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García-Marqueta M, Vázquez M, Krcek R, Kliebsch UL, Baust K, Leiser D, van Heerden M, Pica A, Calaminus G, Weber DC. Quality of Life, Clinical, and Patient-Reported Outcomes after Pencil Beam Scanning Proton Therapy Delivered for Intracranial Grade WHO 1-2 Meningioma in Children and Adolescents. Cancers (Basel) 2023; 15:4447. [PMID: 37760417 PMCID: PMC10526222 DOI: 10.3390/cancers15184447] [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: 07/25/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
PURPOSE The purpose of this study was to report the clinical and patient-reported outcomes of children and adolescents with intracranial meningioma treated with pencil beam scanning proton therapy (PBS-PT). MATERIAL AND METHODS Out of a total cohort of 207 intracranial meningioma patients treated with PBS-PT between 1999 and 2022, 10 (4.8%) were children or adolescents aged < 18 years. Median age was 13.9 years (range, 3.2-17.2). Six (60%) children were treated as primary treatment (postoperative PT, n = 4; exclusive PT, n = 2) and four (40%) at the time of tumor recurrence. Acute and late toxicities were registered according to Common Terminology Criteria of Adverse Events (CTCAE). Quality of life (QoL) before PBS-PT was assessed using PEDQOL questionnaires. Educational, functional, and social aspects after PT were assessed through our in-house developed follow-up surveys. Median follow-up time was 71.1 months (range, 2.5-249.7), and median time to last questionnaire available was 37.6 months (range, 5.75-112.6). RESULTS Five (50%) children developed local failure (LF) at a median time of 32.4 months (range, 17.7-55.4) after PBS-PT and four (80%) were considered in-field. One patient died of T-cell lymphoma 127.1 months after PBS-PT. Estimated 5-year local control (LC) and overall survival (OS) rates were 19.4% and 100.0%, respectively. Except for one patient who developed a cataract requiring surgery, no grade ≥3 late toxicities were reported. Before PT, patients rated their QoL lower than their parents in most domains. During the first year after PT, one child required educational support, one needed to attend to a special school, one had social problems and another three children required assistance for daily basic activities (DBA). Three years after PT, only one child required assistance for DBA. CONCLUSIONS The outcome of children with intracranial meningioma treated with PBS-PT is in line with other centers who have reported results of radiation therapy delivered to this particular patient group. This therapy provides acceptable functional status profiles with no high-grade adverse radiation-induced events.
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Affiliation(s)
- Marta García-Marqueta
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Miriam Vázquez
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Reinhardt Krcek
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Ulrike L. Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Dominic Leiser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Michelle van Heerden
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, 53127 Bonn, Germany
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland; (M.G.-M.)
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Department of Radiation Oncology, University of Zürich, 8091 Zürich, Switzerland
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Tauziède-Espariat A, Pfister SM, Mawrin C, Sahm F. Pediatric meningiomas: A literature review and diagnostic update. Neurooncol Adv 2023; 5:i105-i111. [PMID: 37287580 PMCID: PMC10243870 DOI: 10.1093/noajnl/vdac165] [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: 06/09/2023] Open
Abstract
Background Meningiomas have always represented the most frequently observed primary central nervous system (CNS) tumor in adults. Multiple advances concerning the genetic and epigenetic characterizations of adult meningiomas have been made over the last few years, and a new proposition for integrated histo-molecular grading has recently been offered in the literature. Pediatric meningiomas represent a very small proportion of all diagnosed meningiomas. New literature has determined that pediatric meningiomas are clinically, histopathologically, genetically, and epigenetically distinct from their adult counterparts. Herein, we reviewed and performed a synthesis of literature investigating pediatric meningiomas. We then compared and contrasted pediatric meningiomas with their adult counterparts. Methods We performed an extensive review of cases from English-language literature available in Pubmed using the keywords "pediatric" and "meningioma" as well as "children" and "meningioma". We reviewed and analyzed fifty-six papers that include 498 cases. Results This literature review revealed that pediatric meningiomas differ from their adult counterparts clinically (location, sex ratio) and also in terms of etiology (germline mutations), histopathology (a greater incidence of clear cell subtype), molecular biology, and epigenetics. Conclusions Pediatric meningiomas are, like other brain tumors (such as low-grade and high-grade gliomas), clinically and biologically different from their adult counterparts. Further studies are needed to better understand the tumorigenesis of pediatric meningiomas and to optimize their stratification in terms of outcome and therapeutic strategy.
