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Story E, Johnston DL, Bartels U, Carret AS, Crooks B, Eisenstat DD, Fryer C, Lafay-Cousin L, Larouche V, Wilson B, Zelcer S, Silva M, Brossard J, Bouffet E, Keene DL. Embryonal tumors in Canadian children less than 36 months of age: results from the Canadian Pediatric Brain Tumor Consortium (CPBTC). J Neurooncol 2017; 133:581-587. [PMID: 28508928 DOI: 10.1007/s11060-017-2468-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 05/06/2017] [Indexed: 01/19/2023]
Abstract
Embryonal tumors are a heterogeneous group of central nervous system (CNS) tumors whose subgroups have varying incidence and outcome. Despite these differences, they are often grouped as a single entity for study purposes. To date, there are no Canadian multi-institutional studies examining the incidence and outcome of all embryonal subtypes. The current study is an observational study reviewing embryonal tumors in all patients less than 36 months of age diagnosed with a CNS tumor in Canada from 1990 to 2005. Embryonal tumors accounted for 26.9% of all CNS tumors. Medulloblastomas were the highest proportion of the embryonal tumors at 61.5%. Atypical teratoid/rhabdoid tumors (AT/RT) had the second highest proportion of embryonal tumors at 18%. The proportion of primitive neuroectodermal tumors (PNET) was 16%, with 2.6 and 1.9% for congenital medulloepithelioma and ependymoblastoma tumors, respectively. AT/RT and PNET were more common in younger age groups. Medulloblastoma became more prevalent with increasing age, with its highest prevalence in the 25 to 36 month age group. Survival rates for our Canadian population at 18 and 24 months were 0.74 and 0.68 for medulloblastoma, 0.64 and 0.60 for PNET, and 0.36 and 0.29 for AT/RT, respectively. Overall, our data are comparable with published international rates for embryonal tumors. These incidence and outcome figures can guide future research into these rare tumors.
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Affiliation(s)
- E Story
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - D L Johnston
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - U Bartels
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - A S Carret
- Division of Pediatric Hematology/Oncology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - B Crooks
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, NS, Canada
| | - D D Eisenstat
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - C Fryer
- Division of Pediatric Hematology/Oncology, BC Children's Hospital, Vancouver, BC, Canada
| | - L Lafay-Cousin
- Division of Oncology, Alberta Children's Hospital, Calgary, AB, Canada
| | - V Larouche
- Division of Pediatric Hematology/Oncology, Centre Hospitalier Universitaire de Quebec, Quebec City, QC, Canada
| | - B Wilson
- Division of Pediatric Hematology/Oncology, Stollery Children's Hospital, Edmonton, AB, Canada
| | - S Zelcer
- Division of Pediatric Hematology/Oncology, Children's Hospital of Western Ontario, London, ON, Canada
| | - M Silva
- Division of Pediatric Hematology/Oncology, Kingston General Hospital, Kingston, ON, Canada
| | - J Brossard
- Division of Pediatric Hematology/Oncology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - E Bouffet
- Division of Pediatric Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - D L Keene
- Division of Pediatric Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Johnston DL, Keene D, Kostova M, Strother D, Lafay-Cousin L, Fryer C, Scheinemann K, Carret AS, Fleming A, Percy V, Afzal S, Wilson B, Bowes L, Zelcer S, Mpofu C, Silva M, Larouche V, Brossard J, Bouffet E. Incidence of medulloblastoma in Canadian children. J Neurooncol 2014; 120:575-9. [DOI: 10.1007/s11060-014-1588-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/10/2014] [Indexed: 12/29/2022]
