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Kanamori M, Mugikura S, Iizuka O, Mori N, Shimoda Y, Shibahara I, Umezawa R, Jingu K, Saito R, Sonoda Y, Kumabe T, Suzuki K, Endo H. Clinical significance of cerebral microbleeds in patients with germinoma who underwent long-term follow-up. J Neurooncol 2024; 170:173-184. [PMID: 39133380 PMCID: PMC11447146 DOI: 10.1007/s11060-024-04753-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/15/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE This study identified the factors affecting cerebral microbleed (CMBs) development. Moreover, their effects on intelligence and memory and association with stroke in patients with germinoma who had long-term follow-up were evaluated. METHODS This study included 64 patients with germinoma who were histologically and clinically diagnosed with and treated for germinoma. These patients were evaluated cross-sectionally, with a focus on CMBs on susceptibility-weighted magnetic resonance imaging (SWI), brain atrophy assessed through volumetric analysis, and intelligence and memory. RESULTS The follow-up period was from 32 to 412 (median: 175.5) months. In total, 43 (67%) patients had 509 CMBs and 21 did not have CMBs. Moderate correlations were observed between the number of CMBs and time from initial treatments and recurrence was found to be a risk factor for CMB development. Increased temporal CMBs had a marginal effect on the processing speed and visual memory, whereas brain atrophy had a statistically significant effect on verbal, visual, and general memory and a marginal effect on processing speed. Before SWI acquisition and during the follow-up periods, eight strokes occurred in four patients. All of these patients had ≥ 15 CMBs on SWI before stroke onset. Meanwhile, 33 patients with < 14 CMBs or 21 patients without CMBs did not experience stroke. CONCLUSION Patients with a longer time from treatment initiation had a higher number of CMBs, and recurrence was a significant risk factor for CMB development. Furthermore, brain atrophy had a stronger effect on memory than CMBs. Increased CMBs predict the stroke onset.
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Affiliation(s)
- Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan.
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Osamu Iizuka
- Department of Behavioral and Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshiteru Shimoda
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kyoko Suzuki
- Department of Behavioral and Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
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de Gennaro L, Messina R, Bruno MC, Bozzi MT, Speranzon L, Delvecchio C, Chibbaro S, Marani W, Montemurro N, Signorelli F. The role of neurosurgeon in the multidisciplinary approach to ectopic or bifocal intracranial germinoma: A systematic review and report of two illustrative cases. Clin Neurol Neurosurg 2024; 244:108408. [PMID: 38954867 DOI: 10.1016/j.clineuro.2024.108408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/18/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Pure germinoma typically originates from the midline and is usually found in the pineal and suprasellar regions in 76-90 % of cases. When it is in both regions, it is considered bifocal (10 % at diagnosis). If pure germinoma is located outside of the midline, it is considered ectopic, with a global incidence of about 0.7 %. The study aims to describe the clinical and surgical approach to patients with atypical intracranial ectopic germinoma (IEG) and bifocal germinoma (BG) through a literature review with the goal to delineate the correct diagnostic and therapeutic pathway, to reduce the diagnostic delay and improve the prognosis of these patients. METHODS A systematic review of the literature in most common electronic database (PubMed, Ovid MEDLINE and Ovid EMBASE) on IEG and BG, in according with the "PRISMA statement" criteria, from January 1990 to September 2022 was done. In addition, two rare cases of IEG and BG were reported. RESULTS This systematic review included 16 papers (20 patients) with a final diagnosis of IEG and 30 papers (121 patients) with a final diagnosis of BG. IEGs seems to involve primary basal ganglia (40 %) and corpus callosum (40 %). For IEGs, biopsy (70 %, 14 cases out of 20) was the most common surgical approach: open approach (35 %), stereotactic minimally invasive approach (30 %) or endoscopic trans-sphenoidal approach (5 %). Partial resection was performed in 10 % of cases, whereas a total resection was performed in 20 % of cases. Also for BGs, biopsy was the most common surgical approach in 80 % of patients, whereas surgical resection (partial or total) was performed in 5.3 % of patients. CONCLUSION IEG and BG are rare type of primary intracranial germ cell tumor, whose unusual location often can cause delays in diagnosis, which can have a significant impact on the patient's prognosis and requiring a multidisciplinary and timely approach.
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Affiliation(s)
- Luigi de Gennaro
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro" of Bari, Bari, Italy
| | - Raffaella Messina
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro" of Bari, Bari, Italy
| | | | - Maria Teresa Bozzi
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro" of Bari, Bari, Italy
| | - Luca Speranzon
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro" of Bari, Bari, Italy
| | - Carlo Delvecchio
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro" of Bari, Bari, Italy
| | - Salvatore Chibbaro
- Division of Neurosurgery, Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università di Siena, Italy
| | - Walter Marani
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro" of Bari, Bari, Italy
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy.
| | - Francesco Signorelli
- Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University "Aldo Moro" of Bari, Bari, Italy
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Li B, Zhao S, Li S, Li C, Liu W, Li L, Cui B, Liu X, Chen H, Zhang J, Ren Y, Liu F, Yang M, Jiang T, Liu Y, Qiu X. Novel molecular subtypes of intracranial germ cell tumors expand therapeutic opportunities. Neuro Oncol 2024; 26:1335-1351. [PMID: 38430549 PMCID: PMC11226877 DOI: 10.1093/neuonc/noae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Indexed: 03/04/2024] Open
Abstract
BACKGROUND Intracranial germ cell tumors (IGCTs) are a rare group of malignancies that are clinically classified as germinomas and nongerminomatous germ cell tumors (NGGCTs). Previous studies have found that somatic mutations involving the mitogen-activated protein kinase/mTOR signaling pathway are common early events. However, a comprehensive genomic understanding of IGCTs is still lacking. METHODS We established a cohort including over 100 IGCTs and conducted genomic and transcriptomic sequencing. RESULTS We identified novel recurrent driver genomic aberrations, including USP28 truncation mutations and high-level copy number amplification of KRAS and CRKL caused by replication of extrachromosomal DNA. Three distinct subtypes associated with unique genomic and clinical profiles were identified with transcriptome analysis: Immune-hot, MYC/E2F, and SHH. Both immune-hot and MYC/E2F were predominantly identified in germinomas and shared similar mutations involving the RAS/MAPK signaling pathway. However, the immune-hot group showed an older disease onset age and a significant immune response. MYC/E2F was characterized by a younger disease onset age and increased genomic instability, with a higher proportion of tumors showing whole-genome doubling. Additionally, the SHH subtype was mostly identified in NGGCTs. CONCLUSIONS Novel genomic aberrations and molecular subtypes were identified in IGCTs. These findings provide molecular basis for the potential introduction of new treatment strategies in this setting.
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Affiliation(s)
- Bo Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shuang Zhao
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory of Pediatric Hematology & Oncology Ministry of Health, Department of Hematology & Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shouwei Li
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bowen Cui
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory of Pediatric Hematology & Oncology Ministry of Health, Department of Hematology & Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xing Liu
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huiyuan Chen
- Department of Pathology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yin Ren
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Liu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Yang
- Shandong Provincial Key Laboratory of Radiation Oncology, Cancer Research Center, Shandong Cancer Hospital and Institute, Jinan, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Liu
- Pediatric Translational Medicine Institute, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Key Laboratory of Pediatric Hematology & Oncology Ministry of Health, Department of Hematology & Oncology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoguang Qiu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Ogiwara H, Liao YM, Wong TT. Pineal/germ cell tumors and pineal parenchymal tumors. Childs Nerv Syst 2023; 39:2649-2665. [PMID: 37831207 DOI: 10.1007/s00381-023-06081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Pineal region tumors (PRTs) are tumors arising from the pineal gland and the paraspinal structures. These tumors are rare and heterogeneous that account for 2.8-10.1% and 0.6-3.2% of tumors in children and in all ages, respectively. Almost all types and subtypes of CNS tumors may be diagnosed in this region. These tumors come from cells of the pineal gland (pinealocytes and neuroglial cells), ectopic primordial germ cells (PGC), and cells from adjacent structures. Hence, PRTs are consisted of pineal parenchyma tumors (PPTs), germ cell tumors (GCTs), neuroepithelial tumors (NETs), other miscellaneous types of tumors, cystic tumors (epidermoid, dermoid), and pineal cyst in addition. The symptoms of PRTs correlate to the increased intracranial cranial pressure due to obstructive hydrocephalus and dorsal midbrain compression. The diagnostic imaging studies are mainly MRI of brain (with and without gadolinium) along with a sagittal view of whole spine. Serum and/or CSF AFP/β-HCG helps to identify GCTs. The treatment of PRTs is consisted of the selection of surgical biopsy/resection, handling of hydrocephalus, neoadjuvant and/or adjuvant therapy according to age, tumor location, histopathological/molecular classification, grading of tumors, staging, and threshold value of markers (for GCTs) in addition. METHODS In this article, we review the following focus points: 1. Background of pineal region tumors. 2. Pineal GCTs and evolution of management. 3. Molecular study for GCTs and pineal parenchymal tumors. 4. Review of surgical approaches to the pineal region. 5. Contribution of endoscopy. 6. Adjuvant therapy (chemotherapy, radiotherapy, and combination). 7. FUTURE DIRECTION RESULTS In all ages, the leading three types of PRTs in western countries were PPTs (22.7-34.8%), GCTs (27.3-34.4%), and NETs (17.2-28%). In children and young adults, the leading PRTs were invariably in the order of GCTs (40-80.5%), PPTs (7.6-21.6%), NETs (2.4-37.5%). Surgical biopsy/resection of PRTs is important for precision diagnosis and therapy. Safe resection with acceptable low mortality and morbidity was achieved after 1970s because of the advancement of surgical approaches, CSF shunt and valve system, microscopic and endoscopic surgery. Following histopathological diagnosis and classification of types and subtypes of PRTs, in PPTs, through molecular profiling, four molecular groups of pineoblastoma (PB) and their oncogenic driver were identified. Hence, molecular stratified precision therapy can be achieved. CONCLUSION Modern endoscopic and microsurgical approaches help to achieve precise histopathological diagnosis and molecular classification of different types and subtypes of pineal region tumors for risk-stratified optimal, effective, and protective therapy. In the future, molecular analysis of biospecimen (CSF and blood) along with AI radiomics on tumor imaging integrating clinical and bioinformation may help for personalized and risk-stratified management of patients with pineal region tumors.
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Affiliation(s)
- Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Okura 2-10-1, Setagaya-ku, 157-8535, Tokyo, Japan
| | - Yu-Mei Liao
- Division of Hematology and Oncology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Tai-Tong Wong
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, 252 Wuxing St, Taipei, 11031, Taiwan.
- Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Neuroscience Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
- Pediatric Brain Tumor Program, Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan.
