed, resulting in a poor prognosis. CPC should be present in the diagnosis of atypical brain tumors, especially in children and their atypical symptoms. An early and accurate diagnosis of the lesion can improve the prognosis and maintain the patient's quality of life.
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Affiliation(s)
- Mohammed Moutaz Alshaghel
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
- CME Office, Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | - Wafik Mayo
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
- Mashabek, Aleppo, Syria
- Corresponding author. Faculty of Medicine, University of Aleppo, Aleppo, Syria.
| | - Najeeb Sakkal
- Department of Neurosurgery, Aleppo University Hospital, Aleppo University, Aleppo, Syria
| | - Kutaiba Alali
- Department of Neurosurgery, Aleppo University Hospital, Aleppo University, Aleppo, Syria
| | - Mahmoud Wereeki
- Department of Neurosurgery, Aleppo University Hospital, Aleppo University, Aleppo, Syria
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7
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Final results of the Choroid Plexus Tumor study CPT-SIOP-2000. J Neurooncol 2022; 156:599-613. [PMID: 34997889 PMCID: PMC8860833 DOI: 10.1007/s11060-021-03942-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022]
Abstract
Introduction Standards for chemotherapy against choroid plexus tumors (CPT) have not yet been established. Methods CPT-SIOP-2000 (NCT00500890) was an international registry for all CPT nesting a chemotherapy randomization for high-risk CPT with Carboplatin/Etoposide/Vincristine (CarbEV) versus Cyclophosphamide/Etoposide/Vincristine (CycEV). Patients older than three years were recommended to receive irradiation: focal fields for non-metastatic CPC, incompletely resected atypical choroid plexus papilloma (APP) or metastatic choroid plexus papilloma (CPP); craniospinal fields for metastatic CPC/APP and non-responsive CPC. High risk was defined as choroid plexus carcinoma (CPC), incompletely resected APP, and all metastatic CPT. From 2000 until 2010, 158 CPT patients from 23 countries were enrolled. Results For randomized CPC, the 5/10 year progression free survival (PFS) of patients on CarbEV (n = 20) were 62%/47%, respectively, compared to 27%/18%, on CycEV (n = 15), (intention-to-treat, HR 2.6, p = 0.032). Within the registry, histological grading was the most influential prognostic factor: for CPP (n = 55) the 5/10 year overall survival (OS) and the event free survival (EFS) probabilities were 100%/97% and 92%/92%, respectively; for APP (n = 49) 96%/96% and 76%/76%, respectively; and for CPC (n = 54) 65%/51% and 41%/39%, respectively. Without irradiation, 12 out of 33 patients with CPC younger than three years were alive for a median of 8.52 years. Extent of surgery and metastases were not independent prognosticators. Conclusions Chemotherapy for Choroid Plexus Carcinoma is feasible and effective. CarbEV is superior to CycEV. A subset of CPC can be cured without irradiation. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03942-0.
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8
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Faramand A, Kano H, Niranjan A, Atik AF, Lee CC, Yang HC, Mohammed N, Liscak R, Hanuska J, Tripathi M, Kondziolka D, Sheehan J, Mathieu D, Flickinger JC, Lunsford LD. Stereotactic Radiosurgery for Choroid Plexus Tumors: A Report of the International Radiosurgery Research Foundation. Neurosurgery 2021; 88:791-796. [PMID: 33372216 DOI: 10.1093/neuros/nyaa538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Choroid plexus tumors (CPT) are rare epithelial tumors of the choroid plexus. Gross total resection (GTR) may be curative, but it is not always possible. OBJECTIVE To evaluate the role of Gamma Knife stereotactic radiosurgery (GKSRS) as either a primary or adjuvant management option for WHO grade I-III CPT through a multicenter project. METHODS A total of 32 patients (20 females) with a total of 43 treated tumors were included in the analysis. A total of 25 patients (78%) had undergone initial surgical resection. The median total tumor volume was 2.2 cc, and the median margin and maximum doses were 13 and 25.5 Gy, respectively. RESULTS Local tumor control was achieved in 69% of cases. Local tumor progression-free survival (PFS) rate for low-grade tumors at 1, 3, and 5 yr was 90%, 77%, 58%, respectively. The actuarial local tumor PFS rate for high-grade tumors at 1, 3, and 5 yr was 77%, 62%, and 62%, respectively. There was no significant difference in local tumor control rates between low- and high-grade CPT (P = .3). Gender, age, and degree of resection were not associated with treated tumor PFS. Distant intracranial spread developed in 6 patients at a median of 22 mo after initial SRS. Actuarial distant brain tumor PFS rate at 1, 2, 5, and 10 yr was 93%, 88%, 78%, and 65%, respectively. Three patients (9%) developed persistent symptomatic adverse radiation effects at a median of 11 mo after the procedure. CONCLUSION GKSRS represents a minimally invasive alternative management strategy for imaging defined or surgically recurrent low- and high-grade CPT.
