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Salceda-Rivera V, Tejocote-Romero I, Osorio DS, Bellido-Magaña R, López-Facundo A, Anaya-Aguirre SE, Ortiz-Morales D, Rivera-Luna R, Reyes-Gutiérrez E, Rivera-Gómez R, Velasco-Hidalgo L, Cortés-Alva D, Lagarda-Arrechea S, Arreguín-González FE, Benito-Reséndiz AE, Chávez-Gallegos S, Pérez-Rivera E, Gaytán-Fernández GJ, León-Espitia JA, Domínguez-Sánchez J, Leal-Cavazos C, Simón-González C, Larios-Farak TC, Macías-García NA, García-Espinosa AC, Guerrero-Maymes F, Casillas-Toral P, González-Ramella O. Impact of treatment and clinical characteristics on the survival of children with medulloblastoma in Mexico. Front Oncol 2024; 14:1376574. [PMID: 38756654 PMCID: PMC11096484 DOI: 10.3389/fonc.2024.1376574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/26/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Data on medulloblastoma outcomes and experiences in low- and middle-income countries, especially in Latin America, is limited. This study examines challenges in Mexico's healthcare system, focusing on assessing outcomes for children with medulloblastoma in a tertiary care setting. Methods A retrospective analysis was conducted, involving 284 patients treated at 21 pediatric oncology centers in Mexico. Results High-risk patients exhibited markedly lower event-free survival than standard-risk patients (43.5% vs. 78.3%, p<0.001). Influential factors on survival included anaplastic subtype (HR 2.4, p=0.003), metastatic disease (HR 1.9, p=0.001); residual tumor >1.5cm², and lower radiotherapy doses significantly impacted event-free survival (EFS) and overall survival (OS). Platinum-based chemotherapy showed better results compared to the ICE protocol in terms of OS and EFS, which was associated with higher toxicity. Patients under 3 years old displayed notably lower OS and EFS compared to older children (36.1% vs. 55.9%, p=0.01).
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Affiliation(s)
- Violeta Salceda-Rivera
- Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Department of Pediatrics, Divisions of Pediatric Hematology-Oncology, Guadalajara, Jalisco, Mexico
| | - Isidoro Tejocote-Romero
- IMIEM, Instituto Materno Infantil del Estado de Mexico, Secretaria de Salud, Toluca, Estado de Mexico, Mexico
- Department of Pediatric Oncology, ISSEMYM, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Estado de Mexico, Mexico
| | | | | | - Araceli López-Facundo
- Department of Pediatric Oncology, ISSEMYM, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Estado de Mexico, Mexico
| | | | - Daniel Ortiz-Morales
- Department of Pediatric Oncology, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
- Department of Pediatric Oncology, Hospital Militar de Especialidades de la Mujer y Neonatología, Mexico City, Mexico
| | - Roberto Rivera-Luna
- Department of Pediatric Oncology, Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | - Rebeca Rivera-Gómez
- Hospital General de Tijuana, Universidad Autonoma de Baja California, Tijuana, Baja California, Mexico
| | | | - Deyanira Cortés-Alva
- Hospital del Niño DIF Hidalgo, Sistema Nacional para el Desarrollo Integral de la Familia, Hidalgo, Mexico
| | | | - Farina E. Arreguín-González
- Centro Médico Nacional “20 de Noviembre” del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Alma E. Benito-Reséndiz
- Centro Médico Nacional “20 de Noviembre” del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Silvia Chávez-Gallegos
- Department of Pediatric Oncology, Hospital Infantil “Eva Samano de López Mateos”, Morelia, Michoacan, Mexico
| | - Eloy Pérez-Rivera
- Department of Pediatric Oncology, Hospital Infantil “Eva Samano de López Mateos”, Morelia, Michoacan, Mexico
| | - Guillermo J. Gaytán-Fernández
- Hospital General Regional de Leon, Leon, Guanajuato, Mexico
- Department of Pediatric Oncology, Hospital Regional de Alta Especialidad del Bajío, Leon, Guanajuato, Mexico
| | | | | | - Carlos Leal-Cavazos
- Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo Leon, Nuevo Leon, Mexico
| | - Citlalli Simón-González
- Department of Pediatric Oncology, Hospital Regional de Alta Especialidad del Niño “ Dr. Rodolfo Nieto Padrón”, Tabasco, Mexico
| | - Tania C. Larios-Farak
- Department of Pediatric Oncology, Hospital Infantil del Estado de Sonora, Hermosillo, Sonora, Mexico
| | - Nubia A. Macías-García
- Department of Pediatric Oncology, Hospital del Niño “Dr. Federico Gómez Santos”, Saltillo, Coahuila, Mexico
| | - Ana C. García-Espinosa
- Department of Pediatric Oncology, Hospital Infantil de Especialidades de Chihuahua, Chihuahua, Chihuahua, Mexico
| | | | - Paola Casillas-Toral
- Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Department of Pediatrics, Divisions of Pediatric Hematology-Oncology, Guadalajara, Jalisco, Mexico
| | - Oscar González-Ramella
- Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Department of Pediatrics, Divisions of Pediatric Hematology-Oncology, Guadalajara, Jalisco, Mexico
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Yamada A, Kinoshita M, Kamimura S, Jinnouchi T, Azuma M, Yamashita S, Yokogami K, Takeshima H, Moritake H. Novel Strategy Involving High-Dose Chemotherapy with Stem Cell Rescue Followed by Intrathecal Topotecan Maintenance Therapy without Whole-Brain Irradiation for Atypical Teratoid/Rhabdoid Tumors. Pediatr Hematol Oncol 2023; 40:629-642. [PMID: 37519026 DOI: 10.1080/08880018.2023.2220734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 08/01/2023]
Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is a rare aggressive central nervous system tumor that typically affects children under three years old and has poor survival with a high risk for neurologic deficits. The primary purpose of this study was to successfully treat the disease and delay or avoid whole-brain radiotherapy for children with AT/RT. A retrospective analysis was performed for six children diagnosed with AT/RT and treated with multimodal treatment at a single institute between 2014 and 2020. Furthermore, germline SMARCB1 aberrations and MGMT methylation status of the tumors were analyzed. One patient who did not receive a modified IRS-III regimen replaced with ifosphamide, carboplatin, and etoposide (ICE) in induction chemotherapy was excluded from this analysis. Five patients who received ICE therapy were under three years old. After a surgical approach, they received intensive chemotherapy and high-dose chemotherapy with autologous peripheral blood stem cell transplantation (HDCT/autoPBSCT) followed by intrathecal topotecan maintenance therapy. Three patients underwent single HDCT/autoPBSCT, and the other two received sequential treatment. Two patients with germline SMARCB1 aberrations and metastases died of progressive AT/RT or therapy-related malignancy, while 3 with localized tumors without germline SMARCB1 aberrations remained alive. One survivor received local radiotherapy only, while the other two did not undergo radiotherapy. All three surviving patients were able to avoid whole-brain radiotherapy. Our results suggest that AT/RT patients with localized tumors without germline SMARCB1 aberrations can be rescued with multimodal therapy, including induction therapy containing ICE followed by HDCT/autoPBSCT and intrathecal topotecan maintenance therapy without radiotherapy. Further large-scale studies are necessary to confirm this hypothesis.
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Affiliation(s)
- Ai Yamada
- Division of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Mariko Kinoshita
- Division of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Sachiyo Kamimura
- Division of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takashi Jinnouchi
- Division of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Minako Azuma
- Division of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shinji Yamashita
- Division of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kiyotaka Yokogami
- Division of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hideo Takeshima
- Division of Neurosurgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Moritake
- Division of Pediatrics, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Yuile AK, Kastelan M, Lee APS, Back M, Drummond J, Wheeler HR. The use of Sonidegib in the adjuvant and advanced phases of Sonic Hedge Hog Mutant Medulloblastomas. Oxf Med Case Reports 2022; 2022:omac019. [PMID: 35316996 PMCID: PMC8931813 DOI: 10.1093/omcr/omac019] [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: 05/09/2021] [Revised: 01/20/2022] [Accepted: 01/20/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Medulloblastomas are rare embryonal primary brain tumours originating in the cerebellum. Most medulloblastomas arising in adults are associated with mutations in the Sonic Hedge Hog (SHH) pathway. Patient 1 was prescribed Sonidegib for recurrent metastatic SHH mutated medulloblastoma multiple lines of treatment. His leptomeningeal disease responded after 3 months of therapy. The drug was continued for a further 3 months until progressive central nervous system (CNS) and leptomeningeal disease arose. Progression free survival (PFS) from initiation of Sonidegib of 3 months was observed (overall survival 8.8 years). Patient 2 presented with un-resectable SHH mutated meduloblastoma with high risk of relapse who received 14 months of adjuvant Sonidegib. Following biopsy she was treated with chemotherapy and cranio-spinal radiotherapy, followed by 14 months of adjuvant Sonigedib. She remains free of disease over 51 months later. Both clinical scenarios are poorly described in the literature or evaluated in clinical trials with Sonidegib.
