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Stensvold E, Myklebust TÅ, Cappelen J, Due-Tønnessen BJ, Due-Tønnessen P, Kepka A, Johannesen TB, Krossnes B, Lundar T, Maric S, Miletic H, Moholdt V, Myrmel KS, Nordberg T, Rydland J, Stokland T, Solem K, Solheim O, Torsvik I, Wikran GC, Zeller B, Wesenberg F, Bechensteen AG, Brandal P. Children treated for medulloblastoma and supratentorial primitive neuroectodermal tumor in Norway from 1974 through 2013: Unexplainable regional differences in survival. Pediatr Blood Cancer 2019; 66:e27910. [PMID: 31264356 DOI: 10.1002/pbc.27910] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND A previous study based on Norwegian Cancer Registry data suggested regional differences in overall survival (OS) after treatment for medulloblastoma (MB) and supratentorial primitive neuroectodermal tumor (CNS-PNET) in Norway. The purpose of the present study was to confirm in an extended cohort whether there were regional differences in outcome or not, and if so try to identify possible explanations. MATERIAL AND METHODS Data from patients aged 0-20 years diagnosed with and treated for MB/CNS-PNET at all four university hospitals in Norway from 1974 to 2013 were collected and compared. RESULTS Of 266 identified patients, 251 fulfilled inclusion criteria. MB was diagnosed in 200 and CNS-PNET in 51 patients. Five-year OS and event-free survival (EFS) were 59% and 52%, respectively. There was a significant difference in five-year OS and EFS between MB and CNS-PNET patients; 62% versus 47% (P = 0.007) and 57% versus 35% (P < 0.001). In multivariable analysis, two factors were found to significantly contribute to improved five-year OS and EFS, whereas one factor contributed to improved five-year OS only. Gross total resection (GTR) versus non-GTR (hazard ratio [HR] 0.53, P = 0.003; HR 0.46, P < 0.001) and cerebrospinal irradiation (CSI) versus non-CSI (HR 0.24, P < 0.001; HR 0.28, P < 0.001) for both, and treatment outside Oslo University Hospital for OS only (HR 0.64, P = 0.048). CONCLUSION Survival was comparable with data from other population-based studies, and the importance of GTR and CSI was confirmed. The cause for regional survival differences could not be identified.
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Affiliation(s)
- Einar Stensvold
- The Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pediatric Research, Oslo University Hospital, Oslo, Norway.,Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Tor Åge Myklebust
- Department of Registration, Cancer Registry of Norway, Oslo, Norway.,Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Johan Cappelen
- Department of Neurosurgery, St Olavs Hospital, Trondheim, Norway
| | | | - Paulina Due-Tønnessen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | | | - Bård Krossnes
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Tryggve Lundar
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Snezana Maric
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Hrvoje Miletic
- Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Viggo Moholdt
- Department of Radiology and Nuclear Medicine, St Olavs Hospital, Trondheim, Norway
| | | | - Terje Nordberg
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Jana Rydland
- Department of Radiology and Nuclear Medicine, St Olavs Hospital, Trondheim, Norway
| | - Tore Stokland
- Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway
| | - Kristin Solem
- Department of Pediatrics, St Olavs Hospital, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St Olavs Hospital, Trondheim, Norway
| | - Ingrid Torsvik
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Gry C Wikran
- Department of Radiology and Nuclear Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Bernward Zeller
- Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Solid Tumours in children (KSSB), Oslo University Hospital, Oslo, Norway
| | - Finn Wesenberg
- Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Advisory Unit on Solid Tumours in children (KSSB), Oslo University Hospital, Oslo, Norway
| | | | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway.,Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway.,Centre for Cancer Biomedicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Rossi Espagnet MC, Pasquini L, Napolitano A, Cacchione A, Mastronuzzi A, Caruso R, Tomà P, Longo D. Magnetic resonance imaging patterns of treatment-related toxicity in the pediatric brain: an update and review of the literature. Pediatr Radiol 2017; 47:633-648. [PMID: 27933410 DOI: 10.1007/s00247-016-3750-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/23/2016] [Accepted: 11/02/2016] [Indexed: 02/07/2023]
Abstract
Treatment-related neurotoxicity is a potentially life-threatening clinical condition that can represent a diagnostic challenge. Differentiating diagnoses between therapy-associated brain injury and recurrent disease can be difficult, and the immediate recognition of neurotoxicity is crucial to providing correct therapeutic management, ensuring damage reversibility. For these purposes, the knowledge of clinical timing and specific treatment protocols is extremely important for interpreting MRI patterns. Neuroradiologic findings are heterogeneous and sometimes overlapping, representing the compounding effect of the different treatments. Moreover, MRI patterns can be acute, subacute or delayed and involve different brain regions, depending on (1) the mechanism of action of the specific medication and (2) which brain regions are selectively vulnerable to specific toxic effects. This review illustrates the most common radiologic appearance of radiotherapy, chemotherapy and medication-associated brain injury in children, with special focus on the application of advanced MRI techniques (diffusion, perfusion and proton spectroscopy) in the diagnosis of the underlying processes leading to brain toxicity.
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Affiliation(s)
- Maria Camilla Rossi Espagnet
- Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Luca Pasquini
- Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.,NESMOS Department, Sant' Andrea Hospital, Sapienza University, Via di Grottarossa 1035, Rome, Italy
| | - Antonio Napolitano
- Enterprise Risk Management, Medical Physics Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonella Cacchione
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roberta Caruso
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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