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Cockle JV, Corley EA, Zebian B, Hettige S, Vaidya SJ, Angelini P, Stone J, Leitch RJ, Albanese A, Mandeville HC, Carceller F, Marshall LV. Novel therapeutic approaches for pediatric diencephalic tumors: improving functional outcomes. Front Oncol 2023; 13:1178553. [PMID: 37886179 PMCID: PMC10598386 DOI: 10.3389/fonc.2023.1178553] [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: 03/02/2023] [Accepted: 07/06/2023] [Indexed: 10/28/2023] Open
Abstract
Pediatric diencephalic tumors represent a histopathologically and molecularly diverse group of neoplasms arising in the central part of the brain and involving eloquent structures, including the hypothalamic-pituitary axis (HPA), optic pathway, thalamus, and pineal gland. Presenting symptoms can include significant neurological, endocrine, or visual manifestations which may be exacerbated by injudicious intervention. Upfront multidisciplinary assessment and coordinated management is crucial from the outset to ensure best short- and long-term functional outcomes. In this review we discuss the clinical and pathological features of the neoplastic entities arising in this location, and their management. We emphasize a clear move towards 'function preserving' diagnostic and therapeutic approaches with novel toxicity-sparing strategies, including targeted therapies.
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Affiliation(s)
- Julia V. Cockle
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Elizabeth A. Corley
- Pediatric and Adolescent Oncology Drug Development Team, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Bassel Zebian
- Department of Neurosurgery, Kings College Hospital National Health Service (NHS) Trust, London, United Kingdom
| | - Samantha Hettige
- Atkinson Morley Neurosurgery Centre, St George’s University Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Sucheta J. Vaidya
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Paola Angelini
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Joanna Stone
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - R Jane Leitch
- Department of Ophthalmology, Epsom and St Hellier University Hospitals Trust, Carshalton, United Kingdom
| | - Assunta Albanese
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Pediatric Endocrinology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Henry C. Mandeville
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Fernando Carceller
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Pediatric and Adolescent Oncology Drug Development Team, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Lynley V. Marshall
- Department of Neuro-oncology, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
- Pediatric and Adolescent Oncology Drug Development Team, Children and Young People’s Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
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Coltin H, Pequeno P, Liu N, Tsang DS, Gupta S, Taylor MD, Bouffet E, Nathan PC, Ramaswamy V. The Burden of Surviving Childhood Medulloblastoma: A Population-Based, Matched Cohort Study in Ontario, Canada. J Clin Oncol 2023; 41:2372-2381. [PMID: 36696605 PMCID: PMC10150896 DOI: 10.1200/jco.22.02466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/05/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Survivors of childhood medulloblastoma suffer from substantial late effects. We characterized these sequelae using real-world health services data in a population-based cohort of medulloblastoma survivors. METHODS All 5-year medulloblastoma survivors diagnosed age < 18 years between 1987 and 2015 in Ontario, Canada, were identified and matched 1:5 with population controls. Index date was 5 years from latest pediatric cancer event. Linkage to provincial administrative health data allowed for comparison of cumulative incidences of several adverse outcomes. RESULTS Two hundred thirty survivors, 81.3% of whom had received craniospinal irradiation, were matched with 1,150 controls. The 10-year postindex cumulative incidence of all-cause mortality was 7.9% (95% CI, 3.9 to 11.8) in survivors versus 0.6% (95% CI, 0.1 to 1.1) in controls (hazard ratio [HR], 21.5; 95% CI, 9.8 to 54.0). The cumulative incidence of stroke was higher in survivors (4.8%; 95% CI, 2.2 to 9.0) compared with controls (0.1; 95% CI, 0.01 to 0.7; HR, 45.6; 95% CI, 12.8 to 289.8). Hearing loss requiring an amplification device was present in 24.9% (95% CI, 18.8 to 31.4) of survivors versus 0.3% (95% CI, 0.1 to 1.0) of controls (HR, 96.3; 95% CI, 39.7 to 317.3). Disability support prescription claims were submitted by 44.5% (95% CI, 37.1 to 51.6) of survivors versus 5.5% (95% CI, 4.2 to 7.1) of controls (HR, 10.0; 95% CI, 7.3 to 13.6). Female survivors were significantly less likely to deliver a liveborn child compared with controls (HR, 0.2; 95% CI, 0.1 to 0.7). CONCLUSION Survivors of medulloblastoma have significant long-term medical sequelae, increased all-cause mortality, and are frequently dependent on disability supports. Efforts to reduce the toxicity of current therapy, specifically incorporating molecularly informed risk stratification to spare low- and intermediate-risk survivors the toxicity of treatment, are urgently needed. These findings should prompt a re-evaluation of our current treatment approaches where research focused on late-effect interventions should be prioritized.
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Affiliation(s)
- Hallie Coltin
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Programme in Developmental and Stem Cell Biology, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | | | - Ning Liu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Derek S. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Michael D. Taylor
- Programme in Developmental and Stem Cell Biology, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul C. Nathan
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Programme in Developmental and Stem Cell Biology, Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, Ontario, Canada
- Departments of Medical Biophysics and Paediatrics, University of Toronto, Toronto, Ontario, Canada
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3
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Leblond P, Tresch-Bruneel E, Probst A, Néant N, Solas C, Sterin A, Boulanger T, Aerts I, Faure-Conter C, Bertozzi AI, Chastagner P, Entz-Werlé N, De Carli E, Deley MCL, Bouche G, André N. Phase I Study of a Combination of Fluvastatin and Celecoxib in Children with Relapsing/Refractory Low-Grade or High-Grade Glioma (FLUVABREX). Cancers (Basel) 2023; 15:cancers15072020. [PMID: 37046681 PMCID: PMC10093481 DOI: 10.3390/cancers15072020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Preclinical data support the activity of celecoxib and fluvastatin in high-grade (HGG) and low-grade gliomas (LGG). A phase I trial (NCT02115074) was designed to evaluate the safety of this combination in children with refractory/relapsed HGG and LGG using four dose levels of fluvastatin with a fixed daily dose of celecoxib. A Continual Reassessment Method was used for fluvastatin dose escalation. Dose-limiting toxicities (DLT) were determined on the first treatment cycle. Twenty patients were included. Ten LGG and ten HGG patients received a median of 3.5 treatment cycles. Two DLTs were reported: one grade 3 maculopapular rash (4 mg/kg dose level) and one grade 4 increase of Creatine Phospho-Kinase (6 mg/kg dose level). We identified the dose of 6 mg/kg/day as the recommended phase II dose (RP2D) of fluvastatin with celecoxib. Four patients with LGG continued treatment beyond 12 cycles because of stable disease, including one patient who received 23 treatment cycles. In children with refractory/relapsed glioma, the RP2D of fluvastatin with celecoxib is 6 mg/kg/day. The long-term stable diseases observed in LGG suggest a possible role of the combination in a maintenance setting, given its good tolerance and low cost for children living in low- and middle-income countries.
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Grippin AJ, McGovern SL. Proton therapy for pediatric diencephalic tumors. Front Oncol 2023; 13:1123082. [PMID: 37213290 PMCID: PMC10196353 DOI: 10.3389/fonc.2023.1123082] [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: 12/13/2022] [Accepted: 03/03/2023] [Indexed: 05/23/2023] Open
Abstract
Diencephalic tumors tend to be low grade tumors located near several critical structures, including the optic nerves, optic chiasm, pituitary, hypothalamus, Circle of Willis, and hippocampi. In children, damage to these structures can impact physical and cognitive development over time. Thus, the goal of radiotherapy is to maximize long term survival while minimizing late effects, including endocrine disruption leading to precocious puberty, height loss, hypogonadotropic hypogonadism, and primary amenorrhea; visual disruption including blindness; and vascular damage resulting in cerebral vasculopathy. Compared to photon therapy, proton therapy offers the potential to decrease unnecessary dose to these critical structures while maintaining adequate dose to the tumor. In this article, we review the acute and chronic toxicities associated with radiation for pediatric diencephalic tumors, focusing on the use of proton therapy to minimize treatment-related morbidity. Emerging strategies to further reduce radiation dose to critical structures will also be considered.