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Zeng C, Yang Q, Li Z, Wei Z, Chen T, Deng M, Wang J, Wang J, Sun F, Huang J, Lu S, Zhu J, Sun X, Zhen Z. Treatment outcomes for response-based radiotherapy in children and adolescents with central nervous system germinoma: a prospective study. J Neurooncol 2023; 164:643-653. [PMID: 37768471 DOI: 10.1007/s11060-023-04453-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE The optimal dose and range of radiotherapy for central nervous system (CNS) germinoma have not yet been established. This study aimed to investigate the effects of individualized radiotherapy on the prognosis of patients with germinoma. METHODS Based on imaging examination, tumor markers, and pathologic results, patients with germinoma received different radiotherapy strategies, including R1 (24 Gy whole ventricular irradiation + tumor-bed boost to 40 Gy), R2 (24-30 Gy craniospinal irradiation + tumor-bed boost to 54 Gy), R3 (24 Gy craniospinal irradiation + tumor-bed boost to 40 Gy), and R4 (30 Gy craniospinal irradiation + tumor-bed boost to 54 Gy with 45 Gy to spinal metastasis). RESULTS A total of 77 patients were enrolled in this study between January 2015 and March 2021. The 3-year event-free survival (EFS) and overall survival (OS) of the whole cohort were 94.7% ± 2.6% and 96.0% ± 2.3%, respectively. The 3-year EFS for patients with localized and metastatic disease were 96.6% ± 2.4% and 89.2% ± 7.2%, respectively. The 3-year EFS of patients receiving R1, R2, R3, and R4 radiotherapy were 100%, 94.1% ± 5.7%, 100%, and 86.2% ± 9.1%, respectively. CONCLUSION Good prognosis was still achieved after reducing dose and extent of radiation for the patients who achieved complete response (CR) after induction chemotherapy or pathological CR after second-look surgery.
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Affiliation(s)
- Chenggong Zeng
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Qunying Yang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Zhuoran Li
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Zhiqing Wei
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Tingting Chen
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Meiling Deng
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Jian Wang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Juan Wang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Feifei Sun
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Junting Huang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Suying Lu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Jia Zhu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China
| | - Xiaofei Sun
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
| | - Zijun Zhen
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
- Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
- Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China.
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Foo JC, Yaman Bajin I, Marushchak O, McKeown T, Bouffet E, Tsang DS, Laperriere N, Dirks P, Drake J, Ertl-Wagner B, Bartels U. Time to dismiss boost? Outcomes of children with localized and metastatic germinoma. J Neurooncol 2023; 162:443-448. [PMID: 37039951 DOI: 10.1007/s11060-023-04307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/01/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To determine long-term outcomes of a cohort of children with germinoma treated with chemotherapy and radiation therapy without primary tumor boost even in the absence of complete response to chemotherapy METHODS: This retrospective study analyzed the outcome of patients with germinoma consecutively diagnosed and treated at a tertiary care center from January 2000 to December 2021. MRIs were reviewed by two radiologists, blinded to patient data. Tumor location at diagnosis, tumor response to chemotherapy and at completion of radiation therapy and site of relapse were assessed. Tumor response was assessed radiologically by determining the tumor size and response on diffusion-weighted imaging, in addition to biochemical, cytological parameters and neurological status. RESULTS Of 46 pediatric germinoma patients, 29 children (14 male; median age 12.8 years) received no primary tumor boost. Median follow-up was 63 months (range 9-187 months). Twenty-five children had localized disease and tumor location was suprasellar (n = 11), pineal (n = 10), bifocal (n = 3) and basal ganglia (n = 1) while 4 children had metastatic disease at presentation. All patients completed multi-agent chemotherapy followed by either ventricular irradiation (VI) (23.4 Gy) (n = 23), whole brain (WBI) (23.4 Gy) (n = 5) or craniospinal radiation (CSI) (23.4 Gy) (n = 1). Two children, who had localized disease at presentation and received VI after chemotherapy, relapsed 9 months and 32 months after completion of treatment respectively. No patient had a local relapse. Location of relapse was distant, outside (n = 1) and out- and inside (n = 1) the irradiation field. Five-year progression free survival (PFS) was 91% and overall survival (OS) was 100%. CONCLUSIONS In this case series, excellent 5-year PFS and OS rates were achieved with chemotherapy followed by radiation therapy of 23.4 Gy delivered without primary tumor boost. No local relapse was observed despite omitting primary tumor boost in patients with localized and metastatic germinoma.
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Affiliation(s)
- Jen Chun Foo
- Division of Paediatric Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Inci Yaman Bajin
- Division of Paediatric Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Oksana Marushchak
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
| | - Tara McKeown
- Division of Paediatric Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Eric Bouffet
- Division of Paediatric Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Derek S Tsang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Norman Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Peter Dirks
- Division of Neuro-Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Canada
| | - James Drake
- Division of Neuro-Surgery, Department of Surgery, Hospital for Sick Children, Toronto, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Ute Bartels
- Division of Paediatric Haematology-Oncology, Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
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7
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Cappellano AM, Dassi N, Mançano B, Epelman S, Almeida DB, Cavalheiro S, Dastoli PA, Seixas MT, Nicacio JM, Costa MD, Silva FA, Aguiar SS, Almeida CR, Teixeira GR, Chen M, Figueiredo ML, Silva NS, Finlay JL. Outcome of Children and Adolescents With Primary Intracranial Germinoma Treated With Chemotherapy and Reduced Dose-Field Irradiation: A Prospective Brazilian Experience. JCO Glob Oncol 2023; 9:e2200257. [PMID: 37075267 PMCID: PMC10497279 DOI: 10.1200/go.22.00257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/20/2023] [Accepted: 02/24/2023] [Indexed: 04/21/2023] Open
Abstract
PURPOSE This prospective Brazilian single-arm trial was conducted to determine response to chemotherapy and survival after response-based radiotherapy in children with intracranial germinomas, in the setting of a multi-institutional study in a middle-income country (MIC) with significant disparity of subspecialty care. PATIENTS AND METHODS Since 2013, 58 patients with histologic and/or serum and CSF tumor marker evaluations of primary intracranial germ cell tumors were diagnosed; 43 were germinoma with HCGβ levels ≤200 mIU/mL and five between 100 and 200 mIU/mL. The treatment plan consisted of four cycles of carboplatin and etoposide followed by 18 Gy whole-ventricular field irradiation (WVFI) and primary site(s) boost up to 30 Gy; 24 Gy craniospinal was prescribed for disseminated disease. RESULTS Mean age 13.2 years (range, 4.7-25.5 years); 29 were males. Diagnosis was made by tumor markers (n = 6), surgery (n = 25), or both (n = 10). Two bifocal cases with negative tumor markers were treated as germinoma. Primary tumor location was pineal (n = 18), suprasellar (n = 14), bifocal (n = 10), and basal ganglia/thalamus (n = 1). Fourteen had ventricular/spinal spread documented by imaging studies. Second-look surgery occurred in three patients after chemotherapy. Thirty-five patients achieved complete responses after chemotherapy, and eight showed residual teratoma/scar. Toxicity was mostly grade 3/4 neutropenia/thrombocytopenia during chemotherapy. At a median follow-up of 44.5 months, overall and event-free survivals were 100%. CONCLUSION The treatment is tolerable, and WVFI dose reduction to 18 Gy preserves efficacy; we have demonstrated the feasibility of successfully conducting a prospective multicenter trial in a large MIC despite resource disparity.
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Affiliation(s)
| | - Natalia Dassi
- Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Bruna Mançano
- Pediatric Oncology, Hospital do Amor, Barretos, Brazil
| | - Sidnei Epelman
- Pediatric Oncology, Hospital Santa Marcelina, TUCCA, São Paulo, Brazil
| | - Daniela B. Almeida
- Nursing Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Sergio Cavalheiro
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Patricia A. Dastoli
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Maria Teresa Seixas
- Pathology Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Jardel M. Nicacio
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Marcos D. Costa
- Neurosurgery Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Frederico A. Silva
- Radiology Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | - Simone S. Aguiar
- Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Michael Chen
- Radiotherapy Department, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
| | | | - Nasjla S. Silva
- Pediatric Oncology, IOP-GRAACC, Federal University of São Paulo, São Paulo, Brazil
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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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9
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Yeo KK, Nagabushan S, Dhall G, Abdelbaki MS. Primary central nervous system germ cell tumors in children and young adults: A review of controversies in diagnostic and treatment approach. Neoplasia 2022; 36:100860. [PMID: 36521378 PMCID: PMC9772847 DOI: 10.1016/j.neo.2022.100860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Primary central nervous system (CNS) germ cell tumors (GCT) are a rare heterogenous group of cancers, arising most commonly in the second decade of life. Through several clinical trials conducted around the world by various groups, the treatment approach for CNS GCT has advanced substantially with generally improved overall outcomes. In recent years, the goal of clinical trials has been focused on reduction of the radiotherapy burden and minimization of long-term toxicity. This review summarizes the current diagnostic and treatment regimens for CNS GCT, examines the controversies associated with these approaches, gaps in contemporary knowledge, and underscores the challenges we face. We also explore future directions in the management of CNS GCT with the ultimate overall aim of preserving curative outcomes, identifying novel biomarkers, and mitigating neurocognitive, endocrine, and psychological toxicity through prospective clinical studies.
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Affiliation(s)
- Kee Kiat Yeo
- Dana-Farber / Boston Children's Cancer and Blood Disorder Center, USA,Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Sumanth Nagabushan
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia,University of New South Wales, Randwick, New South Wales, Australia
| | - Girish Dhall
- The Alabama Center for Childhood Cancer and Blood Disorders at Children's of Alabama, Birmingham, USA,University of Alabama, Birmingham, USA,Corresponding author at: The Alabama Center for Childhood Cancer and Blood Disorders at Children's of Alabama, 1600 7th Avenue S, Lowder 512, Birmingham, AL 35233, USA.
| | - Mohamed S. Abdelbaki
- The Division of Hematology and Oncology, St. Louis Children's Hospital, Washington University, School of Medicine in St. Louis, Washington University, St. Louis, Missouri, USA,Co-corresponding author at: Washington University School of Medicine in St. Louis, 660 South Euclid Avenue – Campus Box 8116, St. Louis, MO 63110, USA.
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10
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Amayiri N, Sarhan N, Yousef Y, Ibrahimi AK, Abu-Shanab S, Al-Zebin Z, Al-Hussaini M, Musharbash A, Tawalbeh A, Bouffet E, Bartels U. Feasibility of treating pediatric intracranial germ cell tumors in a middle-income country: The Jordanian experience. Pediatr Blood Cancer 2022; 69:e30011. [PMID: 36131594 DOI: 10.1002/pbc.30011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/16/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pediatric intracranial germ cell tumors (iGCT) are rare, with limited data available from Arabic countries. METHODS We retrospectively reviewed the medical charts of children <18 years diagnosed with iGCT at King Hussein Cancer Center/Jordan (January 2003 to December 2020) for clinical characteristics, treatment, and morbidities. RESULTS Sixteen patients had germinoma; median age was 6.9 years and median symptoms duration 8 months. Nine tumors were suprasellar, five pineal, and two bifocal. Four were metastatic. Eight patients had slightly elevated beta subunit human chorionic gonadotropin and 11 patients had resection/biopsy. Fifteen patients received chemotherapy; mostly carboplatin (450 mg/m2 )/etoposide, which had low toxicity. All patients received radiotherapy (different doses and fields). At median follow-up of 7.7 years, one tumor recurred (progression-free survival: 91% ± 8%). Twelve patients who continued follow-up had stable visual and endocrine deficits to their initial presentation. Five finished or are finishing diploma and seven had poor school performance (four left school). Six patients were diagnosed with nongerminomatous germ cell tumor; median symptom duration was 1 month. Three tumors were pineal, two suprasellar, and one at quadrigeminal plate. Three were metastatic. Five tested patients had high tumor markers and four had resection/biopsy. All patients received chemotherapy, and then five received craniospinal radiation. Two patients are alive, two died with tumor progression, one died in remission with electrolyte imbalance, and one developed leukemia and died with septic shock. CONCLUSIONS We achieved excellent survival in treating germinoma using a feasible protocol for low middle-income countries. However, patients encountered significant morbidities exacerbated by delayed diagnosis and unnecessary surgical interventions despite abnormal tumor markers. Raising awareness on iGCT symptomatology and diagnosis may help limit these morbidities.