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Affiliation(s)
- Alexander K Yuile
- Medical Oncology, Royal North Shore Hospital, Sydney 2065, Australia
| | - Marina Kastelan
- The Brain Cancer Group, North Shore Private Hospital, Sydney 2065, Australia
| | - Adrian PS Lee
- Medical Oncology, Royal North Shore Hospital, Sydney 2065, Australia
| | - Michael Back
- Radiation Oncology, Royal North Shore Hospital, Sydney 2065, Australia
| | - James Drummond
- Radiology, Royal North Shore Hospital, Sydney 2065, Australia
| | - Helen R Wheeler
- Medical Oncology, Royal North Shore Hospital, Sydney 2065, Australia
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Murase M, Saito K, Abiko T, Yoshida K, Tomita H. Medulloblastoma in Older Adults: A Case Report and Literature Review. World Neurosurg 2018; 117:25-31. [PMID: 29883827 DOI: 10.1016/j.wneu.2018.05.216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Medulloblastoma is a malignant tumor of the posterior fossa and is predominantly seen in children younger than 15 years of age. This tumor is uncommon in adults, especially those older than 40 years of age, and reports of cases in patients older than 60 years of age are particularly rare. Although surgery and radiotherapy play important roles in treatment of medulloblastoma in adults, addition of chemotherapy is controversial, especially prior to radiotherapy. CASE DESCRIPTION We present a case of a 63-year-old woman with an atypical medulloblastoma in the cerebellum and a lesion in the suprasellar area that did not appear to be a metastasis of the medulloblastoma. The patient underwent a subtotal resection of the cerebellar medulloblastoma, which was classified histologically as classic subtype and molecularly as non-Wingless/non-Sonic hedgehog subtype in World Health Organization 2016 classification. Then she underwent postoperative chemotherapy followed by radiotherapy. We administered chemotherapy to facilitate therapeutic diagnosis of the suprasellar lesion. The combination treatment resulted in the disappearance of the cerebellar medulloblastoma with treatment toxicity well tolerated. Additionally, the suprasellar lesion remains under control. CONCLUSIONS Even in adults over 60 years of age, medulloblastoma should be included in the differential diagnosis of a cerebellar mass. Chemotherapy for adult medulloblastoma has the potential to be efficacious and tolerable.
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Affiliation(s)
- Makoto Murase
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-shi, Tochigi, Japan.
| | - Katsuya Saito
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-shi, Tochigi, Japan
| | - Tomohiro Abiko
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-shi, Tochigi, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hideyuki Tomita
- Department of Neurosurgery, Ashikaga Red Cross Hospital, Ashikaga-shi, Tochigi, Japan
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Clement J, Varlotto J, Rybka W, Frauenhoffer E, Drabick JJ. Unusual case of recurrent extraneural metastatic medulloblastoma in a young adult: durable complete remission with Ewing sarcoma chemotherapy regimen and consolidation with autologous bone marrow transplantation and local radiation. J Clin Oncol 2013; 31:e316-9. [PMID: 23715566 DOI: 10.1200/jco.2012.42.6700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jincy Clement
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
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Chargari C, Feuvret L, Levy A, Lamproglou I, Assouline A, Hemery C, Ghorbal L, Lopez S, Tep B, G GB, Lang P, Laigle-Donadey F, Cornu P, Mazeron JJ, Simon JM. Reappraisal of clinical outcome in adult medulloblastomas with emphasis on patterns of relapse. Br J Neurosurg 2011; 24:460-7. [PMID: 20726753 DOI: 10.3109/02688691003739881] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Clinical outcome and prognostic factors were assessed in adult medulloblastoma patients, with emphasis on patterns of relapse. PATIENTS AND METHODS Records of 36 consecutive adult patients with medulloblastoma were reviewed. Patients were classified into 2 prognostic groups according to the extent of disease and quality of surgical excision based on the early postoperative magnetic resonance imaging (MRI) findings. Standard-risk (SR) patients (n = 11) received postoperative craniospinal radiation therapy (RT) only, 36 Gy, 1.8 Gy per daily fraction, with a 18 Gy boost to the posterior cerebral fossa (PCF). High-risk (HR) patients (n = 25) received additional adjuvant chemotherapy. RESULTS With a median follow-up of 46 months (range 5-155), 19 patients experienced tumour relapse. Sites of relapse(s) included tumour bed in 6 patients, resulting in a PCF control of 83.4%. Three-year overall survival (OS) and progression-free survival (PFS) were 67.3% and 57.4%, respectively. The comparison of the HR and SR populations demonstrated significant differences in OS (p = 0.005) and PFS (p = 0.001). Quality of surgical excision and extent of disease beyond the PCF were predictive factors for OS (p = 0.04, p = 0.001, respectively) and PFS (p = 0.004, and p = 0.02, respectively). CONCLUSION The quality of resection was a significant prognostic factor, suggesting that surgery should be as extensive as possible. Systematic postoperative MRI allowed accurate selection of SR patients for whom RT alone was enough to obtain high local control. Every effort should be made to avoid RT disruption. Increased delay led to worse outcome.