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5
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Li F, Bondra KM, Ghilu S, Studebaker A, Liu Q, Michalek JE, Kogiso M, Li XN, Kalapurakal JA, James CD, Burma S, Kurmasheva RT, Houghton PJ. Regulation of TORC1 by MAPK Signaling Determines Sensitivity and Acquired Resistance to Trametinib in Pediatric BRAFV600E Brain Tumor Models. Clin Cancer Res 2022; 28:3836-3849. [PMID: 35797217 PMCID: PMC10230442 DOI: 10.1158/1078-0432.ccr-22-1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/29/2022] [Accepted: 07/05/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE We investigated why three patient-derived xenograft (PDX) childhood BRAFV600E-mutant brain tumor models are highly sensitive to trametinib. Mechanisms of acquired resistance selected in situ, and approaches to prevent resistance were also examined, which may translate to both low-grade glioma (LGG) molecular subtypes. EXPERIMENTAL DESIGN Sensitivity to trametinib [MEK inhibitor (MEKi)] alone or in combination with rapamycin (TORC1 inhibitor), was evaluated in pediatric PDX models. The effect of combined treatment of trametinib with rapamycin on development of trametinib resistance in vivo was examined. PDX tissue and tumor cells from trametinib-resistant xenografts were characterized. RESULTS In pediatric models TORC1 is activated through ERK-mediated inactivation of the tuberous sclerosis complex (TSC): consequently inhibition of MEK also suppressed TORC1 signaling. Trametinib-induced tumor regression correlated with dual inhibition of MAPK/TORC1 signaling, and decoupling TORC1 regulation from BRAF/MAPK control conferred trametinib resistance. In mice, acquired resistance to trametinib developed within three cycles of therapy in all three PDX models. Resistance to trametinib developed in situ is tumor-cell-intrinsic and the mechanism was tumor line specific. Rapamycin retarded or blocked development of resistance. CONCLUSIONS In these three pediatric BRAF-mutant brain tumors, TORC1 signaling is controlled by the MAPK cascade. Trametinib suppressed both MAPK/TORC1 pathways leading to tumor regression. While low-dose intermittent rapamycin to enhance inhibition of TORC1 only modestly enhanced the antitumor activity of trametinib, it prevented or retarded development of trametinib resistance, suggesting future therapeutic approaches using rapamycin analogs in combination with MEKis that may be therapeutically beneficial in both KIAA1549::BRAF- and BRAFV600E-driven gliomas.
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Affiliation(s)
- Fuyang Li
- Greehey Children’s Cancer Research Institute, UT Health, San Antonio, Texas
| | - Kathryn M. Bondra
- Greehey Children’s Cancer Research Institute, UT Health, San Antonio, Texas
| | - Samson Ghilu
- Greehey Children’s Cancer Research Institute, UT Health, San Antonio, Texas
| | - Adam Studebaker
- Center for Childhood Cancer and Blood Diseases, Nationwide Children’s Hospital, Columbus, Ohio
| | - Qianqian Liu
- Department of Epidemiology and Biostatistics, UT Health, San Antonio, Texas
| | - Joel E. Michalek
- Department of Epidemiology and Biostatistics, UT Health, San Antonio, Texas
| | - Mari Kogiso
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Cancer Center, Houston, Texas
| | - Xiao-Nan Li
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John A. Kalapurakal
- Department of Radiation Oncology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - C. David James
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sandeep Burma
- Department of Neurosurgery, UT Health, San Antonio, Texas
- Department of Biochemistry and Structural Biology, UT Health, San Antonio, Texas
| | | | - Peter J. Houghton
- Greehey Children’s Cancer Research Institute, UT Health, San Antonio, Texas
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Natsume A, Arakawa Y, Narita Y, Sugiyama K, Hata N, Muragaki Y, Shinojima N, Kumabe T, Saito R, Motomura K, Mineharu Y, Miyakita Y, Yamasaki F, Matsushita Y, Ichimura K, Ito K, Tachibana M, Kakurai Y, Okamoto N, Asahi T, Nishijima S, Yamaguchi T, Tsubouchi H, Nakamura H, Nishikawa R. The first-in-human phase I study of a brain-penetrant mutant IDH1 inhibitor DS-1001 in patients with recurrent or progressive IDH1-mutant gliomas. Neuro Oncol 2022; 25:326-336. [PMID: 35722822 PMCID: PMC9925696 DOI: 10.1093/neuonc/noac155] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Approximately 70% of lower-grade gliomas harbor isocitrate dehydrogenase 1 (IDH1) mutations, resulting in the accumulation of oncometabolite D-2-hydroxyglutarate (D-2-HG); this leads to epigenetic dysregulation, oncogenesis, and subsequent clonal expansion. DS-1001 is an oral brain-penetrant mutant IDH1 selective inhibitor. This first-in-human study investigated the safety, pharmacokinetics, pharmacodynamics, and efficacy of DS-1001. METHODS This was a multicenter, open-label, dose-escalation, phase I study of DS-1001 for recurrent/progressive IDH1-mutant (R132) glioma (N = 47) (NCT03030066). DS-1001 was administered orally at 125-1400 mg twice daily. Dose-escalation used a modified continual reassessment method. RESULTS The maximum tolerated dose was not reached. Eight patients were continuing treatment at the data cutoff. Most adverse events (AEs) were grade 1-2. Twenty patients (42.6%) experienced at least 1 grade 3 AE. No grade 4 or 5 AEs or serious drug-related AEs were reported. Common AEs (>20%) were skin hyperpigmentation, diarrhea, pruritus, alopecia, arthralgia, nausea, headache, rash, and dry skin. The objective response rates were 17.1% for enhancing tumors and 33.3% for non-enhancing tumors. Median progression-free survival was 10.4 months (95% confidence interval [CI], 6.1 to 17.7 months) and not reached (95% CI, 24.1 to not reached) for the enhancing and non-enhancing glioma cohorts, respectively. Seven on-treatment brain tumor samples showed a significantly lower amount of D-2-HG compared with pre-study archived samples. CONCLUSIONS DS-1001 was well tolerated with a favorable brain distribution. Recurrent/progressive IDH1-mutant glioma patients responded to treatment. A study of DS-1001 in patients with chemotherapy- and radiotherapy-naïve IDH1-mutated WHO grade 2 glioma is ongoing (NCT04458272).
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Affiliation(s)
- Atsushi Natsume
- Corresponding Author: Atsushi Natsume, MD, PhD, The Institute of Innovation for Future Society, Nagoya University, NIC Room 803, Furo-Cho, Chikusa-Ku, Nagoya 464-8601, Japan ()
| | | | | | | | - Nobuhiro Hata
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Muragaki
- Graduate School of Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | | | | | - Ryuta Saito
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | - Yohei Mineharu
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | - Hideo Nakamura
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Ryo Nishikawa
- Saitama Medical University International Medical Center, Hidaka, Japan
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7
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Orukari I, Perkins S, Zhao T, Huang J, Caruthers DF, Duriseti S. Brainstem Toxicity in Pediatric Patients Treated with Protons Using a Single-vault Synchrocyclotron System. Int J Part Ther 2022; 9:12-17. [PMID: 35774490 PMCID: PMC9238130 DOI: 10.14338/ijpt-22-00008.1] [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: 02/14/2022] [Accepted: 04/11/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Cranial radiation therapy remains an integral component of curative treatment for pediatric patients with brain tumors. Proton beam radiation therapy (PBT) can limit collateral radiation dose to surrounding normal tissue, thus reducing off-target exposure while maintaining appropriate tumor coverage. While PBT offers significant advantages over photon therapy for pediatric patients with intracranial malignancies, cases of brainstem necrosis after PBT have raised concerns that PBT may pose an increased risk of necrosis over photon therapy. We investigated the incidence of brainstem necrosis at our institution in children treated with PBT for intracranial malignancies. Patients and Methods Patients with pediatric brain tumor treated with passively scattered PBT, using a gantry-mounted, synchrocyclotron single-vault system between 2013 and 2018, were retrospectively reviewed. Inclusion criteria included patients 21 years of age or younger who received a minimum 0.1 cm3 maximum brainstem dose of 50 Gray relative biological effectiveness (GyRBE). Patients were assessed for “central nervous system necrosis” in the brainstem per the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 (US National Cancer Institute, Bethesda, Maryland) criteria. Results Fifty-eight patients were included for analysis. The median age was 10.3 years. Twenty-one (36.2%) patients received craniospinal irradiation. Thirty-four (58.6%) patients received chemotherapy. The median prescription radiation dose was 54 GyRBE. Regarding published dosimetric constraints used at 3 separate proton centers, the goal brainstem D50% <52 GyRBE was exceeded in 23 (40%) patients, but the brainstem Dmax <58 GyRBE was not exceeded in any patients. No patient experienced grade ≥2 brainstem injury. One patient demonstrated radiographic changes consistent with grade 1 toxicity. This patient had myeloablative chemotherapy with tandem stem cell rescue before PBT. Conclusion Our data demonstrates a low risk of any brainstem injury in children treated with passively scattered PBT using a single-vault synchrocyclotron.