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Affiliation(s)
- Andrew Faramand
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hideyuki Kano
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ahmet F Atik
- Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nasser Mohammed
- Department of Neurological Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir Hanuska
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Douglas Kondziolka
- Department of Neurological Surgery, New York University Langone Medical Center, New York, New York
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - David Mathieu
- Department of Neurosurgery, Centre de Recherche du CHUS, Université de Sherbooke, Sherbooke, Quebec, Canada
| | - John C Flickinger
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- Department of Neurological Surgery and Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Feasibility of Proton Beam Therapy for Infants with Brain Tumours: Experiences from the Prospective KiProReg Registry Study. Clin Oncol (R Coll Radiol) 2021; 33:e295-e304. [PMID: 33820696 DOI: 10.1016/j.clon.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/16/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022]
Abstract
AIMS Proton beam therapy (PBT) has increasingly been applied for the treatment of young children when radiotherapy is needed. The treatment requires intensive multimodality care and is logistically demanding. In this analysis, we evaluated our experiences in treating infants with tumours of the central nervous system with PBT. MATERIALS AND METHODS Children younger than 2 years of age treated with PBT for central nervous system tumours enrolled in the prospective registry study KiProReg were retrospectively analysed. Information on patient characteristics, treatment, toxicities and outcome were evaluated. Adverse events were classified according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE V4.0) before, during and after PBT. RESULTS Between September 2013 and June 2018, 51 infants were eligible. The median age was 19 months (range 11-23 months) at the time of PBT. Tumour entities were ependymoma (51.0%), atypical teratoid rhabdoid tumour (39.0%), high-grade glioma (6.0%), pineoblastoma (2.0%) and medulloblastoma (2.0%). The prescribed median total dose was 54.0 Gy (range 45.0-59.4 Gy). Most received local radiotherapy. In four patients, craniospinal irradiation followed by a boost to the local tumour bed was applied. The median follow-up time was 42.0 months (range 7.3-86.2 months). The estimated 3-year local control, progression-free survival and overall survival rates for all patients were 62.7, 47.1 and 76.5%, respectively. During radiotherapy, 24 events of higher-grade (CTCAE ≥ °III) toxicities were reported. Interruption of radiotherapy for more than 2 days was due to infection (n = 3) or shunt complication (n = 2). Unexpected hospitalisation during radiotherapy affected 12 patients. Late adverse events attributable to radiotherapy included endocrinopathy (CTCAE °II; 7.8%), new onset of hearing loss (CTCAE °III; 5.8%) and visual impairment (CTCAE °IV; 1.9%). Transient radiation-induced imaging changes occurred in five patients (9.8%). CONCLUSIONS Our study indicates that PBT is feasible for very young children with central nervous system tumours, at least in the short term. However, it requires challenging interdisciplinary medical care and high logistical effort. For evaluation of late effects, longer follow-up and evaluation of neurocognitive outcome are desirable. More data have to be gathered to further define the role of radiotherapy in infants over time.