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Affiliation(s)
- Nisreen Amayiri
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Nasim Sarhan
- Radiation Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Yacoub Yousef
- Surgery Department, Ophthalmology Division, King Hussein Cancer Center, Amman, Jordan
| | - Ahmed Kh Ibrahimi
- Radiation Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Sobuh Abu-Shanab
- Psychosocial Oncology Program, King Hussein Cancer Center, Amman, Jordan
| | - Zebin Al-Zebin
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Maysa Al-Hussaini
- Department of Pathology and Laboratory Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Awni Musharbash
- Surgery Department, Neurosurgery Division, King Hussein Cancer Center, Amman, Jordan
| | - Ahmed Tawalbeh
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Bartels
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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11
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Yamaguchi S, Okamoto M, Ishi Y, Sawaya R, Motegi H, Sugiyama M, Harada T, Fujima N, Mori T, Hashimoto T, Takakuwa E, Manabe A, Kudo K, Aoyama H, Fujimura M. Long-term consequences of residual lesions after chemoradiotherapy in patients with germinoma at onset. J Neurosurg Pediatr 2022; 30:517-524. [PMID: 36087334 DOI: 10.3171/2022.8.peds22301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In patients with intracranial germ cell tumors, residual lesions are sometimes observed after completion of primary chemoradiotherapy. Although salvage resection of these end-of-treatment residual lesions is recommended for patients with nongerminomatous germ cell tumors, the necessity of early salvage resection for those with germinoma is not clear. The aim of this study was to investigate the frequency of residual germinoma lesions after primary chemoradiotherapy, as well as their management, long-term consequences, and prognosis. METHODS The authors retrospectively reviewed patients who were primarily treated for germinoma between 2002 and 2021. Residual lesions were evaluated with MRI with and without contrast enhancement within 2 weeks after chemoradiotherapy. The decision to perform salvage resection of residual lesions was at the discretion of the treating physicians. The change in appearance of residual lesions was assessed with serial MRI. Overall survival (OS), progression-free survival (PFS), and recurrence pattern were also investigated. RESULTS Sixty-nine patients were treated with chemoradiotherapy for germinoma, with a mean follow-up period of 108 months. Residual lesions were radiologically observed in 30 patients (43.5%). Among these, 5 patients (3 with pineal lesions and 2 with basal ganglia lesions) underwent salvage resection. Pathological examination revealed teratomatous components in 3 patients, whereas no tumoral components were identified in 2 patients. One patient with a basal ganglia lesion showed worsening of hemiparesis postoperatively. The remaining 25 patients received watchful observation without surgical intervention. Chronological periodic radiological change in residual lesions was evaluated in 21 patients. One year after primary treatment, the size of the residual lesions was stable and had decreased in 10 and 11 patients, respectively. None of the lesions increased in size. The 10-year PFS and OS rates were 96.7% and 97.3% in patients without residual lesions (n = 39), and 87.1% and 100% in patients with residual lesions (n = 30), respectively. Presence of residual lesions had no significant effect on PFS or OS. All recurrences occurred at distant sites or via dissemination without progression of the primary tumor site, regardless of the presence of residual lesion. CONCLUSIONS End-of-treatment residual lesions are not rare in patients with germinoma, and these residual lesions seldom show progression. Because of the potential risk of surgical complications, the indication for early salvage surgery for residual lesions should be carefully determined. Watchful observation is recommended for the majority of these cases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Emi Takakuwa
- 5Surgical Pathology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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12
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Partenope C, Pozzobon G, Weber G, Arya VB, Carceller F, Albanese A. Endocrine manifestations of paediatric intracranial germ cell tumours: from diagnosis to long-term follow-up. Endocrine 2022; 77:546-555. [PMID: 35767181 DOI: 10.1007/s12020-022-03121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/17/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE We examined endocrine manifestations in a cohort of paediatric patients with IC-GCTs at diagnosis and during follow-up, integrating clinical, radiological, histopathological and laboratory data. METHODS Diabetes insipidus (DI), growth hormone deficiency (GHD), hypothyroidism, adrenal insufficiency, precocious puberty (PP)/hypogonadism were diagnosed clinically and biochemically. The prevalence of endocrine manifestations was compared to survival rates. RESULTS Our population included 55 children (37 males, 18 females) diagnosed with IC-GCT with a median follow-up of 78.9 months from diagnosis (range 0.5-249.9). At tumour diagnosis, 50.9% patients displayed endocrinopathies: among them, 85.7% were affected by DI, 57.1% central adrenal insufficiency, 50% central hypothyroidism, 28.5% GHD, 10.7% hypogonadotrophic hypogonadism, 10.7% PP. These patients presented predominantly with suprasellar germinoma. If not diagnosed previously, endocrine disorders arose 15.15 months (1.3-404.2) after end of treatment (EOT) in 16.4% patients. At least one endocrinopathy was identified in 67.3% of subjects at last follow-up visit, especially GHD and adrenal insufficiency. DI, hypothyroidism, and adrenal insufficiency occurred earlier than other abnormalities and frequently preceded tumour diagnosis. Subjects with and without endocrine manifestations who survived beyond 12 months after EOT did not show significant difference in overall survival and progression-free survival (p = 0.28 and p = 0.88, respectively). CONCLUSION Endocrinopathies were common presenting symptoms in our population. If present at diagnosis, they often persisted hence after. The spectrum of endocrinopathies expanded during follow-up up to 33.7 years after EOT. Although they did not seem to affect survival rate in our cohort, close lifelong surveillance is mandatory to provide the best care for these patients.
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Affiliation(s)
- Cristina Partenope
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Department of Paediatric Endocrinology, Royal Marsden NHS Foundation Trust, London, UK.
| | - Gabriella Pozzobon
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanna Weber
- Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ved Bhushan Arya
- Department of Paediatric Endocrinology, Variety Children Hospital, King's College Hospital NHS Foundation Trust, London, UK
- Honorary Senior Lecturer, School of Life Sciences, King's College London, London, UK
| | - Fernando Carceller
- Paediatric and Adolescent Oncology Drug Development Team, Children and Young People's Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Assunta Albanese
- Department of Paediatric Endocrinology, Royal Marsden NHS Foundation Trust, London, UK
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13
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Ronsley R, Bouffet E, Dirks P, Drake J, Kulkarni A, Bartels U. Successful management of symptomatic hydrocephalus using a temporary external ventricular drain with or without endoscopic third ventriculostomy in pediatric patients with germinoma. J Neurosurg 2022; 137:807-812. [PMID: 35238528 DOI: 10.3171/2021.8.jns211443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to describe the management of hydrocephalus in a cohort of pediatric patients with germinoma. METHODS The authors conducted a retrospective chart review of patients with germinoma and symptomatic hydrocephalus treated at the Hospital for Sick Children between 2002 and 2020. Descriptive data included tumor location, CSF diversion procedure (external ventricular drain [EVD], endoscopic third ventriculostomy [ETV], ventriculoperitoneal [VP] shunt) and outcomes. The frontooccipital horn ratio (FOR) method was used to determine the presence of ventriculomegaly. RESULTS Of 39 patients with germinoma, 22 (73% male) had symptomatic hydrocephalus at diagnosis (11 pineal, 4 suprasellar, and 7 bifocal). Management of hydrocephalus included EVD (n = 5, 22.7%), ETV (n = 5, 22.7%), and combination ETV and EVD (n = 7, 31.8%), whereas 5 patients (22.7%) did not undergo surgical intervention. The median FOR at diagnosis was 0.42 (range 0.38-0.58), which correlated with moderate to severe ventriculomegaly. Carboplatin and etoposide-based chemotherapy induced fast tumor shrinkage, avoiding CSF diversion (n = 5) and resolving hydrocephalus with a transient EVD (n = 5). The median duration until EVD removal was 7 days (range 2-10 days). Two of 12 patients with EVD ultimately required a VP shunt. Kaplan-Meier overall survival was 100% and progression-free survival was 96.4% at a median follow-up of 10.4 years. CONCLUSIONS Timely initiation of chemotherapy is imperative to rapidly reduce tumor bulk in children with germinoma and limits the need for VP shunt insertions. In children in whom CSF diversion is required, hydrocephalus may be successfully managed with a temporary EVD ± ETV.
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Affiliation(s)
- Rebecca Ronsley
- 1Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia
| | - Eric Bouffet
- 2Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario; and
| | - Peter Dirks
- 3Pediatric Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - James Drake
- 3Pediatric Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Abhaya Kulkarni
- 3Pediatric Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Ute Bartels
- 2Division of Hematology, Oncology & Bone Marrow Transplant, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Ontario; and
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14
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Mak DY, Siddiqui Z, Liu ZA, Dama H, MacDonald SM, Wu S, Murphy ES, Hall MD, Malkov V, Onar-Thomas A, Ahmed S, Dhall G, Tsang DS. Photon versus proton whole ventricular radiotherapy for non-germinomatous germ cell tumors: A report from the Children's Oncology Group. Pediatr Blood Cancer 2022; 69:e29697. [PMID: 35373903 PMCID: PMC9329212 DOI: 10.1002/pbc.29697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To determine if proton therapy reduces doses to cranial organs at risk (OARs) as compared to photon therapy in children with non-germinomatous germ cell tumors (NGGCT) receiving whole ventricular radiotherapy (WVRT). METHODS AND MATERIALS Dosimetric data for patients with NGGCT prospectively enrolled in stratum 1 of the Children's Oncology Group study ACNS1123 who received 30.6 Gy WVRT were compared. Target segmentation was standardized using a contouring atlas. Doses to cranial OARs were compared between proton and photon treatments. Clinically relevant dose-volume parameters that were analyzed included mean dose and dose to 40% of the OAR volume (D40). RESULTS Mean and D40 doses to the supratentorial brain, cerebellum, and bilateral temporal, parietal, and frontal lobes were statistically significantly lower amongst proton-treated patients, as compared to photon-treated patients. In a subgroup analysis of patients uniformly treated with a 3-mm planning target volume, patients who received proton therapy continued to have statistically significantly lower doses to brain OARs. CONCLUSIONS Children treated with proton therapy for WVRT had lower doses to normal brain structures, when compared to those treated with photon therapy. Proton therapy should be considered for patients receiving WVRT for NGGCT.