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Affiliation(s)
- Inema Orukari
- 1 Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Stephanie Perkins
- 1 Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- 2 Department of Radiation Oncology, Washington University School of Medicine/Barnes Jewish Healthcare, St. Louis, Missouri, USA
| | - Tianyu Zhao
- 1 Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- 2 Department of Radiation Oncology, Washington University School of Medicine/Barnes Jewish Healthcare, St. Louis, Missouri, USA
| | - Jiayi Huang
- 1 Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- 2 Department of Radiation Oncology, Washington University School of Medicine/Barnes Jewish Healthcare, St. Louis, Missouri, USA
| | - Douglas F. Caruthers
- 1 Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- 2 Department of Radiation Oncology, Washington University School of Medicine/Barnes Jewish Healthcare, St. Louis, Missouri, USA
| | - Sai Duriseti
- 1 Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
- 2 Department of Radiation Oncology, Washington University School of Medicine/Barnes Jewish Healthcare, St. Louis, Missouri, USA
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8
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Frappaz D, Dhall G, Murray MJ, Goldman S, Faure Conter C, Allen J, Kortmann R, Haas-Kogen D, Morana G, Finlay J, Nicholson JC, Bartels U, Souweidane M, Schöenberger S, Vasiljevic A, Robertson P, Albanese A, Alapetite C, Czech T, Lau CC, Wen P, Schiff D, Shaw D, Calaminus G, Bouffet E. Intracranial germ cell tumors in Adolescents and Young Adults: European and North American consensus review, current management and future development. Neuro Oncol 2021; 24:516-527. [PMID: 34724065 PMCID: PMC8972311 DOI: 10.1093/neuonc/noab252] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The incidence of intracranial germ cell tumors (iGCT) is much lower in European and North American (E&NA) than in Asian population. However, E&NA cooperative groups have simultaneously developed with success treatment strategies with specific attention paid to long-term sequelae. Neurological sequelae may be reduced by establishing a diagnosis with an endoscopic biopsy and/or cerebrospinal fluid (CSF) and/or serum analysis, deferring the need to perform a radical surgery. Depending on markers and/or histological characteristics, patients are treated as either germinoma or non-germinomatous germ cell tumors (NGGCT). Metastatic disease is defined by a positive CSF cytology and/or distant drops in craniospinal MRI. The combination of surgery and/or chemotherapy and radiation therapy is tailored according to grouping and staging. With more than 90% 5-year event-free survival (EFS), localized germinomas can be managed without aggressive surgery, and benefit from chemotherapy followed by whole ventricular irradiation with local boost. Bifocal germinomas are treated as non-metastatic entities. Metastatic germinomas may be cured with craniospinal irradiation. With a 5-year EFS over 70%, NGGCT benefit from chemotherapy followed by delayed surgery in case of residual disease, and some form of radiotherapy. Future strategies will aim at decreasing long-term side effects while preserving high cure rates.
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Affiliation(s)
- D Frappaz
- Institut d'Hématologie Oncologie Pédiatrique, Lyon, France
| | - G Dhall
- University of Alabama at Birmingham (UAB), Birmingham, USA
| | - M J Murray
- Department of Pathology, University of Cambridge, Cambridge, UK.,Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Goldman
- Phoenix Children's Hospital University of Arizona, USA
| | - C Faure Conter
- Institut d'Hématologie Oncologie Pédiatrique, Lyon, France
| | - J Allen
- NYU Grossman School, New York, USA
| | - R Kortmann
- University of Leipzig Medical Center; Leipzig, Germany
| | | | | | - J Finlay
- Nationwide Children's Hospital, Colombus, USA
| | - J C Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ute Bartels
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Souweidane
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - S Schöenberger
- Department of Pediatric Hematology and Oncology, University Hospital Essen, Essen, Germany
| | - A Vasiljevic
- Centre de Pathologie et Neuropathologie Est, Hospices Civils de Lyon, France
| | | | | | | | - T Czech
- Medical University of Vienna, Austria
| | - C C Lau
- Connecticut Children's Medical Center, USA
| | - P Wen
- University of Leipzig Medical Center; Leipzig, Germany
| | - D Schiff
- University of Virginia School of Medicine, Charlottesville, USA
| | - D Shaw
- Seattle Children's Hospital and University of Washington, Seattle USA
| | | | - E Bouffet
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
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9
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Pluimakers VG, van Santen SS, Fiocco M, Bakker MCE, van der Lelij AJ, van den Heuvel-Eibrink MM, Neggers SJCMM. Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review. Obes Rev 2021; 22:e13312. [PMID: 34258851 PMCID: PMC8596408 DOI: 10.1111/obr.13312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/11/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022]
Abstract
Childhood cancer survivors (CCS) are at increased risk to develop metabolic syndrome (MetS), diabetes, and cardiovascular disease. Common criteria underestimate adiposity and possibly underdiagnose MetS, particularly after abdominal radiotherapy. A systematic literature review and meta-analysis on the diagnostic and predictive value of nine newer MetS related biomarkers (adiponectin, leptin, uric acid, hsCRP, TNF-alpha, IL-1, IL-6, apolipoprotein B (apoB), and lipoprotein(a) [lp(a)]) in survivors and adult non-cancer survivors was performed by searching PubMed and Embase. Evidence was summarized with GRADE after risk of bias evaluation (QUADAS-2/QUIPS). Eligible studies on promising biomarkers were pooled. We identified 175 general population and five CCS studies. In the general population, valuable predictive biomarkers are uric acid, adiponectin, hsCRP and apoB (high level of evidence), and leptin (moderate level of evidence). Valuable diagnostic biomarkers are hsCRP, adiponectin, uric acid, and leptin (low, low, moderate, and high level of evidence, respectively). Meta-analysis showed OR for hyperuricemia of 2.94 (age-/sex-adjusted), OR per unit uric acid increase of 1.086 (unadjusted), and AUC for hsCRP of 0.71 (unadjusted). Uric acid, adiponectin, hsCRP, leptin, and apoB can be alternative biomarkers in the screening setting for MetS in survivors, to enhance early identification of those at high risk of subsequent complications.