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10
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Yankelevich M, Finlay JL, Gorsi H, Kupsky W, Boue DR, Koschmann CJ, Kumar-Sinha C, Mody R. Molecular insights into malignant progression of atypical choroid plexus papilloma. Cold Spring Harb Mol Case Stud 2021; 7:mcs.a005272. [PMID: 33608379 PMCID: PMC7903885 DOI: 10.1101/mcs.a005272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
Choroid plexus tumors are rare pediatric neoplasms ranging from low-grade papillomas to overtly malignant carcinomas. They are commonly associated with Li–Fraumeni syndrome and germline TP53 mutations. Choroid plexus carcinomas associated with Li–Fraumeni syndrome are less responsive to chemotherapy, and there is a need to avoid radiation therapy leading to poorer outcomes and survival. Malignant progression from choroid plexus papillomas to carcinomas is exceedingly rare with only a handful of cases reported, and the molecular mechanisms of this progression remain elusive. We report a case of malignant transformation of choroid plexus papilloma to carcinoma in a 7-yr-old male with a germline TP53 mutation in which we present an analysis of molecular changes that might have led to the progression based on the next-generation genetic sequencing of both the original choroid plexus papilloma and the subsequent choroid plexus carcinoma. Chromosomal aneuploidy was significant in both lesions with mostly gains present in the papilloma and additional significant losses in the carcinoma. The chromosomal loss that occurred, in particular loss of Chromosome 13, resulted in the losses of two critical tumor suppressor genes, RB1 and BRCA2, which might play a possible role in the observed malignant transformation.
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Affiliation(s)
- Maxim Yankelevich
- Pediatric Hematology/Oncology Program, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey 08901, USA.,Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - Jonathan L Finlay
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, Ohio 43205, USA
| | - Hamza Gorsi
- Division of Pediatric Hematology/Oncology, Children's Hospital of Michigan and Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - William Kupsky
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
| | - Daniel R Boue
- Department of Pathology, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, Ohio 43205, USA
| | - Carl J Koschmann
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Chandan Kumar-Sinha
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109, USA.,Michigan Center for Translational Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - Rajen Mody
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan 48109, USA
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11
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Farouk Sait S, Walsh MF, Karajannis MA. Genetic syndromes predisposing to pediatric brain tumors. Neurooncol Pract 2021; 8:375-390. [PMID: 34277017 DOI: 10.1093/nop/npab012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The application of high-throughput sequencing approaches including paired tumor/normal sampling with therapeutic intent has demonstrated that 8%-19% of pediatric CNS tumor patients harbor a germline alteration in a classical tumor predisposition gene (NF1, P53). In addition, large-scale germline sequencing studies in unselected cohorts of pediatric neuro-oncology patients have demonstrated novel candidate tumor predisposition genes (ELP1 alterations in sonic hedgehog medulloblastoma). Therefore, the possibility of an underlying tumor predisposition syndrome (TPS) should be considered in all pediatric patients diagnosed with a CNS tumor which carries critical implications including accurate prognostication, selection of optimal therapy, screening, risk reduction, and family planning. The Pediatric Cancer Working Group of the American Association for Cancer Research (AACR) recently published consensus screening recommendations for children with the most common TPS. In this review, we provide an overview of the most relevant as well as recently identified TPS associated with the most frequently encountered pediatric CNS tumors with an emphasis on pathogenesis, genetic testing, clinical features, and treatment implications.
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Affiliation(s)
- Sameer Farouk Sait
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael F Walsh
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Matthias A Karajannis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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12
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Liu APY, Wu G, Orr BA, Lin T, Ashford JM, Bass JK, Bowers DC, Hassall T, Fisher PG, Indelicato DJ, Klimo P, Boop F, Conklin H, Onar-Thomas A, Merchant TE, Ellison DW, Gajjar A, Robinson GW. Outcome and molecular analysis of young children with choroid plexus carcinoma treated with non-myeloablative therapy: results from the SJYC07 trial. Neurooncol Adv 2020; 3:vdaa168. [PMID: 33506206 PMCID: PMC7813199 DOI: 10.1093/noajnl/vdaa168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Choroid plexus carcinoma (CPC) is a rare and aggressive tumor of infancy without a clear treatment strategy. This study describes the outcomes of children with CPC treated on the multi-institutional phase 2 SJYC07 trial and reports on the significance of clinical and molecular characteristics. Methods Eligible children <3 years-old with CPC were postoperatively stratified to intermediate-risk (IR) stratum if disease was localized or high-risk (HR) stratum, if metastatic. All received high-dose methotrexate-containing induction chemotherapy. IR-stratum patients received focal irradiation as consolidation whereas HR-stratum patients received additional chemotherapy. Consolidation was followed by oral antiangiogenic maintenance regimen. Survival rates and potential prognostic factors were analyzed. Results Thirteen patients (median age: 1.41 years, range: 0.21-2.93) were enrolled; 5 IR, 8 HR. Gross-total resection or near-total resection was achieved in ten patients and subtotal resection in 3. Seven patients had TP53-mutant tumors, including 4 who were germline carriers. Five patients experienced progression and died of disease; 8 (including 5 HR) are alive without progression. The 5-year progression-free survival (PFS) and overall survival rates were 61.5 ± 13.5% and 68.4 ± 13.1%. Patients with TP53-wild-type tumors had a 5-year PFS of 100% as compared to 28.6 ± 17.1% for TP53-mutant tumors (P = .012). Extent of resection, metastatic status, and use of radiation therapy were not significantly associated with survival. Conclusions Non-myeloablative high-dose methotrexate-containing therapy with maximal surgical resection resulted in long-term PFS in more than half of patients with CPC. TP53-mutational status was the only significant prognostic variable and should form the basis of risk-stratification in future trials.