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Affiliation(s)
- David Y. Mak
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Zain Siddiqui
- Division of Radiation Oncology, Cancer Center of Southeastern Ontario, Kingston, Ontario
| | - Zhihui Amy Liu
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Hitesh Dama
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Shannon M. MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Erin S. Murphy
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Matthew D. Hall
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Victor Malkov
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Arzu Onar-Thomas
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sameera Ahmed
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
| | - Girish Dhall
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Derek S. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario
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15
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Diagnosis and Treatment of Pineal Region Tumors in Adults: A EURACAN Overview. Cancers (Basel) 2022; 14:cancers14153646. [PMID: 35954310 PMCID: PMC9367474 DOI: 10.3390/cancers14153646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Pineal region tumors are rare intracranial tumors. A deeper knowledge of these tumors’ molecular mechanisms has been gained in recent years, which has led to a new classification and new potential systemic treatments. Surgery remains the mainstay of treatment, while radiotherapy and systemic therapy depend on histological, molecular, and clinical characteristics. This paper highlights recent developments in the diagnosis and treatment of these tumors. Abstract Pineal region tumors are rare intracranial tumors, accounting for less than 1% of all adult intracranial tumor lesions. These lesions represent a histologically heterogeneous group of tumors. Among these tumors, pineal parenchymal tumors and germ cell tumors (GCT) represent the most frequent types of lesions. According to the new WHO 2021 classification, pineal parenchymal tumors include five distinct histotypes: pineocytoma (PC), pineal parenchymal tumors of intermediate differentiation (PPTID), papillary tumor of the pineal region (PTPR), pinealoblastoma (PB), and desmoplastic myxoid tumor of the pineal region, SMARCB1-mutant; GCTs include germinoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, mixed GCTs. Neuroradiological assessment has a pivotal role in the diagnostic work-up, surgical planning, and follow-up of patients with pineal masses. Surgery can represent the mainstay of treatment, ranging from biopsy to gross total resection, yet pineal region tumors associated with obstructive hydrocephalus may be surgically managed via ventricular internal shunt or endoscopic third ventriculostomy. Radiotherapy remains an essential component of the multidisciplinary treatment approach for most pineal region tumors; however, treatment volumes depend on the histological subtypes, grading, extent of disease, and the combination with chemotherapy. For localized germinoma, the current standard of care is chemotherapy followed by reduced-dose whole ventricular irradiation plus a boost to the primary tumor. For pinealoblastoma patients, postoperative radiation has been associated with higher overall survival. For the other pineal tumors, the role of radiotherapy remains poorly studied and it is usually reserved for aggressive (grade 3) or recurrent tumors. The use of systemic treatments mainly depends on histology and prognostic factors such as residual disease and metastases. For pinealoblastoma patients, chemotherapy protocols are based on various alkylating or platinum-based agents, vincristine, etoposide, cyclophosphamide and are used in association with radiotherapy. About GCTs, their chemosensitivity is well known and is based on cisplatin or carboplatin and may include etoposide, cyclophosphamide, or ifosfamide prior to irradiation. Similar regimens containing platinum derivatives are also used for non-germinomatous GCTs with very encouraging results. However, due to a greater understanding of the biology of the disease’s various molecular subtypes, new agents based on targeted therapy are expected in the future. On behalf of the EURACAN domain 10 group, we reviewed the most important and recent developments in histopathological characteristics, neuro-radiological assessments, and treatments for pineal region tumors.
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16
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Liu SJ, Aw NMY, Lim MJR, Tew Seow W, Low DCY, Kimpo MS, Ee Kar Tan E, Tsai Yeo T, Low SYY, Nga VDW. Paediatric brain tumours in Singapore: A 15-year epidemiological and outcome study. J Clin Neurosci 2022; 101:154-161. [PMID: 35597064 DOI: 10.1016/j.jocn.2022.05.006] [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: 11/29/2021] [Revised: 04/06/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
Abstract
Paediatric brain tumours (PBTs) are the most common solid tumours in children. Previous publications reflect variations in incidence rates and frequency of histological types in different global populations. However, there are limited studies on the epidemiology of PBTs in Singapore. This study aims to summarise the epidemiology of paediatric brain tumours managed in Singapore. This is an ethics-approved retrospective study of all patients below 19 years old diagnosed with PBTs managed by Singapore's 2 tertiary paediatric neurosurgical centres, KK Women's and Children's Hospital (KKH) and the National University Hospital (NUH) over a 15-year period from 01 January 2002 to 31 December 2017. Data collected was analysed for age, gender, tumour characteristics, presenting complaints, location, treatment modalities, 1-year and 5-year overall survival (OS). A total of 396 patients were included. The mean age of diagnosis was 7.05 years (0.25-18; ± 4.83) and male-to-female ratio was 1.41:1. Top histological groups were astrocytic (30.6%), embryonal (26.0%), germ cell (11.1%), ependymoma (30, 7.58%) and craniopharyngioma (27, 6.82%). Outcomes included recurrence rate (31.2%), 1-year OS (89.5%) and 5-year OS (72.2%). Poorer 5-year OS were noted in embryonal tumours (47.0%; p < 0.001) and ependymoma (50.0%; p = 0.0074) patients. Of note, the following cohorts also had poorer OS at 5 years: supratentorial tumours (76.2%; p = 0.0426), radiotherapy (67.4%; p = 0.0467) and surgery (74.9%, HR; p < 0.001). Overall, our data reflects patient demographics, presenting complaints, treatment modalities and survival outcomes, that are comparable to other international paediatric neurosurgical centres.
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Affiliation(s)
- Sherry J Liu
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
| | - Natalie M Y Aw
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore
| | - Mervyn J R Lim
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
| | - Wan Tew Seow
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - David C Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore
| | - Miriam S Kimpo
- Division of Paediatric Oncology, Department of Paediatrics, National University Health System, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - Enrica Ee Kar Tan
- Paediatric Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
| | - Sharon Y Y Low
- Neurosurgical Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore; Department of Neurosurgery, National Neuroscience Institute, Singapore; SingHealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Vincent D W Nga
- Division of Neurosurgery, Department of Surgery, National University Health System, Singapore
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17
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Kang YM, Lee YY, Lin SC, Chang FC, Hsu SPC, Lin CF, Liang ML, Chen HH, Wong TT, Lan KL, Chao Y, Chen YW. Bifocal lesions have a poorer treatment outcome than a single lesion in adult patients with intracranial germinoma. PLoS One 2022; 17:e0264641. [PMID: 35231071 PMCID: PMC8887760 DOI: 10.1371/journal.pone.0264641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Intracranial germinoma (IG) rarely occurs in adults. Its optimal treatment strategy is unclear. We evaluated the outcomes of radiotherapy in adults with intracranial germinoma. Data of 29 adult patients (age, 18–52 years; median age, 24.3 years) with IG treated with radiotherapy at Taipei Veterans General Hospital were retrospectively reviewed. They were followed up for a median time of 5.9 years (range, 1.0–12.8 years). We used the Kaplan–Meier method to estimate the progression-free survival (PFS) and overall survival (OS), and univariate and multivariate Cox proportional hazards regression models to identify the factors affecting PFS. PFS and OS were compared between adult and pediatric patients with IG. The 1-, 3-, and 5-year PFS rates were 96.6%, 85.8%, and 77.8%, respectively, in the adult patients, and the OS rate were all 100%. Seven patients (24.1%) experienced recurrence, and in six of them, salvage therapy successfully controlled the disease. Two patients (6.9%) died after 5 years of follow-up due to disease progression and central pontine myelinolysis. In the univariate and multivariate Cox analysis, bifocal lesions had a significantly lower PFS than those with single lesions (p = 0.008). Kaplan–Meier survival analysis showed that adult patients had a poorer PFS (p = 0.06) and OS (p = 0.025) than pediatric patients. Our study showed bifocal lesions were associated with lower PFS than a single lesion among adult IG patients, and adult IG patients tended to have poorer PFS and OS compared to pediatric IG patients. For adult patients with bifocal IG, we recommend treatment with craniospinal irradiation, whole ventricle irradiation (WVI) with chemotherapy, or frequent spine images follow-up for patients who received only WVI.
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Affiliation(s)
- Yu-Mei Kang
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Yen Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Chieh Lin
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sanford P. C. Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Muh-Lii Liang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Hung Chen
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tai-Tong Wong
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Keng-Li Lan
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yee Chao
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wei Chen
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu City, Taiwan
- * E-mail:
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18
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Advances in Molecular Profiling and Developing Clinical Trials of CNS Germ Cell Tumors: Present and Future Directions. Curr Oncol Rep 2022; 24:105-112. [DOI: 10.1007/s11912-022-01195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/03/2022]
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19
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Chen H, Ni M, Xu Y, Zhong LY. Pituitary Stalk Germ Cell Tumors: Retrospective Case Series and Literature Review. Int J Endocrinol 2022; 2022:9213220. [PMID: 35378836 PMCID: PMC8976628 DOI: 10.1155/2022/9213220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/11/2022] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Intracranial germ cell tumors with isolated pituitary stalk involvement are rare. Early recognition and long-term monitoring deserve further exploration. METHODS A retrospective study reviewing eleven intracranial germ cell tumor patients with isolated pituitary stalk involvement was performed. RESULTS Seven boys and four girls who presented with a hyperintense pituitary stalk on postcontrast T1-weighted magnetic resonance imaging without a posterior pituitary signal were included. The average maximum width of the pituitary stalk was 5.2 ± 1.6 mm. Polydipsia and polyuria occurred in all patients, followed by growth retardation, fatigue, and amenorrhoea. Eight patients (72%) had concomitant partial anterior pituitary hormone deficiency. Seven patients initially had elevated human chorionic gonadotropin levels. After chemoradiotherapy, ten patients attended follow-up. Central diabetes insipidus remained in all survivors, and four (40%) of them had concomitant partial anterior pituitary hormone deficiency, primarily of growth hormone and insulin-like growth factor-1. The causes of the delayed diagnosis of previous studies were mainly negative tumor markers and the initial pathological diagnosis of autoimmune diseases. CONCLUSION Isolated pituitary stalk lesions could be a signal of intracranial germ cell tumors, especially coexisting with diabetes insipidus, hypopituitarism, and a worse response to glucocorticoid therapy. Negative results of tumor markers and pathology could not exclude the diagnosis. Chemoradiotherapy is an effective therapy, leaving mild-t-moderate hypothalamus-pituitary dysfunction. This rare neuroimaging feature may be used as a factor to predict long-term neuroendocrine outcomes.
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Affiliation(s)
- Han Chen
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Ming Ni
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yun Xu
- Department of Obstetrics and Gynaecology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Li-Yong Zhong
- Department of Endocrinology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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20
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Bartels U, Onar-Thomas A, Patel SK, Shaw D, Fangusaro J, Dhall G, Souweidane M, Bhatia A, Embry L, Trask CL, Murphy ES, MacDonald S, Wu S, Boyett JM, Leary S, Fouladi M, Gajjar A, Khatua S. Phase II trial of response-based radiation therapy for patients with localized germinoma: a Children's Oncology Group study. Neuro Oncol 2021; 24:974-983. [PMID: 34850169 PMCID: PMC9159444 DOI: 10.1093/neuonc/noab270] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The study aimed to evaluate whether simplified chemotherapy followed by dose-reduced irradiation was effective for treating patients (ages 3-21 years) with localized germinoma. The primary endpoint was 3-year progression-free survival (PFS) rate. METHODS Patients with a complete response to chemotherapy with carboplatin and etoposide received 18 Gy WVI + 12 Gy boost to the tumor bed. Patients with partial response proceeded to 24 Gy WVI + 12 Gy. Longitudinal cognitive functioning was evaluated prospectively on ALTE07C1 and was a primary study aim. RESULTS One hundred and fifty-one patients were enrolled; 137 were eligible. Among 90 evaluable patients, 74 were treated with 18 Gy and 16 with 24 Gy WVI. The study failed to demonstrate noninferiority of the 18 Gy WVI regimen compared to the design threshold of 95% 3-year PFS rate, where, per design, patients who could not be assessed for progression at 3 years were counted as failures. The Kaplan-Meier (KM)-based 3-year PFS estimates were 94.5 ± 2.7% and 93.75 ± 6.1% for the 18 Gy and 24 Gy WVI cohorts, respectively. Collectively, estimated mean IQ and attention/concentration were within normal range. A lower mean attention score was observed at 9 months for patients treated with 24 Gy. Acute effects in processing speed were observed in the 18 Gy cohort at 9 months which improved at 30-month assessment. CONCLUSIONS While a failure according to the prospective statistical noninferiority design, this study demonstrated high rates of chemotherapy responses, favorable KM-based PFS and OS estimates in the context of reduced irradiation doses and holds promise for lower long-term morbidities for patients with germinoma.