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Affiliation(s)
| | - Selveta S van Santen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Medical Statistics, Department of Biomedical Data Science, Leiden UMC, Leiden, Netherlands.,Mathematical Institute, Leiden University, Leiden, Netherlands
| | - Marie-Christine E Bakker
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, University Medical Center Utrecht, Netherlands
| | - Aart J van der Lelij
- Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Sebastian J C M M Neggers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Medicine, Endocrinology, Erasmus Medical Center, Rotterdam, Netherlands
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10
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Thomas P, Galopin N, Bonérandi E, Clémenceau B, Fougeray S, Birklé S. CAR T Cell Therapy's Potential for Pediatric Brain Tumors. Cancers (Basel) 2021; 13:cancers13215445. [PMID: 34771608 PMCID: PMC8582542 DOI: 10.3390/cancers13215445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary T cells that are genetically engineered to express chimeric antigen receptors constitute an effective new therapy with curative potential for patients with hematological tumors. The value of chimeric antigen receptor T cells in childhood brain tumors, the leading cause of cancer death in children, is less clear. In this context, the main obstacles for these engineered T cells remain how to find them, allow them to infiltrate, and induce them to remain active in the tumor site. Here, we discuss recent progress in the field and examine future directions for realizing the potential of this therapy. Abstract Malignant central nervous system tumors are the leading cause of cancer death in children. Progress in high-throughput molecular techniques has increased the molecular understanding of these tumors, but the outcomes are still poor. Even when efficacious, surgery, radiation, and chemotherapy cause neurologic and neurocognitive morbidity. Adoptive cell therapy with autologous CD19 chimeric antigen receptor T cells (CAR T) has demonstrated remarkable remission rates in patients with relapsed refractory B cell malignancies. Unfortunately, tumor heterogeneity, the identification of appropriate target antigens, and location in a growing brain behind the blood–brain barrier within a specific suppressive immune microenvironment restrict the efficacy of this strategy in pediatric neuro-oncology. In addition, the vulnerability of the brain to unrepairable tissue damage raises important safety concerns. Recent preclinical findings, however, have provided a strong rationale for clinical trials of this approach in patients. Here, we examine the most important challenges associated with the development of CAR T cell immunotherapy and further present the latest preclinical strategies intending to optimize genetically engineered T cells’ efficiency and safety in the field of pediatric neuro-oncology.
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Affiliation(s)
- Pauline Thomas
- Université de Nantes, INSERM, CRCINA, F-44000 Nantes, France; (P.T.); (N.G.); (E.B.); (S.F.)
| | - Natacha Galopin
- Université de Nantes, INSERM, CRCINA, F-44000 Nantes, France; (P.T.); (N.G.); (E.B.); (S.F.)
| | - Emma Bonérandi
- Université de Nantes, INSERM, CRCINA, F-44000 Nantes, France; (P.T.); (N.G.); (E.B.); (S.F.)
| | - Béatrice Clémenceau
- Université de Nantes, CHU Nantes, CNRS, INSERM, CRCINA, F-44000 Nantes, France;
| | - Sophie Fougeray
- Université de Nantes, INSERM, CRCINA, F-44000 Nantes, France; (P.T.); (N.G.); (E.B.); (S.F.)
| | - Stéphane Birklé
- Université de Nantes, INSERM, CRCINA, F-44000 Nantes, France; (P.T.); (N.G.); (E.B.); (S.F.)
- Correspondence: ; Tel.: +33-228-08-03-00
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11
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Roux C, Revon-Rivière G, Gentet JC, Verschuur A, Scavarda D, Saultier P, Appay R, Padovani L, André N. Metronomic Maintenance With Weekly Vinblastine After Induction With Bevacizumab-Irinotecan in Children With Low-grade Glioma Prevents Early Relapse. J Pediatr Hematol Oncol 2021; 43:e630-e634. [PMID: 33235152 DOI: 10.1097/mph.0000000000002002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/09/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric low-grade glioma (pLGG) represents the most common brain tumor in childhood. Previous studies have reported that a therapeutic strategy on the basis of the association of bevacizumab alone (B) or in combination with irinotecan (BI) could produce rapid tumor response and clinical improvement in children with pLGG. Nevertheless, a majority of patients relapses shortly (median, 5 mo) after stopping B or BI treatment. We proposed metronomic maintenance with weekly vinblastine added after a 6 months induction of B/BI to prevent early relapse. PATIENTS AND METHODS Monocentric retrospective analysis of a patient with pLGG treated with B or BI for 6 months followed by a 12-month maintenance with weekly vinblastine (6 mg/m²) from October 2012 to September 2019 in a single institution. RESULTS In total, 18 patients (7 males and 11 females) were identified. Because of progression during the B or BI induction 2/18 children were excluded. In total, 16 patients were analyzed with a median age of 10 years (range, 4 to 16 y). A total of 13 patients received BI and 3 patients received B alone. The mean duration of induction was 6.2 months (range, 2 to 12 mo). After induction 5/16 patients had a partial radiologic response, 11/16 patients had stable disease. All patients started maintenance (median duration, 12 mo; range, 3 to 12 mo). With a median follow-up of 3.9 years after the end of B or BI (range, 11 mo to 7.2 y), 15/16 patients were alive and 9/16 patients were progression-free. Seven of 16 children progressed with a median time to progression of 23 months (ranges, 5 to 39 mo). Three of 16 (18%) children progressed during vinblastine maintenance and 4/16 (25%) patients after the end of maintenance. After the total duration of treatment, clinical improvement was noted in 4 patients, 9 patients had stable symptoms, and only 3 patients progressed. One and 2-year event-free survival were, respectively, 81.2% and 56.2%. Two-year overall survival was 93.7%. CONCLUSIONS We report here, the potential benefit and the improvement of progression-free survival by adding metronomic maintenance with weekly vinblastine after initial induction with B or BI in children with low-grade glioma.
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Affiliation(s)
- Clémence Roux
- Departments of Pediatric Hematology, Immunology and Oncology
| | | | | | - Arnauld Verschuur
- Departments of Pediatric Hematology, Immunology and Oncology
- Metronomics Global Health Initiative
| | | | - Paul Saultier
- Departments of Pediatric Hematology, Immunology and Oncology
- C2VN, INSERM, INRAe, Aix Marseille University
| | | | - Laetitia Padovani
- Radiotherapy Department, La Timone Children's University Hospital, AP-HM
| | - Nicolas André
- Departments of Pediatric Hematology, Immunology and Oncology
- Metronomics Global Health Initiative
- SMARTc unit Centre de Recherche en Cancérologie de Marseille Inserm U1068, Aix Marseille University, Marseille, France
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12
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Alemany M, Velasco R, Simó M, Bruna J. Late effects of cancer treatment: consequences for long-term brain cancer survivors. Neurooncol Pract 2020; 8:18-30. [PMID: 33664966 DOI: 10.1093/nop/npaa039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Late adverse effects of cancer treatments represent a significant source of morbidity and also financial hardship among brain tumor patients. These effects can be produced by direct neurologic damage of the tumor and its removal, and/or by complementary treatments such as chemotherapy and radiotherapy, either alone or combined. Notably, young adults are the critical population that faces major consequences because the early onset of the disease may affect their development and socioeconomic status. The spectrum of these late adverse effects is large and involves multiple domains. In this review we classify the main long-term adverse effects into 4 sections: CNS complications, peripheral nervous system complications, secondary neoplasms, and Economic impact. In addition, CNS main complications are divided into nonfocal and focal symptoms. Owing to all the secondary effects mentioned, it is essential for physicians to have a high level of clinical suspicion to prevent and provide early intervention to minimize their impact.
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Affiliation(s)
- Montse Alemany
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Roser Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Marta Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
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13
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Frič R, Due-Tønnessen BJ, Lundar T, Egge A, Kronen Krossnes B, Due-Tønnessen P, Stensvold E, Brandal P. Long-term outcome of posterior fossa medulloblastoma in patients surviving more than 20 years following primary treatment in childhood. Sci Rep 2020; 10:9371. [PMID: 32523021 PMCID: PMC7286882 DOI: 10.1038/s41598-020-66328-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/14/2020] [Indexed: 11/11/2022] Open
Abstract
The aim of the study was to analyze the long-term outcome (>20 years) after treatment of posterior fossa medulloblastoma (MB) in childhood. We analyzed data from patients treated for posterior fossa MB between 1974 (introduction of the first international treatment protocol in Norway) and 1987 (when use of radiotherapy was abandoned in children under 4 years of age). Out of 47 children, 24 survived >20 years. At the time of analysis, 16 patients (median age 41 years, range 32–52) were alive (median follow-up 34 years, range 30–42), while 8 patients died 22–41 years (median 31 years) after primary treatment: one late death (after 22 years) was due to tumor recurrence whilst other 7 deaths (after 23 to 41 years) were related to the detrimental effects of the treatment (secondary tumors, stroke, severe epilepsy and depression). Observed 20- and 30-year survival rates were 51% and 44%, respectively. Despite successful treatment of MB in childhood and satisfactory tumor control during the first 20 years following primary treatment, our data indicates that even long-term survivors may die from tumor recurrence. However, the main factors causing late mortality and morbidity in long-term survivors seem to be the complications related to radiotherapy given in childhood.