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Affiliation(s)
- Cyrus Chargari
- Department of Radiation Oncology, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris, France
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Flatt T, Lewing K, Gonzalez C, Anthony K, Ryan R, Jones R, Gamis A, Dalal J. Successful mobilization with AMD3100 and filgrastim with engraftment of autologous peripheral blood stem cells in a heavily pretreated pediatric patient with recurrent Burkitt lymphoma. Pediatr Hematol Oncol 2010; 27:138-49. [PMID: 20201695 DOI: 10.3109/08880010903447367] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors report a case of a 13-year-old female with recurrent Burkitt lymphoma who was heavily pretreated with chemotherapy. During chemotherapy for relapse, she developed serious aspergillus infection of the palate and sinuses. Despite 10 microg/kg of filgrastim for 5 days, peripheral blood CD34(+) cells remained <or=1/microL. Hematopoietic progenitor cells were subsequently successfully mobilized with a combination of AMD3100 and filgrastim without tumor or fungus contamination. After transplantation, the patient achieved complete engraftment without exacerbation of fungal infection. This is the first case report of a pediatric patient with relapsed Burkitt lymphoma with mobilization of hematopoietic progenitor cells by AMD3100 without any adverse reactions.
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Affiliation(s)
- Terrie Flatt
- The Children's Mercy Hospital, Department of Hematology/Oncology, 2401 Gillham Rd, Kansas City, MO 64108, USA.
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Mascarin M, Dall'Oglio S, Palazzi M, Sartor G, Marradi PL, Romano M, Maluta S. A Case of Relapsed Medulloblastoma Treated with Intensity-Modulated Radiotherapy and Temozolomide. TUMORI JOURNAL 2010; 96:327-31. [PMID: 20572594 DOI: 10.1177/030089161009600223] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of relapsed high-risk non-metastatic medulloblastoma in a 14-year-old boy, which was treated with intensity-modulated radiotherapy (IMRT) and temozolomide (TMZ). At the age of 11, the patient underwent an MRI-confirmed incomplete resection of a fourth-ventricle medulloblastoma, followed by conventional chemotherapy, craniospinal irradiation (55.8 Gy, 1.8 Gy/fraction) and then myeloablative chemotherapy followed by peripheral blood progenitor cell rescue. After 18 months of complete remission following the completion of chemotherapy, MRI showed a 2.5-cm mass in the olfactory notch. The patient underwent IMRT (45 Gy, 1.8 Gy/fraction) with concomitant administration of TMZ (180 mg/m2, 5 days every 21 days), which was well tolerated. After 5 cycles of TMZ, MRI showed complete remission with no evidence of the mass. TMZ was continued for another 5 cycles and then stopped. At 14 months from the completion of IMRT, a new MRI scan showed multiple nodular relapses around the fourth ventricle and the patient is currently treated with oral etoposide.
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Affiliation(s)
- Maurizio Mascarin
- Department of Radiotherapy Centro di Riferimento Oncologico, Aviano, Pordenone
| | | | - Mario Palazzi
- Department of Radiotherapy Azienda Ospedaliera, Verona, Italy
| | - Giovanna Sartor
- Department of Medical Physics, Centro di Riferimento Oncologico, Aviano, Pordenone
| | | | - Mario Romano
- Department of Radiotherapy Azienda Ospedaliera, Verona, Italy
| | - Sergio Maluta
- Department of Radiotherapy Azienda Ospedaliera, Verona, Italy
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Mueller S, Chang S. Pediatric brain tumors: current treatment strategies and future therapeutic approaches. Neurotherapeutics 2009; 6:570-86. [PMID: 19560746 PMCID: PMC5084192 DOI: 10.1016/j.nurt.2009.04.006] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 04/11/2009] [Accepted: 04/13/2009] [Indexed: 01/19/2023] Open
Abstract
Pediatric CNS tumors are the most common solid tumors of childhood and the second most common cancer after hematological malignancies accounting for approximate 20 to 25% of all primary pediatric tumors. With over 3,000 new cases per year in the United States, childhood CNS tumors are the leading cause of death related to cancer in this population. The prognosis for these patients has improved over the last few decades, but current therapies continue to carry a high risk of significant side effects, especially for the very young. Currently a combination of surgery, radiation, and chemotherapy is often used in children greater than 3 years of age. This article will outline current and future therapeutic strategies for the most common pediatric CNS tumors, including primitive neuroectodermal tumors such as medulloblastoma, as well as astrocytomas and ependymomas.
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Affiliation(s)
- Sabine Mueller
- Department of Neurology, Division of Child Neurology, University of San Francisco, San Francisco, California, USA.
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Bibliography. Current world literature. Hematology and oncology. Curr Opin Pediatr 2008; 20:107-13. [PMID: 18197049 DOI: 10.1097/mop.0b013e3282f572b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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