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Affiliation(s)
- Ute Bartels
- Corresponding Author: Ute Bartels, MD, The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada ()
| | - Arzu Onar-Thomas
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Sunita K Patel
- City of Hope National Medical Center, Departments of Population Sciences and Supportive Care Medicine, Duarte, California, USA
| | - Dennis Shaw
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jason Fangusaro
- Department of Pediatrics, Children’s Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Girish Dhall
- Children’s of Alabama, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| | - Mark Souweidane
- Department of Neurological Surgery, Weill Cornell Medicine and Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Aashim Bhatia
- Department of Radiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, New York, USA
| | - Leanne Embry
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Christine L Trask
- Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Erin S Murphy
- Department of Pediatrics, Children’s Hospital and Regional Medical Center, Seattle, Washington, USA
| | - Shannon MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Shengjie Wu
- Department of Biostatistics, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | - Sarah Leary
- Department of Pediatrics, Children’s Hospital and Regional Medical Center, Seattle, Washington, USA
| | - Maryam Fouladi
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Amar Gajjar
- Department of Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Soumen Khatua
- Department of Pediatric Hematology-Oncology, Mayo Clinic, Rochester, Minnesota, USA
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21
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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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22
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Li B, Wang J, Yang J, Li Y, Liu Y, Liu S, Qiu X. Characteristics of growth disturbances in patients with intracranial germinomas of different origins. Childs Nerv Syst 2021; 37:2531-2537. [PMID: 34028562 DOI: 10.1007/s00381-021-05189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore the characteristics of growth disturbance in patients with intracranial germinoma with different origins. METHODS Clinical data of 151 patients with single-origin germinomas were studied retrospectively. Z-score of height (ZSOH) at both diagnosis and the last follow-up was calculated using the WHO AnthroPlus software. Linear regression was used to analyse the correlation between the absolute change in ZSOH (|ZSOH last follow-up - ZSOH diagnosis|) and clinical factors. RESULTS The mean ZSOH decreased significantly in every origin subgroup at the last follow-up. In patients with sellar germinoma (n = 62), the mean ZSOH values at both diagnosis and the last follow-up were significantly lower than those in patients with pineal (n = 30) (p < 0.001) or basal ganglia germinomas (n = 59) (p < 0.001), respectively. In patients with basal ganglia germinoma, the mean absolute change in ZSOH decreased significantly compared to that in the patients with sellar (p = 0.006) or pineal germinomas (p = 0.04). Linear analysis revealed that sex (male vs female; p = 0.003) and age at diagnosis (≤10 years vs >10 years; p = 0.026) had negative correlations, while radiation dose at the hypothalamic-pituitary axis (HPA) (≤40 Gy vs >40 Gy; p = 0.085) had a marginally positive correlation, with absolute change in ZSOH. CONCLUSIONS Patients with germinoma experienced growth retardation after treatments. The growth disturbance was consistent and more severe in patients with germinoma of sellar origin, while the greatest aggravation was observed in patients with germinoma of basal ganglia origin. Decreasing radiation dose to the HPA may minimize the negative impact of radiotherapy on growth.
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Affiliation(s)
- Bo Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,Beijing Neurosurgery Institute, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Jiayi Wang
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Jiongxian Yang
- Department of Clinical Nutrition, Beijing Children's Hospital, Capital Medical University, No. 56, Nanli shilu, Xicheng District, Beijing, 100045, China
| | - Yanong Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yanwei Liu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Shuai Liu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xiaoguang Qiu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,Beijing Neurosurgery Institute, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
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Shimizu H, Motomura K, Ohka F, Aoki K, Tanahashi K, Hirano M, Chalise L, Nishikawa T, Yamaguchi J, Yoshida J, Natsume A, Wakabayashi T. Long-term survival in patients with primary intracranial germ cell tumors treated with surgery, platinum-based chemotherapy, and radiotherapy: a single-institution study. J Neurosurg 2021; 135:449-457. [PMID: 33007755 DOI: 10.3171/2020.6.jns20638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The current study aimed to evaluate the treatment outcomes and toxicities of patients with intracranial germ cell tumors (GCTs). METHODS This study retrospectively included 110 consecutive patients (70 patients in the germinomatous group and 40 patients in the nongerminomatous GCT [NGGCT] groups) receiving surgery, platinum-based chemotherapy, and radiotherapy for newly diagnosed primary intracranial GCTs. In the authors' protocol, patients with GCTs were further divided into the following four groups: the germinomatous group and the NGGCT groups (mature teratoma, intermediate prognosis, or poor prognosis). RESULTS The median overall survival (OS) and progression-free survival (PFS) rates of the patients in the germinomatous group were significantly higher than those in the NGGCT group (p < 0.001). The 5-, 10-, and 20-year OS rates in the germinomatous group were 97.1%, 95.7%, and 93.2%, respectively, with a median follow-up of 11.0 years. On the contrary, the 5-, 10-, and 20-year OS rates in the NGGCT group were 67.3%, 63.4%, and 55.4%, respectively. The 5-, 10-, and 20-year PFS rates were 91.4%, 86.6%, and 86.6%, respectively, in the germinomatous group, whereas those of the NGGCT group were approximately 67.4%, 60.2%, and 53.5%, respectively. Based on the four types of classification in our study, the 5-, 10-, and 20-year OS rates in the NGGCT intermediate prognosis group were 78.9%, 71.8%, and 53.8%, respectively. On the contrary, the 3- and 5-year OS rates in the NGGCT poor prognosis group were 42.9% and 34.3%, respectively. Moreover, toxicities with the treatment of intracranial GCTs were found to be tolerable in the present study population. The multivariate survival models for OS in the NGGCT intermediate prognosis and poor prognosis groups demonstrated that only the alpha-fetoprotein status was significantly associated with worsened OS (HR 3.88, 95% CI 1.29-11.66; p = 0.02). CONCLUSIONS The authors found that platinum-based chemotherapy and radiotherapy result in favorable survival outcomes in patients with germinomatous GCTs. Clinical outcomes were still unfavorable in the NGGCT intermediate prognosis and poor prognosis groups; therefore, a new protocol that increases the survival rate of patients belonging in both groups should be considered.
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24
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Molecular Pathology and Targeted Therapies for Personalized Management of Central Nervous System Germinoma. J Pers Med 2021; 11:jpm11070661. [PMID: 34357128 PMCID: PMC8306901 DOI: 10.3390/jpm11070661] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/05/2021] [Accepted: 07/10/2021] [Indexed: 12/19/2022] Open
Abstract
Intracranial germinomas are rare tumours, usually affecting male paediatric patients. They frequently develop in the pineal and suprasellar regions, causing endocrinological disturbances, visual deficits, and increased intracranial pressure. The diagnosis is established on magnetic resonance imaging (MRI), serum and cerebrospinal fluid (CSF) markers, and tumour stereotactic biopsy. Imaging techniques, such as susceptibility-weighted imaging (SWI), T2* (T2-star) gradient echo (GRE) or arterial spin labelling based perfusion-weighted MRI (ASL-PWI) facilitate the diagnosis. Germinomas are highly radiosensitive tumours, with survival rates >90% in the context of chemoradiotherapy. However, patients with resistant disease have limited therapeutic options and poor survival. The aim of this review is to highlight the genetic, epigenetic, and immunologic features, which could provide the basis for targeted therapy. Intracranial germinomas present genetic and epigenetic alterations (chromosomal aberrations, KIT, MAPK and PI3K pathways mutations, DNA hypomethylation, miRNA dysregulation) that may represent targets for therapy. Tyrosine kinase and mTOR inhibitors warrant further investigation in these cases. Immune markers, PD-1 (programmed cell death protein 1) and PD-L1 (programmed death-ligand 1), are expressed in germinomas, representing potential targets for immune checkpoint inhibitors. Resistant cases should benefit from a personalized management: genetic and immunological testing and enrolment in trials evaluating targeted therapies in intracranial germinomas.
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Baroni LV, Oller A, Freytes CS, Sampor CV, Pinto N, Fernandez NP, Rugilo C, Lubieniecki F, Zubizarreta P, Alderete D. Intracranial germ cells tumour: a single institution experience in Argentina. J Neurooncol 2021; 152:363-372. [PMID: 33660119 DOI: 10.1007/s11060-021-03709-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intracranial germ cell tumor (iGCT) represents a rare and heterogeneous group, with variable incidence and diverse treatment strategies. Although multiagent chemotherapy with reduced radiotherapy strategy has been applied by several cooperative groups in North America and Western Europe, there is a paucity of data to understand if this combined regimen is suitable in low-middle income countries (LMIC). METHODS We evaluate the outcome in a cohort of iGCT treated by SIOP-CNS-GCT-96 strategy at hospital J.P Garrahan in Argentina over the last 20 years. Radiation field and dose included focal radiotherapy (FRT) before 2009 or focal radiotherapy plus whole ventricular radiotherapy (WVRT) after 2009 for localized germinoma and FRT or FRT plus WVRT or CSI for non germinomatous germ cell tumors (NGGCT) RESULTS: Sixty iGCT were identified; 39 germinoma and 21 NGGCT. Median follow-up was 6.57 years (range 0.13-20.5). 5-year PFS and OS were 83.5% (95% CI [165.53-223.2]) and 88.7% (95% CI [169.84-223.2]) for the germinoma group, while for the NGGCT group were 75% (95% CI [133.27-219.96]) and 64.2% (95% CI [107.38-201.81]) respectively. The localized germinoma group showed poor results between 2000 and 2009 with 5-year PFS and OS of 69 and 75% respectively, and an excellent outcome between 2010 and 2019 with a 5-years PFS and OS of 92.8 and 100%. A univariable analysis identified this difference in survival as related to the field of radiotherapy, specifically whole ventricular radiotherapy. FRT increased the risk of recurrence in localized germinoma, involving not only ventricular relapses; but spinal cord and disseminated disease as well. There were no relapses of localized NGGCT after FRT and FRT plus WVRT. CONCLUSION Herein we demonstrate that intensive chemotherapy followed by FRT plus WVRT for germinoma is a feasible and effective strategy, warranting further study in the developing world.