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Affiliation(s)
- Radek Frič
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
| | | | - Tryggve Lundar
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arild Egge
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | | | - Paulina Due-Tønnessen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Einar Stensvold
- Department of Pediatrics, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Petter Brandal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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14
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Raleigh DR, Reiter JF. Misactivation of Hedgehog signaling causes inherited and sporadic cancers. J Clin Invest 2019; 129:465-475. [PMID: 30707108 DOI: 10.1172/jci120850] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The Hedgehog pathway is critical for the development of diverse organs. Misactivation of the Hedgehog pathway can cause developmental abnormalities and cancers, including medulloblastoma, the most common pediatric brain tumor, and basal cell carcinoma, the most common cancer in the United States. Here, we review how basic, translational, and clinical studies of the Hedgehog pathway have helped reveal how cells communicate, how intercellular communication controls development, how signaling goes awry to cause cancer, and how to use targeted molecular agents to treat both inherited and sporadic cancers.
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Affiliation(s)
- David R Raleigh
- Department of Radiation Oncology.,Department of Neurological Surgery, and
| | - Jeremy F Reiter
- Department of Biochemistry and Biophysics, UCSF, San Francisco, California, USA
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15
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Wells EM, Ullrich NJ, Seidel K, Leisenring W, Sklar CA, Armstrong GT, Diller L, King A, Krull KR, Neglia JP, Stovall M, Whelan K, Oeffinger KC, Robison LL, Packer RJ. Longitudinal assessment of late-onset neurologic conditions in survivors of childhood central nervous system tumors: a Childhood Cancer Survivor Study report. Neuro Oncol 2019; 20:132-142. [PMID: 29016809 DOI: 10.1093/neuonc/nox148] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Survivors of childhood central nervous system (CNS) tumors experience high rates of treatment-related neurologic sequelae. Whether survivors continue to be at increased risk for new events as they age is unknown. Methods Adverse neurologic health conditions in 5-year survivors of CNS tumors from the Childhood Cancer Survivor Study (n = 1876) were evaluated longitudinally at a median 23.0 years from diagnosis (range, 5.1-38.9), median age at last evaluation 30.3 years (range, 6.1-56.4). Multivariable regression estimated hazard ratios (HRs) and 95% CIs. Results From 5 to 30 years post diagnosis, cumulative incidence increased for seizures from 27% to 41%, motor impairment 21% to 35%, and hearing loss 9% to 23%. Risks were elevated compared with siblings (eg, seizures HR: 12.7; 95% CI: 9.6-16.7; motor impairment HR: 7.6; 95% CI: 5.8-9.9; hearing loss HR: 18.4; 95% CI: 13.1-25.9). Regional brain doses of radiation therapy were associated with development of new deficits (eg, frontal ≥50 Gy and motor impairment HR: 2.0; 95% CI: 1.2-3.4). Increased risk for motor impairment was also associated with tumor recurrence (HR: 2.6; 95% CI: 1.8-3.8), development of a meningioma (HR: 2.3; 95% CI: 0.9-5.4), and stroke (HR: 14.9; 95% CI: 10.4-21.4). Seizure risk was doubled by recurrence (HR: 2.3; 95% CI: 1.6-3.2), meningioma (HR: 2.6; 95% CI: 1.1-6.5), and stroke (HR: 2.0; 95% CI: 1.1-3.4). Conclusions CNS tumor survivors remain at risk for new-onset adverse neurologic events across their lifespans at a rate greater than siblings. Cranial radiation, stroke, tumor recurrence, and development of meningioma were independently associated with late-onset adverse neurologic sequelae.
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Affiliation(s)
- Elizabeth M Wells
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute.,Division of Neurology, Children's National Health System, Washington, DC
| | - Nicole J Ullrich
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - Kristy Seidel
- Clinical Research Division, Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington
| | - Wendy Leisenring
- Programs in Clinical Statistics and Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles A Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Lisa Diller
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - Allison King
- Departments of Hematology and Oncology, Occupational Therapy and Pediatrics, Washington University, St Louis, Missouri
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Psychology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Joseph P Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Marilyn Stovall
- Department of Radiation Physics, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimberly Whelan
- Department of Hematology and Oncology, University of Alabama, Birmingham, Alabama
| | | | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Brain Tumor Institute.,Division of Neurology, Children's National Health System, Washington, DC
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16
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Pluimakers VG, van Waas M, Neggers SJCMM, van den Heuvel-Eibrink MM. Metabolic syndrome as cardiovascular risk factor in childhood cancer survivors. Crit Rev Oncol Hematol 2018; 133:129-141. [PMID: 30661649 DOI: 10.1016/j.critrevonc.2018.10.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/06/2018] [Accepted: 10/28/2018] [Indexed: 12/14/2022] Open
Abstract
Over the past decades, survival rates of childhood cancer have increased considerably from 5 to 30% in the early seventies to current rates exceeding 80%. This is due to the development of effective chemotherapy, surgery, radiotherapy and stem cell transplantation, combined with an optimized stratification of therapy and better supportive care regimens. As a consequence, active surveillance strategies of late sequelae have been developed to improve the quality of survival. Several epidemiological studies have reported an increased incidence of (components of) metabolic syndrome (MetS) and cardiovascular disease in childhood cancer survivors (CCS). Growth hormone deficiency (GHD) after cranial radiotherapy (CRT) has been previously described as an important cause of MetS. New insights suggest a role for abdominal radiotherapy as a determinant for MetS as well. The role of other risk factors, such as specific chemotherapeutic agents, steroids, gonadal impairment, thyroid morbidity and genetics, warrants further investigation. This knowledge is important to define subgroups of CCS that are at risk to develop (subclinical) MetS features. These survivors might benefit from standard surveillance and early interventions, for example lifestyle and diet advice and medical treatment, thereby preventing the development of cardiovascular disease.
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Affiliation(s)
- V G Pluimakers
- Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands.
| | - M van Waas
- Department of Pediatric Oncology/Hematology, Erasmus MC - Sophia Children's Hospital Rotterdam, the Netherlands
| | - S J C M M Neggers
- Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands; Department of Medicine, section Endocrinology, Erasmus University Medical Centre Rotterdam, the Netherlands
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17
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Banerjee A, Jakacki RI, Onar-Thomas A, Wu S, Nicolaides T, Young Poussaint T, Fangusaro J, Phillips J, Perry A, Turner D, Prados M, Packer RJ, Qaddoumi I, Gururangan S, Pollack IF, Goldman S, Doyle LA, Stewart CF, Boyett JM, Kun LE, Fouladi M. A phase I trial of the MEK inhibitor selumetinib (AZD6244) in pediatric patients with recurrent or refractory low-grade glioma: a Pediatric Brain Tumor Consortium (PBTC) study. Neuro Oncol 2018; 19:1135-1144. [PMID: 28339824 DOI: 10.1093/neuonc/now282] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Activation of the mitogen-activated protein kinase pathway is important for growth of pediatric low-grade gliomas (LGGs). The aim of this study was to determine the recommended phase II dose (RP2D) and the dose-limiting toxicities (DLTs) of the MEK inhibitor selumetinib in children with progressive LGG. Methods Selumetinib was administered orally starting at 33 mg/m2/dose b.i.d., using the modified continual reassessment method. Pharmacokinetic analysis was performed during the first course. BRAF aberrations in tumor tissue were determined by real-time polymerase chain reaction and fluorescence in situ hybridization. Results Thirty-eight eligible subjects were enrolled. Dose levels 1 and 2 (33 and 43 mg/m2/dose b.i.d.) were excessively toxic. DLTs included grade 3 elevated amylase/lipase (n = 1), headache (n = 1), mucositis (n = 2), and grades 2-3 rash (n = 6). At dose level 0 (25 mg/m2/dose b.i.d, the RP2D), only 3 of 24 subjects experienced DLTs (elevated amylase/lipase, rash, and mucositis). At the R2PD, the median (range) area under the curve (AUC0-∞) and apparent oral clearance of selumetinib were 3855 ng*h/mL (1780 to 7250 ng × h/mL) and 6.5 L × h-1 × m-2 (3.4 to 14.0 L × h-1 × m-2), respectively. Thirteen of 19 tumors had BRAF abnormalities. Among the 5 (20%) of 25 subjects with sustained partial responses, all at the RP2D, 4 had BRAF aberrations, 1 had insufficient tissue. Subjects received a median of 13 cycles (range: 1-26). Fourteen (37%) completed all protocol treatment (26 cycles [n = 13], 13 cycles [n = 1]) with at least stable disease; 2-year progression-free survival at the RP2D was 69 ± SE 9.8%. Conclusion Selumetinib has promising antitumor activity in children with LGG. Rash and mucositis were the most common DLTs.