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Affiliation(s)
- Arnault Tauziède-Espariat
- Department of Neuropathology, Sainte-Anne Hospital, Paris, France
- Inserm, UMR 1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Stefan M Pfister
- Hopp Children's Cancer Center (KiTZ) Heidelberg, Heidelberg, Germany
- Division Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke University Hospital, Magdeburg, Germany
- Center for Behavioral Brain Studies (CBBS), University of Magdeburg, Germany
| | - Felix Sahm
- Hopp Children's Cancer Center (KiTZ) Heidelberg, Heidelberg, Germany
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Azmitia L, Taylor G, Massimi L, Visocchi M. Pediatric Meningiomas: Current Insights on Pathogenesis and Management. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:69-74. [PMID: 38153451 DOI: 10.1007/978-3-031-36084-8_12] [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: 12/29/2023]
Abstract
Meningiomas are rare tumors in children, ranging from 0.4 to 4% of intracranial tumors. Differently from their adult counterpart, pediatric meningiomas (PMs) often show peculiar aspects such as the development of tumoral cysts, the involvement of the intraventricular space, and missing attachment to the dura mater. The most important difference with adults is represented by the high incidence of WHO grade II and III variants, which can account for more than 70% of cases. The prognosis of PMs mainly depends on the initial surgical resection because radiotherapy, which is the main treatment option in the case of tumor recurrence or progression, does not seem to increase the relapse free survival and the overall survival, and chemotherapy still misses specific and effective protocols.On these grounds, the need to better understand these tumors, to favor an appropriate multidisciplinary management, is particularly felt. The present review is focused on the advances on the pathogenesis, the molecular aspects, and the managements of PMs, with the goal to improve the knowledge of these challenging neoplasms.
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Affiliation(s)
- Luis Azmitia
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Military Hospital, Hamburg, Germany
| | - Gerardo Taylor
- Department of Neurosurgery, Hospital de Chimaltenango, Chimaltenango, Guatemala
| | - Luca Massimi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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Rombi B, Ruggi A, Sardi I, Zucchelli M, Scagnet M, Toni F, Cammelli S, Giulietti G, Fabbri VP, Gianno F, Amichetti M, Yock TI, Morganti AG, Pession A, Melchionda F. Proton therapy: A therapeutic opportunity for aggressive pediatric meningioma. Pediatr Blood Cancer 2021; 68:e28919. [PMID: 33682333 DOI: 10.1002/pbc.28919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/07/2021] [Indexed: 11/12/2022]
Abstract
Meningiomas are an extremely rare histology among pediatric brain tumors, and there is a shortage of literature on their management. Proton therapy is currently used safely and effectively for many types of both pediatric and adult cancer, and its main advantage is the sparing of healthy tissues from radiation, which could translate in the reduction of late side effects. We review the literature on radiotherapy and proton therapy for pediatric meningiomas and report clinical outcomes for two aggressive pediatric meningiomas we treated with protons. Proton therapy might be a safe and effective therapeutic option for this rare subgroup of tumors.