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Bergthold G, El Kababri M, Varlet P, Dhermain F, Sainte-Rose C, Raquin MA, Kieffer V, Goma G, Grill J, Valteau-Couanet D, Dufour C. High-dose busulfan-thiotepa with autologous stem cell transplantation followed by posterior fossa irradiation in young children with classical or incompletely resected medulloblastoma. Pediatr Blood Cancer 2014; 61:907-12. [PMID: 24470384 DOI: 10.1002/pbc.24954] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 12/31/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND The aim of the study is to evaluate the outcome of young children with high risk localized medulloblastomas (newly diagnosed classical or incompletely resected) treated by high-dose busulfan-thiotepa with autologous stem cell rescue (ASCT) followed by focal radiation therapy (RT). PROCEDURE Between September 1994 and January 2010, 19 children younger than 5 years old at diagnosis fulfilling the above inclusion criteria were treated at the Institute Gustave Roussy. After conventional chemotherapy, they received busulfan at a dose of 600 mg/m(2) and thiotepa at a dose of 900 mg/m(2) followed by ASCT. Focal RT was delivered at least 70 days after ASCT. RESULTS The median follow-up was 40.5 months (range, 14.5-191.2 months). The 3-year event-free survival (EFS) and OS were 68% (95% CI 45-84%) and 84% (95% CI 61-94%), respectively. Acute toxicity consisted mainly in hepatic veno-occlusive disease (6/19 patients) and bone marrow aplasia (all patients). No toxic death occurred. The Full Scale Intellectual Quotient tended to decrease over time at a mean rate of 0.9 point per year from the date of diagnosis. CONCLUSIONS This intensive treatment resulted in a high overall survival rate in young children with newly diagnosed non-metastatic classic or incompletely resected MB. In spite of a high incidence of hepatic veno-occlusive disease (32%), the acute toxicity was manageable. Delayed neuropsychological side effects remain main concerns. These results should to be confirmed in a larger cohort.
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Affiliation(s)
- Guillaume Bergthold
- Department of Paediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France; American Memorial Hospital, CHU de Reims, Reims, France
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Ashley DM, Merchant TE, Strother D, Zhou T, Duffner P, Burger PC, Miller DC, Lyon N, Bonner MJ, Msall M, Buxton A, Geyer R, Kun LE, Coleman L, Pollack IF. Induction chemotherapy and conformal radiation therapy for very young children with nonmetastatic medulloblastoma: Children's Oncology Group study P9934. J Clin Oncol 2012; 30:3181-6. [PMID: 22851568 DOI: 10.1200/jco.2010.34.4341] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE P9934 was a prospective trial of systemic chemotherapy, second surgery, and conformal radiation therapy (CRT) limited to the posterior fossa and primary site for children between 8 months and 3 years old with nonmetastatic medulloblastoma. The study was open from June 2000 until June 2006. PATIENTS AND METHODS After initial surgery, children received four cycles of induction chemotherapy, followed by age- and response-adjusted CRT to the posterior fossa (18 or 23.4 Gy) and tumor bed (cumulative 50.4 or 54 Gy) and maintenance chemotherapy. Neurodevelopmental outcomes were evaluated and event-free survival (EFS) results were directly compared with a previous study of multiagent chemotherapy without irradiation (Pediatric Oncology Group [POG] trial 9233). RESULTS Seventy-four patients met eligibility requirements. The 4-year EFS and overall survival probabilities were 50% ± 6% and 69% ± 5.5%, respectively, which compared favorably to the results from POG 9233. Analysis showed that the desmoplastic/nodular subtype was a favorable factor in predicting survival. Our 4-year EFS rate was 58% ± 8% for patients with desmoplasia. Whereas seven of 10 patients who had disease progression before CRT had primary-site failure, 15 of 19 patients who progressed after CRT had distant-site failure. Neurodevelopmental assessments did not show a decline in cognitive or motor function after protocol-directed chemotherapy and CRT. CONCLUSION The addition of CRT to postoperative chemotherapy in young children with nonmetastatic medulloblastoma increased event-free survival compared with the use of postoperative chemotherapy alone. Future studies will use histopathologic typing (desmoplastic/nodular versus nondesmoplastic/nodular) to stratify patients for therapy by risk of relapse.
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