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Affiliation(s)
- Anuradha Banerjee
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Regina I Jakacki
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arzu Onar-Thomas
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Shengjie Wu
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Theodore Nicolaides
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tina Young Poussaint
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason Fangusaro
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joanna Phillips
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arie Perry
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Turner
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael Prados
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roger J Packer
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ibrahim Qaddoumi
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sridharan Gururangan
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ian F Pollack
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Stewart Goldman
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lawrence A Doyle
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Clinton F Stewart
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James M Boyett
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Larry E Kun
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maryam Fouladi
- University of California San Francisco, San Francisco, California; Boston Children's Hospital, Boston, Massachusetts; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; St Jude Children's Research Hospital, Memphis, Tennessee; Lurie Children's Hospital, Chicago, Illinois; Children's National Medical Center, Washington, DC; Duke University Medical Center, Durham, North Carolina; Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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18
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King AA, Seidel K, Di C, Leisenring WM, Perkins SM, Krull KR, Sklar CA, Green DM, Armstrong GT, Zeltzer LK, Wells E, Stovall M, Ullrich NJ, Oeffinger KC, Robison LL, Packer RJ. Long-term neurologic health and psychosocial function of adult survivors of childhood medulloblastoma/PNET: a report from the Childhood Cancer Survivor Study. Neuro Oncol 2018; 19:689-698. [PMID: 28039368 DOI: 10.1093/neuonc/now242] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Medulloblastoma is the most common malignant childhood brain tumor, although long-term risks for chronic neurologic health and psychosocial functioning in aging adult survivors are incompletely characterized. Methods The Childhood Cancer Survivor Study (CCSS) includes 380 five-year survivors of medulloblastoma/primitive neuroectodermal tumor (PNET; median age at follow-up: 30 y, interquartile range 24-36) and sibling comparison (n = 4031). Cumulative incidence of neurologic health conditions was reported. Cox regression models provided hazard ratios (HRs) and 95% CIs. Cross-sectional outcomes were assessed using generalized linear models. Results Compared with siblings, survivors were at increased risk of late-onset hearing loss (HR: 36.0, 95% CI: 23.6-54.9), stroke (HR: 33.9, 95% CI: 17.8-64.7), seizure (HR: 12.8, 95% CI: 9.0-18.1), poor balance (HR: 10.4, 95% CI: 6.7-15.9), tinnitus (HR: 4.8, 95% CI: 3.5-6.8), and cataracts (HR: 31.8, 95% CI: 16.7-60.5). Temporal/frontal lobe radiotherapy of 50 Gy or more increased risk for hearing loss (HR: 1.9, 95% CI: 1.1-1.3), seizure (HR: 2.1, 95% CI: 1.1-3.9), stroke (HR: 3.5, 95% CI: 1.3-9.1), and tinnitus (HR: 2.0, 95% CI: 1.0-3.9). Survivors were less likely than siblings to earn a college degree (relative risk [RR]: 0.49, 95% CI: 0.39-0.60), marry (RR: 0.35, 95% CI: 0.29-0.42), and live independently (RR: 0.58, 95% CI: 0.52-0.66). Conclusions Adult survivors of childhood medulloblastoma/PNET demonstrate pronounced risk for hearing impairment, stroke, lower educational attainment, and social independence. Interventions to support survivors should be a high priority.
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Affiliation(s)
- Allison A King
- Washington University School of Medicine, Siteman Cancer Center, St. Louis Children's Hospital, and Barnes Jewish Hospital, St. Louis, Missouri, USA
| | - Kristy Seidel
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Chongzhi Di
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Stephanie Mabry Perkins
- Washington University School of Medicine, Siteman Cancer Center, St. Louis Children's Hospital, and Barnes Jewish Hospital, St. Louis, Missouri, USA
| | - Kevin R Krull
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Daniel M Green
- St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Lonnie K Zeltzer
- Mattel Children's Hospital at the University of California Los Angeles, Los Angeles,California, USA
| | | | - Marilyn Stovall
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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19
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Pediatric Medulloblastoma: a Case of Recurrent Disease and Resiliency. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2017. [DOI: 10.1007/s40817-017-0032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Raleigh DR, Tomlin B, Buono BD, Roddy E, Sear K, Byer L, Felton E, Banerjee A, Torkildson J, Samuel D, Horn B, Braunstein SE, Haas-Kogan DA, Mueller S. Survival after chemotherapy and stem cell transplant followed by delayed craniospinal irradiation is comparable to upfront craniospinal irradiation in pediatric embryonal brain tumor patients. J Neurooncol 2016; 131:359-368. [PMID: 27778212 DOI: 10.1007/s11060-016-2307-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 10/17/2016] [Indexed: 01/28/2023]
Abstract
Pediatric embryonal brain tumor patients treated with craniospinal irradiation (CSI) are at risk for adverse effects, with greater severity in younger patients. Here we compare outcomes of CSI vs. high-dose chemotherapy (HD), stem cell transplant (SCT) and delayed CSI in newly diagnosed patients. Two hundred one consecutive patients treated for medulloblastoma (72 %), supratentorial primitive neuroectodermal tumor (sPNET; 18 %) or pineoblastoma (10 %) at two institutions between 1988 and 2014 were retrospectively identified. Progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method and compared by log-rank tests. Adjuvant CSI regimens were used for 56 % of patients (upfront-CSI), and HD/SCT regimens were used in 32 % of patients. HD/SCT patients were significantly younger than those receiving upfront-CSI (2.9 vs. 7.8 years; P < 0.0001). There were no differences in metastases, extent of resection, or CSI dose between upfront-CSI and HD/SCT patients, but median follow-up was shorter in the HD/SCT group (6.2 vs. 3.9 years; P = 0.007). There were no significant outcome differences between upfront-CSI and HD/SCT patients who received CSI as a prophylaxis or following relapse (OS 66 % vs. 61 %, P = 0.13; PFS 67 % vs. 62 %, P = 0.12). Outcomes were equivalent when restricting analyses to HD/SCT patients who received prophylactic CSI prior to relapse (OS 66 % vs. 65 %, P = 0.5; PFS 67 % vs. 74 %, P = 0.8). At last follow-up, 48 % of HD/SCT patients had received neither definitive nor salvage radiotherapy. In this retrospective cohort, outcomes with adjuvant HD/SCT followed by delayed CSI are comparable to upfront-CSI for carefully surveyed pediatric embryonal brain tumor patients. Future prospective studies are required to validate this finding, and also to assess the impact of delayed CSI on neurocognitive outcomes.