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Affiliation(s)
- Barbara Rombi
- Proton Therapy Center, Santa Chiara Hospital, Trento, Italy.,Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
| | | | - Iacopo Sardi
- Pediatric Neuro-Oncology Unit, Meyer Children's Hospital, Florence, Italy
| | - Mino Zucchelli
- Pediatric Neurosurgery, Institute of Neurological Science, IRCCS Bellaria Hospital, Bologna, Italy
| | - Mirko Scagnet
- Department of Neurosurgery, Meyer Children's Hospital, Florence, Italy
| | - Francesco Toni
- Pediatric Neuroradiology of Institute of Neurological Science, IRCCS Bellaria Hospital, Bologna, Italy
| | - Silvia Cammelli
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
| | | | - Viscardo Paolo Fabbri
- Department of Biomedical and Neuromotor Sciences, Pathology Department, University of Bologna, IRCCS Bellaria Hospital, Bologna, Italy
| | - Francesca Gianno
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Torunn Ingrid Yock
- Pediatric Radiation Oncology Department, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alessio Giuseppe Morganti
- Radiation Oncology Center, Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, University of Bologna, Bologna, Italy
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Rennert RC, Levy DM, Plonsker J, Steinberg JA, Friedman RA, Crawford JR, Levy ML. Middle fossa approach for a pediatric facial nerve meningioma. J Neurosurg Pediatr 2020; 26:578-582. [PMID: 32858509 DOI: 10.3171/2020.5.peds2034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/19/2020] [Indexed: 11/06/2022]
Abstract
Pediatric cerebellopontine angle (CPA) meningiomas are extremely rare and are usually treated with a retrosigmoid surgical approach or radiation. The authors present the use of a middle fossa approach for the treatment of a symptomatic CPA meningioma in a 22-month-old female. The patient initially presented at 17 months with isolated progressive, long-standing right-sided facial weakness. MRI demonstrated a 5.0 × 5.0-mm right CPA lesion just superior to the cisternal segment of cranial nerve (CN) VII, which demonstrated growth on interval imaging. At 22 months of age she underwent a successful middle fossa craniotomy, including wide exposure of the porus acusticus, allowing for a gross-total resection with preservation of CNs VII and VIII. Pathological analysis revealed a WHO grade I meningioma. The patient remained neurologically stable on follow-up. The middle fossa approach can be used to safely access the CPA in properly selected pediatric patients.
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Affiliation(s)
| | | | | | | | - Rick A Friedman
- 2Surgery, Division of Otolaryngology, Head and Neck Surgery, and
| | - John R Crawford
- 3Neurosciences and Pediatrics, University of California, San Diego, California
| | - Michael L Levy
- 3Neurosciences and Pediatrics, University of California, San Diego, California
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Tsurubuchi T, Matsuda M, Muroi A, Sakamoto N, Ishikawa E, Matsumura A. An Aggressive Extension of Dumbbell-Type Pediatric Skull Base Meningioma: A Case Report with Review of the Literature. World Neurosurg 2020; 139:535-547. [PMID: 32371076 DOI: 10.1016/j.wneu.2020.04.152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric meningiomas account for less than 2% of pediatric brain tumors. Pediatric clear cell meningiomas (CCMs) occurring in the posterior fossa are particularly rare. Therapeutic strategies differ among the previous pediatric CCM case reports. Therefore, to clarify the clinical features of pediatric CCMs, we report a rare case of dumbbell-type pediatric CCM and a corresponding literature review. CASE DESCRIPTION A 7-year-old boy with complaints of headache, left facial palsy, dysarthria, and left-sided ataxic gait was emergently admitted to our hospital. His consciousness level was slight stupor, with Glasgow Coma Scale score 3-5-6, and he showed left ptosis, dysarthria, and ataxias of the left trunk and extremities. Magnetic resonance imaging (MRI) scan showed acute obstructive hydrocephalus because of the tumor's compression of the brainstem. The dumbbell-shaped tumor extended from the lateral wall of the cavernous sinus, through the left Meckel's cave, to the cerebellopontine angle. Physical examination and perioperative MRI scan showed no evidence regarding neurofibromatosis type I or II. The tumor was removed in a 2-staged operation. Postoperative proton therapy was done to treat some residual tumors. One year after postoperative proton therapy, there is no recurrence, and apart from left corneal and facial hypesthesia, he is healthy. CONCLUSIONS We reported a rare case of pediatric skull base-type CCM with huge extension originating from the anteromedial wall of Meckel's cave firmly adhered to the cavernous sinus wall to the posterior fossa that was successfully treated with surgery and postoperative proton therapy. CCM has a high recurrence rate; therefore, careful prolonged follow-up is needed.
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Affiliation(s)
- Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Ai Muroi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Noriaki Sakamoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; Department of Diagnostic Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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