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Affiliation(s)
- Anthony P Y Liu
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gang Wu
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Brent A Orr
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Tong Lin
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jason M Ashford
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Johnnie K Bass
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Daniel C Bowers
- Division of Pediatric Hematology and Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tim Hassall
- Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Paul G Fisher
- Department of Neurology, Stanford University, Palo Alto, California, USA
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine-Jacksonville, Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Paul Klimo
- Department of Surgery, St. Jude Children's Research Hospital, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Frederick Boop
- Department of Surgery, St. Jude Children's Research Hospital, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, University of Tennessee Health Science Center, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Semmes Murphey Clinic, Memphis, Tennessee, USA.,Semmes Murphey Clinic, Memphis, Tennessee, USA
| | - Heather Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David W Ellison
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Giles W Robinson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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13
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Ma Y, Lim DH, Cho H, Lee JW, Sung KW, Yoo KH, Koo HH, Shin HJ, Suh YL. Tandem High-dose Chemotherapy without Craniospinal Irradiation in Treatment of Non-metastatic Malignant Brain Tumors in Very Young Children. J Korean Med Sci 2020; 35:e405. [PMID: 33316857 PMCID: PMC7735913 DOI: 10.3346/jkms.2020.35.e405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Infants and very young children with malignant brain tumors have a poorer survival and a higher risk for neurologic deficits. The present study evaluated the feasibility and effectiveness of multimodal treatment including tandem high-dose chemotherapy and autologous stem cell transplantation (HDCT/auto-SCT) in minimizing use of radiotherapy (RT) in very young children with non-metastatic malignant brain tumors. METHODS Twenty consecutive patients younger than 3 years were enrolled between 2004 and 2017. Tandem HDCT/auto-SCT was performed after six cycles of induction chemotherapy. Local RT was administered only to patients with post-operative gross residual tumor at older than 3 years. Since September 2015, early post-operative local RT for patients with atypical teratoid/rhabdoid tumor or primitive neuroectodermal tumor was administered. RESULTS All 20 enrolled patients underwent the first HDCT/auto-SCT, and 18 proceeded to the second. Two patients died from toxicity during the second HDCT/auto-SCT, and four patients experienced relapse/progression (one localized and three metastatic), three of whom remained alive after salvage treatment including RT. A total of 17 patients remained alive at a median 7.8 (range, 2.5-5.7) years from diagnosis. Nine survivors received no RT, six survivors received local RT alone, and two survivors who experienced metastatic relapse after tandem HDCT/auto-SCT received both local and craniospinal RT. The 5-year overall, event-free, and craniospinal RT-free survival rates were 85.0% ± 8.0%, 70.0% ± 10.2%, and 75.0% ± 9.7%, respectively. Neuroendocrine and neurocognitive functions evaluated 5 years after tandem HDCT/auto-SCT were acceptable. CONCLUSION Our results suggest that non-metastatic malignant brain tumors in very young children could be treated with multimodal therapy including tandem HDCT/auto-SCT while minimizing RT, particularly craniospinal RT.
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Affiliation(s)
- Youngeun Ma
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heewon Cho
- 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
| | - Ki Woong Sung
- 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
| | - Hyung Jin Shin
- Department of Neurosurgery, 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
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14
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Ellenbogen Y, Yang K, Ajani O. Transition of Care for Children with High-Grade Central Nervous System Tumors. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1716909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractThe increase in survival rates of children with high-grade central nervous system tumors has highlighted the necessity for and challenges associated with transition of care as these children grow into adult life. Late recurrence and treatment effects are some of the conditions that require care after transition. Several models of transition have been proposed in the literature. An effective transition will not only ensure adequate continuity of care but will also include assessment of effectiveness of the transition by health care personnel and the patient/patient's family themselves.