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Affiliation(s)
- Lorena V Baroni
- Service of Hematology/Oncology, Hospital JP Garrahan, 1881 Combate de los Pozos Street, Buenos Aires, Argentina.
| | - Agustina Oller
- Service of Hematology/Oncology, Hospital JP Garrahan, 1881 Combate de los Pozos Street, Buenos Aires, Argentina.
| | - Candela S Freytes
- Service of Hematology/Oncology, Hospital JP Garrahan, 1881 Combate de los Pozos Street, Buenos Aires, Argentina
| | - Claudia V Sampor
- Service of Hematology/Oncology, Hospital JP Garrahan, 1881 Combate de los Pozos Street, Buenos Aires, Argentina
| | - Natalia Pinto
- Service of Radiotherapy, Hospital JP Garrahan, Buenos Aires, Argentina
| | - Nicolas Ponce Fernandez
- Service of Hematology/Oncology, Hospital JP Garrahan, 1881 Combate de los Pozos Street, Buenos Aires, Argentina
| | - Carlos Rugilo
- Service of Diagnostic Imaging, Hospital JP Garrahan, Buenos Aires, Argentina
| | | | - Pedro Zubizarreta
- Service of Hematology/Oncology, Hospital JP Garrahan, 1881 Combate de los Pozos Street, Buenos Aires, Argentina
| | - Daniel Alderete
- Service of Hematology/Oncology, Hospital JP Garrahan, 1881 Combate de los Pozos Street, Buenos Aires, Argentina.
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Li B, Feng J, Chen L, Li Y, Wang J, Lv W, Li Y, Liu Y, Liu S, Luo S, Qiu X. Relapse pattern and quality of life in patients with localized basal ganglia germinoma receiving focal radiotherapy, whole-brain radiotherapy, or craniospinal irradiation. Radiother Oncol 2021; 158:90-96. [PMID: 33610622 DOI: 10.1016/j.radonc.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/21/2021] [Accepted: 02/08/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE The optimal target volume in localized basal ganglia (BG) germinoma is still undetermined. Thus, based on the relapse pattern and health-related quality of life (HRQOL), we evaluated three target volumes. MATERIAL AND METHODS The clinical data of 161 patients with localized BG germinoma were included in this retrospective study. Relapse status and relapse sites after treatment were explored. HRQOL was evaluated using the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) (≤15 years) and Short Form-36 (SF-36) (>15 years) questionnaires based on the patients' age at last follow-up. RESULTS After a median follow-up duration of 83 months (range, 20-214 months), 19 patients experienced relapse, including 15, 4, and 0 patients in the focal radiotherapy (FR) (n = 35), whole-brain radiotherapy (WBRT) plus boost (n = 109), and craniospinal irradiation (CSI) plus boost (n = 17) groups, respectively. The 5-year disease-free survival rates were 74.3%, 97.2%, and 100%, respectively (p < 0.001). Among the 15 patients who relapsed after FR, 14 had positive radiological findings, including seven (50.0%) with lesions in the periventricular area and seven (50.0%) with frontal lobe lesions. Relapse in both these areas were significantly reduced by WBRT or CSI. HRQOL data were available for 69 patients, who generally scored low. Among 38 patients evaluated by SF-36, those receiving CSI had significantly lower mental component scores than those receiving WBRT (p = 0.027) or FR (p = 0.011). CONCLUSIONS Considering both disease control and HRQOL, WBRT is the optimal target volume in our series. The relapse pattern identified in patients receiving FR is informative for further treatment volume optimization.
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Affiliation(s)
- Bo Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China; Beijing Neurosurgery Institute, Capital Medical University, China
| | - Jin Feng
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Li Chen
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Youqi Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Jiayi Wang
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Wenyi Lv
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Yanong Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Yanwei Liu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Shuai Liu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Shiqi Luo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China
| | - Xiaoguang Qiu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, China; Beijing Neurosurgery Institute, Capital Medical University, China
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Long term toxicity of intracranial germ cell tumor treatment in adolescents and young adults. J Neurooncol 2020; 149:523-532. [PMID: 33034840 DOI: 10.1007/s11060-020-03642-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study is to describe the long-term toxicities of intracranial germ cell tumor (IGCT) in the adolescent and young adult (AYA) population. METHODS We report late toxicities of a multi-center cohort of AYA patients treated for IGCT between 1975 and 2015. Charts were retrospectively reviewed for hormone deficiency, ototoxicity, seizure disorder, visual deterioration, cerebrovascular events, second neoplasm, psychiatric illness, and neurocognitive impairment. Statistical analysis was performed for late toxicities to evaluate the influence of select factors. RESULTS Our patient cohort included 112 patients with IGCTs; 84% of patients had a germinoma as opposed to a non-germinomatous germ cell tumor (NGGCT), median age at radiotherapy (RT) was 19 years, and median follow-up was 8.3 years. Of the 94 patients with germinoma, 32 (34%) received both chemotherapy and RT as part of their upfront treatment, while 62 (66%) received RT alone. All 18 patients with NGGCT received chemotherapy and RT. The most common late toxicity following IGCT treatments was physician-reported neurocognitive impairment, with a 10-year cumulative incidence (CI) of 38.5%. Ten-year CI of treatment-induced ototoxicity was 39.2% for patients who received cisplatin, compared to 3.6% for those who received carboplatin but no cisplatin (p < 0.005). Suprasellar/hypothalamic tumor location was associated with 10-year CI of treatment-induced hormone deficiency (36.1 vs 6.2%, p < 0.005). CONCLUSIONS A significant proportion of AYAs treated for IGCTs experience late effects from treatment, including neurocognitive impairment, ototoxicity, and hormone deficiency. Suprasellar/hypothalamic tumor location and cisplatin were associated with a higher risk of treatment-induced hormone deficiency and ototoxicity, respectively.
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Biassoni V, Schiavello E, Gandola L, Pecori E, Poggi G, Spreafico F, Terenziani M, Meazza C, Podda M, Ferrari A, Luksch R, Casanova M, Puma N, Chiaravalli S, Bergamaschi L, Cefalo G, Simonetti F, Gattuso G, Seregni EC, Pallotti F, Gianno F, Diletto B, Barretta F, Massimino M. Secreting Germ Cell Tumors of the Central Nervous System: A Long-Term Follow-up Experience. Cancers (Basel) 2020; 12:cancers12092688. [PMID: 32967085 PMCID: PMC7565315 DOI: 10.3390/cancers12092688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Due to the rarity of nongerminomatous germ cell tumors (NGGCT) with non-standard treatment as yet, we report retrospectively our 30 year experience with chemotherapy followed by craniospinal irradiation (CSI), plus a boost of whole ventricular irradiation (WVI)/tumor bed (TB), tailored to pre-radiation chemotherapy response. METHODS Between 1988 and 2016, 28 patients received four cycles of PEB (cisplatin/etoposide/bleomycin), then CSI, and two further PEB cycles. Between 1988 and1994, CSI was 25.5 Gy for patients in complete remission (CR), 30 Gy if in partial remission (PR) or metastatic, with a boost to TB up to 45-54 Gy. In the period of 1995-2010, the boost included WVI and any extra-ventricular tumor sites up to 45 Gy. After 2010, CSI was reduced to 25.5 Gy for all non-metastatic patients, and a boost was given only to TB up to 40.5/45.5 Gy, depending on patients' CR/PR status. After 2003, patients with alfafetoprotein (αFP) > 1000 ng/mL received intensified treatment, also including autologous stem cell transplantation. RESULTS Among 28 patients (23 males; median age 12 years, 6 metastatic), 25 responded to PEB, and three progressed (PD) after one to four cycles; 26 received radiotherapy obtaining 13 CR, 7 PR and 5 stable disease (SD), 1 PD; 6 (21%) died (5 for disease, 1 for pneumonia while in CR). Five-year overall survival (OS) and progression-free survival (PFS) were both 81%; 10 year OS and PFS 81% and 76%, respectively (median follow-up 11 years). CONCLUSIONS Survival for children with NGGCT, independently from disease extent, was encouraging. Further studies should elucidate which patients could benefit from reduced volume and dose irradiation.
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Affiliation(s)
- Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
- Correspondence: ; Tel.: +39-0223902590; Fax: +39-0223902648
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Lorenza Gandola
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (E.P.); (B.D.)
| | - Emilia Pecori
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (E.P.); (B.D.)
| | - Geraldina Poggi
- Neuro-Oncological Unit and Neuropsychological Rehabilitation Unit Scientific Institute, IRCCS E. Medea, Bosisio Parini, 23842 Lecco, Italy;
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Cristina Meazza
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Marta Podda
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Roberto Luksch
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Nadia Puma
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Stefano Chiaravalli
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Luca Bergamaschi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Graziella Cefalo
- Department of Pediatrics, University of Milan, San Paolo Hospital, Santi Paolo e Carlo ASST, 20121 Milan, Italy;
| | - Fabio Simonetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
| | - Ettore Cesare Seregni
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.C.S.); (F.P.)
| | - Federica Pallotti
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.C.S.); (F.P.)
| | - Francesca Gianno
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University Sapienza of Rome, 00161 Rome, Italy;
| | - Barbara Diletto
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (L.G.); (E.P.); (B.D.)
| | - Francesco Barretta
- Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (E.S.); (F.S.); (M.T.); (C.M.); (M.P.); (A.F.); (R.L.); (M.C.); (N.P.); (S.C.); (L.B.); (F.S.); (G.G.); (M.M.)
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Wang Z, Zhu J, Yao Y, Zhu H, Deng K, Lu L, Zhang Y, Duan L, Wang L, Yang H, Xiao Y, Zhao D, You H, Feng F, Ma J, Wang X, Pan H. Clinical and pathological features of 124 patients with indistinguishable sellar lesions and central diabetes insipidus. J Clin Neurosci 2020; 80:215-222. [PMID: 33099348 DOI: 10.1016/j.jocn.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/26/2020] [Accepted: 08/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Sellar lesions with central diabetes insipidus have a wide range of causes, and diagnosis is relatively difficult. The indication and clinical value of biopsy are still controversial. OBJECTIVE To describe the etiology, demographic characteristics, manifestations, laboratory tests and imaging findings of this disease and to explore the clinical value and safety of endoscopic transsphenoidal biopsy. METHODS Retrospective analysis of 124 patients with sellar lesions and central diabetes insipidus who underwent endoscopic transsphenoidal biopsy at the Neurosurgery Department, Peking Union Medical College Hospital, from 2011 to 2019. RESULTS The main etiology includes congenital diseases, inflammatory/infectious diseases and tumor diseases. The most common diseases were germ cell tumors, Langerhans cell histiocytosis, lymphocytic hypophysitis, and Rathke's cleft cysts. Except for the age at the time of biopsy of patients with tumor diseases, which was significantly lower than that of the other two, the other clinical manifestations of the three types of diseases were not significantly different. Among the 124 patients, biopsy was performed via an endoscopic transsphenoidal approach for 101 with intrasellarly available lesions or via an endoscopic extended transsphenoidal approach for 23 with intrasellarly unavailable lesions. 6 patients had central nervous system infections after surgery, and 3 had cerebrospinal fluid rhinorrhea, of which 2 were surgically repaired. These incidences were basically the same as those of classic surgery. 2 patients had worse visual acuity, 2 had worse visual field, and 2 had worse eye movement. Excepting one patient, all of whom have recovered after treatment. CONCLUSIONS Noninvasive examination is difficult for identifying the common causes of this type of disease. Endoscopic transsphenoidal biopsy is relatively safe and effective, helps doctors to select the best treatment for patients, and is worth promoting.