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Affiliation(s)
- David R Raleigh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Bryan Tomlin
- Department of Economics, California State University Chanel Islands, Camarillo, CA, USA
| | - Benedict Del Buono
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Erika Roddy
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Katherine Sear
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Lennox Byer
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Erin Felton
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Anu Banerjee
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Joseph Torkildson
- Pediatric Hematology-Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - David Samuel
- Pediatric Hematology-Oncology, Valley Children's Healthcare, Madera, CA, USA
| | - Biljana Horn
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sabine Mueller
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. .,Department of Neurology, Neurosurgery and Pediatrics, University of California San Francisco, 550 Sandler Neuroscience, 625 Nelson Rising Lane, 402B, Box 0434, San Francisco, CA, 94143, USA.
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21
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Occult Gastrointestinal Bleeding in a 15-Year-Old Pediatric Cancer Survivor. J Pediatr Gastroenterol Nutr 2016; 62:e62-3. [PMID: 25061718 DOI: 10.1097/mpg.0000000000000511] [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: 12/10/2022]
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22
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Tallen G, Resch A, Calaminus G, Wiener A, Leiss U, Pletschko T, Friedrich C, Langer T, Grabow D, Driever PH, Kortmann RD, Timmermann B, Pietsch T, Warmuth-Metz M, Bison B, Thomale UW, Krauss J, Mynarek M, von Hoff K, Ottensmeier H, Frühwald M, Kramm CM, Temming P, Müller HL, Witt O, Kordes U, Fleischhack G, Gnekow A, Rutkowski S. Strategies to improve the quality of survival for childhood brain tumour survivors. Eur J Paediatr Neurol 2015; 19:619-39. [PMID: 26278499 DOI: 10.1016/j.ejpn.2015.07.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/05/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Tumours of the central nervous system (CNS) are the most frequent solid tumours and the second most frequent type of cancer in children and adolescents. Overall survival has continuously improved in Germany, since an increasing number of patients have been treated according to standardised, multicentre, multimodal treatment recommendations, trials of the German Paediatric Brain Tumour Consortium (HIT-Network) or the International Society of Paediatric Oncology-Europe (SIOP-E) during the last decades. Today, two out of three patients survive. At least 8000 long-term childhood brain tumour survivors (CBTS) are currently living in Germany. They face lifelong disease- and treatment-related late effects (LE) and associated socioeconomic problems more than many other childhood cancer survivors (CCS). METHOD We review the LE and resulting special needs of this particular group of CCS. RESULTS Despite their increasing relevance for future treatment optimisation, neither the diversity of chronic and cumulative LE nor their pertinent risk factors and subsequent impact on quality of survival have yet been comprehensively addressed for CBTS treated according to HIT- or SIOP-E-protocols. Evidence-based information to empower survivors and stakeholders, as well as medical expertise to manage their individual health care, psychosocial and educational/vocational needs must still be generated and established. CONCLUSION The establishment of a long-term research- and care network in Germany shall contribute to a European platform, that aims at optimising CBTSs' transition into adulthood as resilient individuals with high quality of survival including optimal levels of activity, participation and acceptance by society.
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Affiliation(s)
- Gesche Tallen
- Department of Paediatric Oncology/Haematology, Charité-Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany; Department of Paediatrics, Faculty of Medicine, University of Calgary, 2888 Shaganappi Trail N.W., Calgary, Alberta T3B 6A8, Canada.
| | - Anika Resch
- Department of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Gabriele Calaminus
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Andreas Wiener
- Department of Paediatric Haematology and Oncology, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany.
| | - Ulrike Leiss
- Medical University Vienna, Department of Paediatric and Adolescent Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Thomas Pletschko
- Medical University Vienna, Department of Paediatric and Adolescent Medicine, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Carsten Friedrich
- Department of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany; Division of Paediatric Oncology, Haematology and Haemostaseology, Department of Woman's and Children's Health, University Hospital Leipzig, Liebigstr. 20a, 04103 Leipzig, Germany.
| | - Thorsten Langer
- Department of Paediatric Oncology/Haematology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Desiree Grabow
- German Childhood Cancer Registry (GCCR), Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center, University of Mainz, Gebäude 902, Obere Zahlbacher Straße 69, 55131 Mainz, Germany.
| | - Pablo Hernáiz Driever
- Department of Paediatric Oncology/Haematology, Charité-Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Rolf-Dieter Kortmann
- Department of Radiation Oncology, University of Leipzig, Stephanstr. 9a, 04103 Leipzig, Germany.
| | - Beate Timmermann
- Particle Therapy Clinic at West German Proton Therapy Centre Essen, University Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - Torsten Pietsch
- Institute of Neuropathology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
| | - Monika Warmuth-Metz
- Dept. of Neuroradiology, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany.
| | - Brigitte Bison
- Dept. of Neuroradiology, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany.
| | - Ulrich-Wilhelm Thomale
- Department of Paediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Jürgen Krauss
- Department of Neurosurgery, Head Clinic, University of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany.
| | - Martin Mynarek
- Department of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Katja von Hoff
- Department of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Holger Ottensmeier
- University Children's Hospital Würzburg, Dept. of Paed. Haematology, Oncology, Josef-Schneider-Str. 2, 97080 Würzburg, Germany.
| | - Michael Frühwald
- Department of Paediatric Oncology/Haematology, Klinikum Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Christof M Kramm
- Division of Paediatric Haematology and Oncology, University of Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.
| | - Petra Temming
- Paediatric Haematology/Oncology, Paediatrics III, University of Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - Hermann L Müller
- Paediatric Oncology/Haematology, Klinikum Oldenburg, Medical Campus University Oldenburg, Rahel-Straus-Str. 10, 26133 Oldenburg, Germany.
| | - Olaf Witt
- German Cancer Research Centre (DKFZ) and Department of Paediatric Oncology/Haematology, University of Heidelberg, Heidelberg, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Uwe Kordes
- Department of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Gudrun Fleischhack
- Paediatric Haematology/Oncology, Paediatrics III, University of Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - Astrid Gnekow
- Department of Paediatric Oncology/Haematology, Klinikum Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany.
| | - Stefan Rutkowski
- Department of Paediatric Haematology and Oncology, University Medical Centre Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
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Gunn ME, Mört S, Arola M, Taskinen M, Riikonen P, Möttönen M, Lähteenmäki PM. Quality of life and late‐effects among childhood brain tumor survivors: a mixed method analysis. Psychooncology 2015; 25:677-83. [DOI: 10.1002/pon.3995] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 12/15/2022]
Affiliation(s)
| | - Susanna Mört
- Department of PediatricsTurku University Hospital Turku Finland
- Turku University of Applied Sciences Turku Finland
| | - Mikko Arola
- Department of PediatricsTampere University Hospital Tampere Finland
| | - Mervi Taskinen
- Children's HospitalHelsinki University Central Hospital Helsinki Finland
| | - Pekka Riikonen
- Department of PediatricsKuopio University Hospital Kuopio Finland
| | - Merja Möttönen
- Department of PediatricsOulu University Hospital Oulu Finland
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24
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Alken SP, D'Urso P, Saran FH. Managing teenage/young adult (TYA) brain tumors: a UK perspective. CNS Oncol 2015; 4:235-46. [PMID: 26118974 DOI: 10.2217/cns.15.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Tumors of the CNS are among the commonest malignancies occurring in teenage/young adult patients (i.e., those aged between 15 and 24 years). The treatment of this patient population is challenging. Adolescence and young adulthood are a turbulent period of life, with physical, emotional, social and cognitive changes. Best practice advocates their treatment in dedicated teenage/young adult units, with multidisciplinary team input and access to clinical trials. Treatment of CNS malignancies is dependent upon histological subtype and staging, with varying combinations of surgery, radiotherapy and chemotherapy used. Clinical trials directly targeted at this patient population are rare; treatments are based on pediatric protocols as studies have demonstrated improved outcomes in patients (with other malignancies) treated as such. Scope for improvement lies in minimizing patient risk of recurrence and long-term sequelae of treatment. Molecular characterization of tumors may provide further information.