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Affiliation(s)
- Yosef Ellenbogen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kaiyun Yang
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi Ajani
- Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- McMaster University Medical Center and Children's Hospital, Hamilton, Ontario, Canada
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15
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Ruiz-Garcia H, Huayllani MT, Incontri D, Whaley JJ, Marenco-Hillembrand L, Ebot J, Chaichana KL, Sheehan J, Quiñones-Hinojosa A, Trifiletti DM. Intraventricular choroid plexus tumors: clinical characteristics and impact of current management on survival. J Neurooncol 2020; 149:283-292. [PMID: 32897467 DOI: 10.1007/s11060-020-03603-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Choroid plexus tumors (CPTs) represent one of the most common intraventricular tumors. Although most are benign, they often reach considerable sizes before clinical manifestation, challenging their surgical management. We aim to describe the clinical characteristics and the impact of current management on the survival of patients harboring intraventricular CPT. METHODS The National Cancer Database (NCDB) was queried to identify biopsy-proven intraventricular CPT patients (2004-2015). Demographic and patterns of care were described, the log-rank method was used to independently analyze survival according to age, WHO grade and extent of resection (EOR). Multivariate analysis was performed to investigate the impact of prognostic factors on overall survival (OS). RESULTS A total of 439 CPT patients with known WHO grade were included. WHO grade I tumors were more frequent in adults, while WHO grade III tumors were more common in pediatric population. Most CPTs were benign, with a median tumor size of 3-4 cm. Mean tumor size in pediatric population was greater than in adult population (4.39 cm vs. 2.7 cm; p < 0.01). Frequency was similar between males and females (51.7% vs. 48.3%; p > 0.0.5). Five- and ten-year OS among all patients was 87% and 84%, respectively. EOR was not associated with survival for any WHO grade. On multivariable analysis, only patient age (p = 0.022), WHO grade (p = 0.003) and medical comorbidity scores (p = 0.002) were independently associated with OS after diagnosis. CONCLUSION Patients with CPTs present at different stages of life, with sizable tumor burden and distinct WHO grade prevalence. Considering their favorable survival, efforts to improve tumor control should be meticulously weighed against the long-term risk associated with surgery, radiation, and chemotherapy.
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Affiliation(s)
- Henry Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Maria T Huayllani
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Diego Incontri
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Juan J Whaley
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - James Ebot
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA. .,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
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16
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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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17
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Abstract
Pediatric central nervous system (CNS) tumors are the most common solid tumors in children and comprise 15% to 20% of all malignancies in children. Presentation, symptoms, and signs depend on tumor location and age of the patient at the time of diagnosis. This article summarizes the common childhood CNS tumors, presentations, classification, and recent updates in treatment approaches due to the increased understanding of the molecular pathogenesis of pediatric brain tumors.
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Affiliation(s)
- Yoko T Udaka
- The Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Oncology, Center for Cancer and Blood Disorders, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Roger J Packer
- The Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; The Brain Tumor Institute, Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010, USA.
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18
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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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19
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Perinatal (fetal and neonatal) choroid plexus tumors: a review. Childs Nerv Syst 2019; 35:937-944. [PMID: 30953158 DOI: 10.1007/s00381-019-04135-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/20/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The object of this review is to describe the choroid plexus tumors (CPTs) occurring in the fetus and neonate with regard to clinical presentation, location, pathology, treatment, and outcome. MATERIALS AND METHODS Case histories and clinical outcomes were reviewed from 93 cases of fetal and neonatal tumors obtained from the literature and our own institutional experience from 1980 to 2016. RESULTS Choroid plexus papilloma (CPP) is the most common tumor followed by choroid plexus carcinoma (CPC) and atypical choroid plexus papilloma (ACPP). Hydrocephalus and macrocephaly are the presenting features for all three tumors. The lateral ventricles are the main site of tumor origin followed by the third and fourth ventricles, respectively. CPTs of the fetus are detected most often near the end of the third trimester of pregnancy by fetal ultrasound. The extent of surgical resection plays an important role in the treatment and outcome. In spite of excellent survival, which is especially true in the case of CPP, surgical resection may carry significant risks in an immature baby. Given the neonatal low blood volume and increased vascularity of the tumors, there is potential risk for hemorrhage. Although advances in neurosurgical techniques have led to a greater degree of complete surgical resections, survival for the perinatal CPC group remains low even with multimodality therapies. CONCLUSION Perinatal CPTs have variable overall survivals depending on degree of surgical resection and tumor biology. An increased understanding of the molecular features of these tumors may lead to improved therapies and ultimately survival.