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Affiliation(s)
- Zhicheng Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Jianyu Zhu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yong Yao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China.
| | - Kan Deng
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Lin Lu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yi Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Lian Duan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Linjie Wang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Yu Xiao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Jin Ma
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Xuqian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
| | - Hui Pan
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
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A single-center study of treatment outcomes of pediatric basal ganglia germinoma in Taiwan. Childs Nerv Syst 2020; 36:1745-1753. [PMID: 32090282 DOI: 10.1007/s00381-020-04543-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/08/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE A basal ganglia (BG) germinoma is a rare tumor, and the optimal treatment remains unknown. We evaluated the clinical outcomes of treatment of BG germinoma in pediatric patients in Taiwan. METHODS We retrospectively reviewed the medical records of 34 children with BG germinoma who were treated with radiotherapy (RT) at Taipei Veterans General Hospital between 1989 and 2016. The median follow-up time is 8.3 years (1.8-25.2 years). Survival was analyzed using the Kaplan-Meier estimate. Univariate Cox proportional-hazards models were used to identify the potential risk factors. RESULTS Only four patients (11.8%) experienced recurrence and all successfully underwent salvage therapy. One patient (2.97%) died due to suspected radiotherapy (RT)-related sarcoma in the scalp. The 2-, 3-, and 5-year DFS rates were 91.2%, 88.2%, and 79.4%, respectively; the 2-, 3-, and 5-year OS rates were 97.1%, 94.1%, and 82.4%, respectively. Focal RT showed low DFS in the Kaplan-Meier survival curves (P = .028) compared with non-focal RT (whole ventricle, whole brain, or cranial spinal area). In the univariate Cox proportional-hazards model, there was a significant difference in DFS between focal and non-focal RT (P = .03). There is no difference in DFS and OS between BG germinoma patients and non-BG germinoma patients. CONCLUSIONS We found an excellent DFS and OS in pediatric patients with BG germinoma treated with RT. Whole ventricle irradiation is recommended for good tumor control and low treatment-related toxicity. BG germinoma patients showed similar treatment results as germinoma patients in other common sites.
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Celik O, Ozyurt S, Saglican Y. Suprasellar germinoma with hypopituitarism in an 18-year old man: A case report and review of literature. Clin Neurol Neurosurg 2020; 196:106026. [PMID: 32580069 DOI: 10.1016/j.clineuro.2020.106026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/20/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
An 18 year old patient was presented to the ophtalmology outpatient clinic with blurrred vision, headache and fatigue for 6 months. Ophtalmological examination showed loss of visual acuity in the left eye and decreased in the right eye and bilateral optic atrophy. Further physical examination pointed out delayed sexual development. Hypopituitarism was observed in endocrinological examination. Brain magnetic resonance imaging (MRI) demonstrated contrast enhancing mass lesion at suprasellar region with involvement of posterior perimesencephalic cisternal region. The mass resected by craniotomy and pathology showed germinoma. Afterwards he received systemic chemotherapy with bleomisin, etoposide, cisplatin for 4 cycles followed by cranial radiotherapy with 30.6 Gy with a boost to the primary tumor at a dose of 19.8 Gy. On his follow-up MRI, there are no signs of residual tumor nor tumor recurrence. His final examination reveals slightly increased visual acuity in the right eye and he continued to take hydrocortisone and L-thyroxin. After one year follow-up, human chorionic gonadotropin (hCG) alpha treatment was started for sexual development. Here in, we present a case with suprasellar germinoma in the context of the review of the literature.
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Affiliation(s)
- Ozlem Celik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Acibadem Medical School, University of Acibadem, Istanbul, Turkey.
| | - Semih Ozyurt
- Department of Internal Medicine, Acibadem Medical School, University of Acibadem, Istanbul, Turkey
| | - Yesim Saglican
- Department of Pathology, Acibadem Medical School, University of Acibadem, Istanbul, Turkey
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Pediatric Central Nervous System Germinoma: What Can We Understand From a Worldwide Effort to Maximize Cure and Minimize Risk? Int J Radiat Oncol Biol Phys 2020; 107:227-231. [DOI: 10.1016/j.ijrobp.2020.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 11/20/2022]
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de Rezende ACP, Weltman E, Chen MJ, Helito JK, de Carvalho ÍT, Sakuraba RK, Silva NS, Cappellano AM, Hamerschlak N. Intensity-modulated ventricular irradiation for intracranial germ-cell tumors: Survival analysis and impact of salvage re-irradiation. PLoS One 2019; 14:e0226350. [PMID: 31860688 PMCID: PMC6924640 DOI: 10.1371/journal.pone.0226350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022] Open
Abstract
Background and purpose The roles of surgery, chemotherapy, and parameters of radiation therapy for treating very rare central nervous system germ cell tumors (CNS-GCT) are still under discussion. We aimed to evaluate the survival and recurrence patterns of patients with CNS-GCT treated with chemotherapy followed by whole ventricle irradiation with intensity-modulated radiation therapy. Materials and methods We reviewed the clinical outcomes of 20 consecutive patients with CNS-GCT treated with chemotherapy and intensity-modulated radiation therapy from 2004 to 2014 in two partner institutions. Results Twenty children with a median age of 12 years were included (16 males). Sixteen tumors were pure germinomas, and 4 were non-germinomatous germ cell tumors (NGGCT). All patients were treated with intensity-modulated radiation therapy guided by daily images, and 70% with volumetric intensity-modulated arc radiotherapy additionally. The median dose for the whole-ventricle was 25.2 Gy (range: 18–30.6 Gy) and 36 Gy (range: 30–54 Gy) for the tumor bed boost. The median post-radiation therapy follow-up was 57.5 months. There were 3 recurrences (2 NGGCT and 1 germinoma that recurred as a NGGCT), with 1 death from the disease and the other 2 cases each successfully rescued with chemotherapy and craniospinal irradiation. The overall survival at 5 years was 95% and disease-free survival was 85%. Conclusions The results of this study suggest that the combined use of chemotherapy followed by whole ventricle irradiation with intensity-modulated radiation therapy is effective for CNS-GCTs, especially pure germinomas. Even being rescued with craniospinal irradiation, the NGGCT cases have markedly worse prognoses and should be more rigorously selected for localized treatment.
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Affiliation(s)
| | - Eduardo Weltman
- Department of Radiation Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Radiation Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Michael Jenwei Chen
- Department of Radiation Oncology, Instituto de Oncologia Pediátrica - Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) da Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | | | | | - Nasjla Saba Silva
- Department of Pediatric Oncology, Instituto de Oncologia Pediátrica - Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) da Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andrea Maria Cappellano
- Department of Pediatric Oncology, Instituto de Oncologia Pediátrica - Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC) da Universidade Federal de São Paulo, São Paulo, Brazil
| | - Nelson Hamerschlak
- Department of Hematology and Clinical Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Gottardo NG, Bartels U. "Not all that glitters is gold": insights from the Far East and how to solve a conundrum. Neuro Oncol 2019; 21:1490-1492. [PMID: 31593594 PMCID: PMC6917397 DOI: 10.1093/neuonc/noz188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nicholas G Gottardo
- Department of Paediatric and Adolescent Oncology/ Haematology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Brain Tumour Research Programme, Telethon Kids Institute, Nedlands, Western Australia, Australia.,School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Ute Bartels
- Paediatric Brain Tumour Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
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Yeo KK, Kayser K, Margol AS, Wong KK, Robison N, Finlay J, Dhall G. Clinical and neuropsychological outcome of pediatric non-midline central nervous system germinoma treated with chemotherapy and reduced dose/volume irradiation: The Children's Hospital Los Angeles experience. Pediatr Blood Cancer 2019; 66:e27983. [PMID: 31502379 DOI: 10.1002/pbc.27983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Germ cell tumors (GCT) arising from non-midline structures (basal ganglia, thalamus, and posterior fossa) are rare. Although patients with midline (pineal and suprasellar) germinoma have excellent survival with chemotherapy and whole ventricular irradiation (WVI), germinoma in non-midline locations have traditionally been treated with craniospinal irradiation (CSI) or whole brain irradiation (WBI) to achieve similar outcomes. However, CSI and WBI are associated with significant long-term neuropsychological sequelae. METHODS We describe the clinical and neuropsychological outcomes of patients with non-midline germinoma treated at the Children's Hospital Los Angeles between 1990 and 2015. RESULTS Nine patients had basal ganglia/thalamic germinoma and one patient had a cerebellar primary. Eight patients received chemotherapy followed by reduced dose/volume irradiation, whereas two patients received chemotherapy alone as upfront therapy. One patient in the chemotherapy alone group relapsed after 4.3 years and was salvaged with CSI plus boost. The overall survival for the entire cohort was 100% at a median follow-up of 8.5 years. Neuropsychological data were available for six patients at a median of five months (baseline) and 4.2 years (follow-up) post-diagnosis. At four-year follow-up, data available revealed intact overall cognitive ability, verbal memory, and executive functioning, but persistent deficits in fine motor function. Comparison of baseline to follow-up suggests a downward trend in working memory, planning/problem-solving, verbal memory, and visuospatial integration. CONCLUSION Chemotherapy followed by reduced dose/volume of irradiation is an effective strategy resulting in long-term survival in patients with non-midline germinoma. Neuropsychological data suggest relatively minimal morbidity over time.
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Affiliation(s)
- Kee Kiat Yeo
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Kimberly Kayser
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California
| | - Ashley S Margol
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California
| | - Kenneth K Wong
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California.,University of Southern California, Department of Radiation Oncology, Los Angeles, California
| | - Nathan Robison
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan Finlay
- The Neuro-oncology Program, Division of Hematology, Oncology and BMT, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Girish Dhall
- Children's Center for Cancer and Blood Diseases, Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, Los Angeles, California.,The Alabama Center for Childhood Cancer and Blood Disorders at Children's of Alabama, University of Alabama at Birmingham (UAB), Birmingham, Alabama
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Nishimoto M, Ohara K, Kamamoto D, Tamura R, Miwa T, Yoshida K, Sasaki H. Tumor immune microenvironment is associated with the growth of intracranial germinomas. J Neurooncol 2019; 146:139-146. [PMID: 31773448 DOI: 10.1007/s11060-019-03355-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The role of immune checkpoint molecules and the tumor immune microenvironment in the development of intracranial germ cell tumors remains unclear. METHODS We investigated the expression of programed cell death-1 (PD-1), programed cell death ligand-1 (PD-L1), and tumor-infiltrating lymphocytes (TILs) in 8 patients who had intracranial germinomas with sufficient tumor tissue by immunohistochemistry, to analyze the associations between their clinical courses and radiological features. The 8 patients were categorized based on the duration between symptom onset and pathological diagnosis into the long-term onset (LTO) group (> 1 year of symptoms) and the short-term onset (STO) group (< 1 year of symptoms). RESULTS Three patients belonged to the LTO group and 5 patients to the STO group. Compared with STO tumors, LTO tumors were significantly associated with a lower ratio of PD-L1-positive tumor cells (p = 0.012), higher number of infiltrating CD3- and CD8-positive lymphocytes (p = 0.016, 0.003, respectively), and lower ratio of PD-1-positive cells per CD8-positive lymphocytes (p = 0.047). LTO germinomas were significantly smaller in size than STO tumors, not associated with hydrocephalus, and tended to be present in patients with older age at diagnosis and atypical tumor location. CONCLUSIONS Our data suggest that the tumor immune microenvironment, including PD-1/PD-L1 signaling, is associated with the growth of intracranial germinomas.