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Affiliation(s)
- Scheryll P Alken
- Department of Neuro Oncology, Royal Marsden Hospital, Sutton, UK
| | - Pietro D'Urso
- Department of Neurosurgery, Salford Royal Hospital Foundation Trust, Salford, UK
| | - Frank H Saran
- Department of Neuro Oncology, Royal Marsden Hospital, Sutton, UK
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25
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Olsson DS, Andersson E, Bryngelsson IL, Nilsson AG, Johannsson G. Excess mortality and morbidity in patients with craniopharyngioma, especially in patients with childhood onset: a population-based study in Sweden. J Clin Endocrinol Metab 2015; 100:467-74. [PMID: 25375987 DOI: 10.1210/jc.2014-3525] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
CONTEXT Craniopharyngiomas (CPs) in adults have been associated with excess mortality. OBJECTIVE The aim of the study was to investigate mortality and morbidity in patients with childhood-onset and adult-onset CP. METHODS PATIENTS with CP were identified and followed in Swedish national health registries, 1987 through 2011. The inclusion criteria for the CP diagnosis were internally validated against patient records in 28% of the study population. SETTINGS This was a nationwide population-based study. PATIENTS A total of 307 patients (151 men and 156 women) were identified and included (mean follow-up, 9 years; range, 0-25 years). The inclusion criteria had a positive predictive value of 97% and a sensitivity of 92%. INTERVENTION There were no interventions. MAIN OUTCOME MEASURES Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) with 95% confidence intervals were calculated using the Swedish population as the reference. RESULTS During the study, 54 patients died compared with the expected number of 14.1, resulting in an SMR of 3.2 (2.2-4.7) for men and 4.9 (3.2-7.2) for women. PATIENTS with childhood-onset (n = 106) and adult-onset (n = 201) CP had SMRs of 17 (6.3-37) and 3.5 (2.6-4.6), respectively. PATIENTS with hypopituitarism (n = 250), diabetes insipidus (n = 110), and neither of these (n = 54) had SMRs of 4.3 (3.1-5.8), 6.1 (3.5-9.7), and 2.7 (1.4-4.6), respectively. The SMR due to cerebrovascular diseases was 5.1 (1.7-12). SIRs were 5.6 (3.8-8.0) for type 2 diabetes mellitus, 7.1 (5.0-9.9) for cerebral infarction, 0.7 (0.2-1.7) for myocardial infarction, 2.1 (1.4-3.0) for fracture, and 5.9 (3.4-9.4) for severe infection. The SIR for all malignant tumors was 1.3 (0.8-2.1). CONCLUSIONS This first nationwide population-based study of patients with CP demonstrated excess mortality that was especially marked in patients with childhood-onset disease and among women. Death due to cerebrovascular diseases was increased 5-fold. Hypopituitarism and diabetes insipidus were negative prognostic factors for mortality and morbidity. PATIENTS with CP had increased disease burden related to type 2 diabetes mellitus, cerebral infarction, fracture, and severe infection.
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Affiliation(s)
- Daniel S Olsson
- Department of Endocrinology (D.S.O., A.G.N., G.J.), Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden; Department of Occupational and Environmental Medicine (E.A.), Sahlgrenska University Hospital, SE-405 30 Gothenburg, Sweden; and Department of Occupational and Environmental Medicine (I.-L.B.), Örebro University Hospital, SE-701 85 Örebro, Sweden
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Acharya S, DeWees T, Shinohara ET, Perkins SM. Long-term outcomes and late effects for childhood and young adulthood intracranial germinomas. Neuro Oncol 2014; 17:741-6. [PMID: 25422317 DOI: 10.1093/neuonc/nou311] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/05/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pediatric and young adult central nervous system (CNS) germinomas have favorable cure rates. However, long-term follow-up data are limited because of the rarity of this tumor. We report the long-term overall survival (OS) and causes of late mortality for these patients. METHODS Data between 1973 and 2005 from the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. Kaplan Meier survival analysis was performed on 5-year survivors of childhood CNS germinomatous germ cell tumors (GGCTs) and nongerminomatous germ cell tumors (NGGCTs). Standardized mortality ratios (SMRs) were calculated using US population data to compare observed versus expected all-cause death and death from stroke. Cumulative incidence was calculated using a competing risk model. RESULTS Four hundred five GGCTs and 94 NGGCTs cases were eligible. OS at 20 and 30 years for GGCTs was 84.1% and 61.9%, respectively, and was 86.7% for NGGCTs at both time points. Five-year survivors of GGCTs and NGGCTs experienced a 10-fold increase in mortality risk compared with their peers (SMR, 10.41; 95% confidence interval [CI], 7.71-13.76 vs SMR, 10.39;95% CI, 4.83-19.73, respectively). Five-year survivors GGCTs also experienced a nearly 59-fold increase in risk of death from stroke (SMR, 58.93; 95% CI, 18.72-142.10). At 25 years, the cumulative incidence of death due to cancer and subsequent malignancy was 16% and 6.0%, respectively. CONCLUSION Although CNS germinomas have favorable cure rates, late recurrences, subsequent malignancies, and stroke significantly affect long-term survival. Close attention to long-term follow-up with assessment of stroke risk factors is recommended.
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Affiliation(s)
- Sahaja Acharya
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.)
| | - Todd DeWees
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.)
| | - Eric T Shinohara
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.)
| | - Stephanie M Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (S.A., T.D., S.M.P.); Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee (E.T.S.)
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27
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Gunn ME, Lähdesmäki T, Malila N, Arola M, Grönroos M, Matomäki J, Lähteenmäki PM. Late morbidity in long-term survivors of childhood brain tumors: a nationwide registry-based study in Finland. Neuro Oncol 2014; 17:747-56. [PMID: 25422316 DOI: 10.1093/neuonc/nou321] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 10/26/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The population of long-term survivors of childhood brain tumors (BTs) is growing. The aim of our study was to evaluate late-appearing morbidity in BT survivors. METHODS Patients diagnosed with a BT at the age of 0-15 years between 1970 and 2004, and surviving at least 5 years, were identified from the Finnish Cancer Registry (n = 740). Their late new morbidity ≥ 5 years after cancer diagnosis was assessed using the Hospital Discharge Registry containing hospitalizations and outpatient visits in specialized health care settings. The morbidity of BT survivors was compared with that of the sibling cohort (n = 3615). RESULTS The 5-year survivors had a significantly increased hazard ratio (HR) for endocrine diseases (HR, 14.7), psychiatric disorders (HR, 1.8), cognitive and developmental disorders (HR, 16.6), neurological diseases (HR, 9.8), disorders of vision and hearing (HR, 10.5), and diseases of the circulatory system (HR, 2.7) compared with the sibling cohort. The HRs for disorders of musculoskeletal system (HR, 1.4) and diseases of the kidney (HR, 2.1) were not significantly increased. Radiation treatment did not explain all of the excess morbidity. Female survivors had a higher risk for disorders of vision and hearing (P = .046). Age at diagnosis did not show an effect on HRs. The HRs for endocrine diseases and disorders of vision or hearing loss were highest for survivors treated in the 1980s or later. CONCLUSIONS Pediatric BT survivors had significant neurocognitive consequences. This, together with the considerable risk for endocrine morbidity, will motivate us to organize systematic follow-up procedures for pediatric BT survivors.
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Affiliation(s)
- Mirja Erika Gunn
- Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.)
| | - Tuire Lähdesmäki
- Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.)
| | - Nea Malila
- Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.)
| | - Mikko Arola
- Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.)
| | - Marika Grönroos
- Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.)
| | - Jaakko Matomäki
- Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.)
| | - Päivi Maria Lähteenmäki
- Department of Pediatrics, Turku University Hospital, PO Box 52, Turku, Finland (M.E.G., T.L., M.G., J.M., P.M.L.); Finnish Cancer Registry, Unioninkatu 22, FI-00130 Helsinki, Finland (N.M.); School of Health Sciences, University of Tampere, Tampere FI-33014, Finland (N.M.); Department of Pediatrics, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland (M.A.)
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Thorp N, Taylor R. Management of Central Nervous System Tumours in Children. Clin Oncol (R Coll Radiol) 2014; 26:438-45. [DOI: 10.1016/j.clon.2014.04.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
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