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20
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Hosmann A, Hinker F, Dorfer C, Slavc I, Haberler C, Dieckmann K, Knosp E, Czech T. Management of choroid plexus tumors-an institutional experience. Acta Neurochir (Wien) 2019; 161:745-754. [PMID: 30783805 PMCID: PMC6431303 DOI: 10.1007/s00701-019-03832-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022]
Abstract
Background Choroid plexus tumors are rare entities. Resection is the mainstay of treatment in grade I and grade II tumors and adjuvant treatment is usually reserved for the less frequent choroid plexus carcinoma (CPC). Outcome is not only related to their histological grade but also dependent on their size, location, and presence of often multifactorial disturbances of cerebrospinal fluid (CSF) circulation. Methods Retrospective analysis of 36 consecutive patients operated on a choroid plexus tumor at our institution in a mixed pediatric and adult population between 1991 and 2016. Results Twenty-one CPP, 11 atypical choroid plexus papillomas (aCPP), and four CPC were encountered in 17 children and 19 adults. Regardless of histological grading, gross-total resection (GTR) could be achieved in 91.7% of patients. Tumor recurrence (25.0%) was significantly associated with histological grading (p = 0.004), subtotal resection (p = 0.002), and intraoperatively evident zones of tumor infiltration (p = 0.001). Adjuvant therapy was performed in 19.4% of patients, mainly diagnosed with CPC. The 5-year overall survival rate was 95.2% for CPP and 100.0% for both aCPP and CPC. Survival was related to the extent of resection (p = 0.001), tumor progression (p = 0.04), and the presence of leptomeningeal metastases (p = 0.002). Even after resection, either ventricular or subdural shunting was required in 25.0% of patients. Conclusions We could confirm that GTR is crucial for treatment of choroid plexus tumors. Parenchymal tumor infiltration as detected intraoperatively was associated with the extent of resection and not limited to CPC. CSF disturbances mandating treatment may persist after resection.
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Affiliation(s)
- Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Felix Hinker
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescence Medicine, Medical University of Vienna, Vienna, Austria
| | - Christine Haberler
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.
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Dash C, Moorthy S, Garg K, Singh PK, Kumar A, Gurjar H, Chandra PS, Kale SS. Management of Choroid Plexus Tumors in Infants and Young Children Up to 4 Years of Age: An Institutional Experience. World Neurosurg 2019; 121:e237-e245. [DOI: 10.1016/j.wneu.2018.09.089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW This article describes the most common pediatric brain tumors and highlights recent developments in their diagnosis and treatment strategies. RECENT FINDINGS We are in the midst of a molecular era for pediatric brain tumors. Genetic and epigenetic profiling of tumors has impacted their diagnosis, allowing for the subgrouping of heterogeneous tumor groups and leading to the complete renaming of some tumor types. These advances are reflected in the new 2016 World Health Organization classification. For example, primitive neuroectodermal tumors have been completely eliminated and replaced by subgroups defined by the absence or presence of specific chromosomal amplification. Medulloblastomas, diffuse astrocytomas, and ependymomas now have specific subtypes that are based on defining molecular features. More recent epigenetic-based subgrouping of atypical teratoid/rhabdoid tumors have not yet made it into the official classification system, but will surely have an impact on how these tumors are regarded in future preclinical and clinical trials. SUMMARY Genetic and epigenetic data are changing how pediatric brain tumors are diagnosed, are leading to new guidelines for how treatment outcome analyses can be organized, and are offering molecular targets that can be used for the development of novel therapies.
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Zaky W, Finlay JL. Pediatric choroid plexus carcinoma: Biologically and clinically in need of new perspectives. Pediatr Blood Cancer 2018. [PMID: 29528196 DOI: 10.1002/pbc.27031] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Choroid plexus (CP) carcinoma is a rare pediatric brain neoplasm. Recent studies have highlighted the potential of genome-wide methylation and gene expression profiling to provide additional layers of information to improve tumor risk-stratification. There is a lack of data regarding the best therapy, and approaches have been heterogeneous. Despite multidisciplinary treatment approaches, the outcome remains guarded and treatments have been based on case series and expert opinions. In this study, we discuss the recent wealth of data regarding CP carcinoma molecular biology and current management. We also briefly highlight the remaining barriers to formulate the best treatment strategies, and future therapeutic potentials.
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Affiliation(s)
- Wafik Zaky
- The Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan L Finlay
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
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Effect of Surgery, Adjuvant Therapy, and Other Prognostic Factors on Choroid Plexus Carcinoma: A Systematic Review and Individual Patient Data Analysis. Int J Radiat Oncol Biol Phys 2017; 99:1199-1206. [DOI: 10.1016/j.ijrobp.2017.08.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/10/2017] [Indexed: 12/15/2022]
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25
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Successful multimodal treatment of a gigantic choroid plexus carcinoma (CPC) in an 8-year-old girl. Childs Nerv Syst 2017; 33:1875-1877. [PMID: 28889280 DOI: 10.1007/s00381-017-3590-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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26
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Cochrane AM, Cheung C, Rangan K, Freyer D, Nahata L, Dhall G, Finlay JL. Long-term follow-up of endocrine function among young children with newly diagnosed malignant central nervous system tumors treated with irradiation-avoiding regimens. Pediatr Blood Cancer 2017; 64. [PMID: 28475292 DOI: 10.1002/pbc.26616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The adverse effects of irradiation on endocrine function among patients with pediatric brain tumor are well documented. Intensive induction chemotherapy followed by marrow-ablative chemotherapy with autologous hematopoietic cell rescue (AuHCR) without central nervous system (CNS) irradiation has demonstrated efficacy in a proportion of very young children with some malignant CNS tumors. This study assessed the long-term endocrine function of young children following chemotherapy-only treatment regimens. PROCEDURES A retrospective chart review was performed on 99 patients under 6 years of age with malignant brain tumors newly diagnosed between May 1991 and October 2010 treated with irradiation-avoiding strategies. Thirty patients survived post-AuHCR without cranial irradiation for a mean of 8.1 years (range 3.0-22.25 years). The patient cohort included 18 males and 12 females (mean age at AuHCR of 2.5 years, range 0.8-5.1 years). RESULTS All 30 surviving patients had documented normal age-related thyroid function, insulin-like growth factor binding protein 3 (IGF-BP3), prolactin, testosterone, and estradiol levels. Insulin-like growth factor 1 age-related levels were abnormal in one child with normal height. Ninety-seven percent of patients had normal cortisol levels, while follicle-stimulating hormone and LH levels among females were normal in 83% and 92%, respectively, and in 100% of males. Growth charts demonstrated age-associated growth within 2 standard deviations of the mean in 67% of patients. Of 10 patients (33%) with short stature, 6 had proportional diminutions in both height and weight. CONCLUSIONS These findings demonstrate that the use of relatively brief, intensive chemotherapy regimens including marrow-ablative chemotherapy with AuHCR results in fewer endocrine sequelae than treatment schemes utilizing CNS irradiation.
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Affiliation(s)
- Anne M Cochrane
- Division of Hematology and Oncology, Children's Hospital Los Angeles, California
| | - Clement Cheung
- Division of Endocrinology, Children's Hospital Los Angeles, California
| | - Kasey Rangan
- Division of Hematology and Oncology, Children's Hospital Los Angeles, California
| | - David Freyer
- Division of Hematology and Oncology, Children's Hospital Los Angeles, California
| | - Leena Nahata
- Division of Endocrinology, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Girish Dhall
- Division of Hematology and Oncology, Children's Hospital Los Angeles, California
| | - Jonathan L Finlay
- Division of Hematology, Oncology and BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
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Abstract
The management of choroid plexus carcinoma (CPC) is challenging and multifaceted. Here, we discuss a 3-year-old girl with CPC and Li-Fraumeni syndrome who achieved full remission after surgery and chemotherapy, with radiation therapy spared. At recurrence, we used a novel, standard-dose cytotoxic chemotherapy regimen, focal proton radiation therapy, and targeted agents based on morphoproteomic analysis to achieve long-term survival. We highlight the rationale for our therapy at recurrence, as well as the risk-benefit analyses necessary in decision making for these patients. Our strategy may be effective in managing other patients with recurrent CPC and Li-Fraumeni syndrome.
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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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Siegfried A, Morin S, Munzer C, Delisle MB, Gambart M, Puget S, Maurage CA, Miquel C, Dufour C, Leblond P, André N, Branger DF, Kanold J, Kemeny JL, Icher C, Vital A, Coste EU, Bertozzi AI. A French retrospective study on clinical outcome in 102 choroid plexus tumors in children. J Neurooncol 2017; 135:151-160. [DOI: 10.1007/s11060-017-2561-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/26/2017] [Indexed: 01/15/2023]
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30
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Bahar M, Hashem H, Tekautz T, Worley S, Tang A, de Blank P, Wolff J. Choroid plexus tumors in adult and pediatric populations: the Cleveland Clinic and University Hospitals experience. J Neurooncol 2017; 132:427-432. [DOI: 10.1007/s11060-017-2384-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 02/23/2017] [Indexed: 11/24/2022]
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31
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Kramer K. Rare Primary Central Nervous System Tumors Encountered in Pediatrics. J Child Neurol 2016; 31:1394-8. [PMID: 26801774 PMCID: PMC5028308 DOI: 10.1177/0883073815627878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 12/20/2015] [Indexed: 01/03/2023]
Abstract
As part of the special issue on Pediatric Neuro-Oncology, this article will focus on 4 of the rarer tumors in this spectrum, including atypical teratoid rhabdoid tumors, embryonal tumors with multilayered rosettes, choroid plexus tumors, and pleomorphic xanthoastrocytoma. Incidence and current understanding of the molecular pathogenesis of these tumors are discussed, and avenues of therapy both current and prospective are explored.
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Affiliation(s)
- Kim Kramer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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32
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Segal D, Karajannis MA. The promise of molecular profiling of choroid plexus tumors for diagnostic and prognostic stratification: where to go from here? Neuro Oncol 2016; 18:757-8. [DOI: 10.1093/neuonc/now048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 02/21/2016] [Indexed: 01/04/2023] Open
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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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Passariello A, Tufano M, Spennato P, Quaglietta L, Verrico A, Migliorati R, Cinalli G. The role of chemotherapy and surgical removal in the treatment of Choroid Plexus carcinomas and atypical papillomas. Childs Nerv Syst 2015; 31:1079-88. [PMID: 25863950 DOI: 10.1007/s00381-015-2697-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/30/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We performed a retrospective study on clinical assessment, tumor location, radiological imaging, histopathological characteristics, and therapeutic management of 7 patients affected by choroid plexus carcinoma (CPC) or atypical choroid plexus papilloma (ACPP) who have been observed in the last 12 years. METHODS Four patients fulfilled the criteria for classification as ACPP and three cases as CPC. The median age of the patients at the diagnosis was 42 months (range 3-190 months). Except one older patient (15 years old), all patients were younger than 3 years of age. In all patients affected by ACPP, a total surgical resection was achieved. Two children relapsed 12 and 8 months following radical removal. Both of them underwent adjuvant chemotherapy (carboplatin, cyclophosphamide, etoposide, doxorubicin, and methotrexate); a complete remission was maintained in all cases. In all three patients with CPC, it was impossible to achieve complete resection at first surgery. The response to chemotherapy was variable: in one case, it was complete with complete remission following 6 months; in one case, it was partial with reduction on volume (the patient underwent second-look surgery with complete resection); in the third case, there was no response and the patient progressed and finally died with metastatic disease, 8 months after chemotherapy was started. For children with CPC, the OS was 75% at 6 years. RESULTS In our series, surgery associated with chemotherapy led to long-term survival in 4/4 patients affected by ACPP and 2/3 patients affected by CPC. Clinical results achieved in our series confirm that our therapeutic regimen is feasible and efficient as a possible adjuvant treatment for both CPC and ACPP. It also suggests that surgery has a pivotal role in the management of most children affected by CPTs.
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Affiliation(s)
- Annalisa Passariello
- Department of Translational Medicine Science, University of Naples "Federico II", Naples, Italy
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