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Affiliation(s)
- Masaaki Nishimoto
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kentaro Ohara
- Department of Pathology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Dai Kamamoto
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryota Tamura
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoru Miwa
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
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Denyer S, Bhimani AD, Patil SN, Mudreac A, Behbahani M, Mehta AI. Treatment and survival of primary intracranial germ cell tumors: a population-based study using SEER database. J Cancer Res Clin Oncol 2019; 146:671-685. [DOI: 10.1007/s00432-019-03088-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022]
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Abstract
In pediatric brain tumors, the intensification of chemotherapy has allowed for a reduction in radiotherapy (RT) volume to an involved field approach, particularly in patients with medulloblastoma. For patients with low-grade gliomas, the trend has remained to delay RT with chemotherapy; however, when RT is used, typically smaller clinical target volume margins are used. For patients with extracranial tumors, intensive chemotherapy to address systemic disease with local control is considered standard. Proton beam therapy shows significant promise in addressing both short-term and long-term toxicities in both central nervous system (CNS) and non-CNS pediatric tumors.
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Affiliation(s)
- Sujith Baliga
- Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Francis H. Burr Proton Therapy Center, 30 Fruit Street, Boston, MA 02114, USA
| | - Torunn I Yock
- Francis H. Burr Proton Therapy Center, 30 Fruit Street, Boston, MA 02114, USA; Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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Emergency irradiation with 3.4 Gy/2f in sellar/suprasellar germinoma patients with rapid visual acuity decline. Chin Med J (Engl) 2019; 132:2073-2078. [PMID: 31261204 PMCID: PMC6793780 DOI: 10.1097/cm9.0000000000000315] [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] [Indexed: 11/29/2022] Open
Abstract
Background: Rapid visual acuity (VA) decline was a common complaint in patients with sellar/suprasellar germinoma. In our hospital, 3.4 Gy/2f of emergency irradiation was applied to save patient VA and enable subsequent chemoradiotherapy. This study aimed to investigate the efficacy of emergency irradiation with 3.4 Gy/2f in patients with sellar/suprasellar germinoma who had rapid VA decline. Methods: From January 2014 to December 2017, 33 patients with sellar/suprasellar germinoma who complained of VA decline within 3 months received 3.4 Gy/2f of emergency irradiation in Beijing Tiantan Hospital. The best-corrected VA (BCVA) and mean deviation (MD) were measured. Correlations between visual function change and clinical factors, including age at diagnosis, duration of VA decline, extent of tumor regression, serum level of tumor markers, were analyzed. Results: Among 33 patients with sellar/suprasellar germinoma, the median diameter and volume of sellar/suprasellar lesions were 32 mm (range: 5–55 mm) and 12.9 cm3 (range 0.6–58.5 cm3), respectively. Data on pre- and post-emergency-irradiation BCVA were obtained in 32 patients. For the right eyes, BCVA was improved in 23 patients (71.9%), unchanged in 7 (21.9%), and worsened in 2 (6.2%); and for the left eyes, these numbers were 27 (84.4%), 4 (12.5%), and 1 (3.1%), respectively. In terms of the logarithm of the minimum angle of resolution (logarithm of the minimum angle of resolution = Log (1/BCVA) score, the improvement was significant in both eyes (P < 0.001). In terms of MD, six patients had paired data and the improvement was marginal in the right eyes (P = 0.068) and significant in the left eyes (P = 0.043). However, no clinical factor was found to have correlation with visual function improvement. Conclusion: In sellar/suprasellar germinoma patients with VA decline, 3.4 Gy/2f of emergency irradiation was effective in improving visual function.
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Abstract
Pediatric central nervous system (CNS) tumors are the most common solid tumors in children and comprise 15% to 20% of all malignancies in children. Presentation, symptoms, and signs depend on tumor location and age of the patient at the time of diagnosis. This article summarizes the common childhood CNS tumors, presentations, classification, and recent updates in treatment approaches due to the increased understanding of the molecular pathogenesis of pediatric brain tumors.
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Affiliation(s)
- Yoko T Udaka
- The Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; Division of Oncology, Center for Cancer and Blood Disorders, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - Roger J Packer
- The Brain Tumor Institute, Center for Neuroscience and Behavioral Medicine, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; The Brain Tumor Institute, Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, 111 Michigan Avenue Northwest, Washington, DC 20010, USA.
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Yan M, Laperriere N, Velec M, Bartels U, Ramaswamy V, Bouffet E, Tsang DS. Redefining Ventricular Target Volume in Germinoma: Is Inclusion of Temporal Horns Necessary? Int J Radiat Oncol Biol Phys 2019; 104:852-858. [PMID: 30940528 DOI: 10.1016/j.ijrobp.2019.03.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE We reviewed the outcomes of a retrospective germinoma cohort and analyzed radiation therapy plans to determine dosimetric differences for critical structures. METHODS AND MATERIALS Data from pediatric patients treated with photon radiation for intracranial germinoma were analyzed for clinical outcomes and dosimetry to critical structures, with particular interest in the temporal ventricular horns (TVHs). A consensus contour was generated for TVH-sparing ventricular clinical target volumes (CTVs) via deformable image registration. RESULTS Twelve and 10 patients had their TVHs included or excluded in their ventricular CTVs, respectively. All patients were living at the time of analysis. One patient relapsed in the fourth ventricle, which had been omitted from the radiation therapy field. Mean dose was significantly lower to the hippocampi (Δ = -578 cGy, P = .0016) and temporal lobes (Δ = -599 cGy, P = .0007) in the TVH-excluded cohort compared with those with TVHs included in the treatment field. CONCLUSIONS Exclusion of the TVHs from the CTV results in significant dose sparing to the hippocampi and temporal lobes. Clinical outcomes remain excellent with no deaths and no TVH failures. Exclusion of TVHs from the ventricular CTV in germinoma requires prospective study.
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Affiliation(s)
- Michael Yan
- Division of Radiation Oncology, Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Michael Velec
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Ute Bartels
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Vijay Ramaswamy
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Canada.
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Wildeman ME, Shepard MJ, Oldfield EH, Lopes MBS. Central Nervous System Germinomas Express Programmed Death Ligand 1. J Neuropathol Exp Neurol 2019; 77:312-316. [PMID: 29415126 DOI: 10.1093/jnen/nly008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Immunomodulation and tumor-induced tolerance is one of the central mechanisms in the oncogenesis of malignant and benign neoplasms. While numerous pathways have been described, signaling through the programmed death receptor 1 (PD-1) on T lymphocytes, via activation through its ligand, programmed death ligand 1 (PD-L1) expressed on tumor cells is one of the central pathways involved in tumor-induced tolerance. While the neoplastic component of germinomas of the CNS is the germ cell, these tumors also exhibit an abundance of quiescent tumor-infiltrating lymphocytes. We therefore investigated whether PD-L1 expression may be responsible for germinoma-induced T cell anergy, and if these tumors may be susceptible to immunotherapy. Pathologic specimens obtained from 21 cases of CNS germinomas between 2000 and 2016 were analyzed for the presence of PD-L1 and PD-1 expression by immunohistochemistry. Nineteen of 21 germinomas (90%) harbored germ cell components that stained positively for PD-L1. Positive lymphocyte staining for PD-L1 was evident in 16 cases. PD-1 expression was largely confined to lymphocytes; PD-L1 therefore may contribute to lymphocyte quiescence observed in these tumors. These results raise the possibility that immune checkpoint inhibitors such as nivolumab may have a therapeutic role in future treatment of germinomas.
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Affiliation(s)
- Miriam E Wildeman
- Department of Pathology (Neuropathology), University of Virginia, Charlottesville, Virginia
| | - Matthew J Shepard
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Edward H Oldfield
- Department of Neurological Surgery (Posthumous), University of Virginia, Charlottesville, Virginia
| | - M Beatriz S Lopes
- Department of Pathology (Neuropathology) and Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Zapka P, Dörner E, Dreschmann V, Sakamato N, Kristiansen G, Calaminus G, Vokuhl C, Leuschner I, Pietsch T. Type, Frequency, and Spatial Distribution of Immune Cell Infiltrates in CNS Germinomas: Evidence for Inflammatory and Immunosuppressive Mechanisms. J Neuropathol Exp Neurol 2019; 77:119-127. [PMID: 29237087 DOI: 10.1093/jnen/nlx106] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Central nervous system germinomas are characterized by a massive immune cell infiltrate. We systematically characterized these immune cells in 28 germinomas by immunophenotyping and image analysis. mRNA expression was analyzed by Nanostring technology and in situ RNA hybridization. Tumor infiltrating lymphocytes (TILs) were composed of 61.8% ± 3.1% (mean ± SE) CD3-positive T cells, including 45.2% ± 3.5% of CD4-positive T-helper cells, 23.4% ± 1.5% of CD8-positive cytotoxic T cells, 5.5% ± 0.9% of FoxP3-positive regulatory T cells, and 11.9% ±1.3% PD-1-positive TILs. B cells accounted for 35.8% ± 2.9% of TILs and plasma cells for 9.3% ± 1.6%. Tumor-associated macrophages consisted of clusters of activated PD-L1-positive macrophages and interspersed anti-inflammatory macrophages expressing CD163. Germinoma cells did not express PD-L1. Expression of genes encoding immune cell markers and cytokines was high and comparable to mRNA levels in lymph node tissue. IFNG and IL10 mRNA was detected in subfractions of TILs and in PD-L1-positive macrophages. Taken together, the strong immune reaction observed in germinomas involves inflammatory as well as various suppressive mechanisms. Expression of PD-1 and PD-L1 and infiltration of cytotoxic T cells are biomarkers predictive of response to anti-PD-1/PD-L1 therapies, constituting a rationale for possible novel treatment approaches.
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Affiliation(s)
- Pia Zapka
- Department of Neuropathology and Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Evelyn Dörner
- Department of Neuropathology and Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Verena Dreschmann
- Department of Neuropathology and Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Noriaki Sakamato
- Department of Diagnostic Pathology/Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Glen Kristiansen
- Department of Pathology, University of Bonn Medical Center, Bonn, Germany
| | - Gabriele Calaminus
- Department of Pediatric Haematology and Oncology, University of Bonn Medical Center, Bonn, Germany
| | - Christian Vokuhl
- Pediatric Tumor Registry, Pediatric Pathology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Ivo Leuschner
- Pediatric Tumor Registry, Pediatric Pathology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Torsten Pietsch
- Department of Neuropathology and Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
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Li B, Li Y, Li C, Liu Y, Liu S, Qiu X, Luo S. Emergency irradiation of 3.4Gy/2f in pineal gland germinoma patients with symptomatic hydrocephalus. Chin Neurosurg J 2019; 5:13. [PMID: 32922913 PMCID: PMC7398300 DOI: 10.1186/s41016-019-0160-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Surgical interventions including ventriculostomy and ventriculo-peritoneal shunt were usually administrated in pineal germ cell tumor patients with symptomatic hydrocephalus. Considering higher sensitivity of germinoma to anti-tumor therapy, we explored emergency irradiation as non-invasive measure in this situation. Methods Data of 35 germinoma patients with symptomatic hydrocephalus who received emergency irradiation of 3.4 Gy/2f were studied retrospectively. The maximum width of frontal horn and the minimum width of trunk of corpus callosum (TCC) were measured to evaluate hydrocephalus changing. Besides, mean deviation (MD) of Humphrey perimetry was employed to evaluate visual field defect. Correlations between hydrocephalus changing and clinical factors, including age, percentage of tumor regression, radiographic re-evaluation interval, and serum beta-human chorionic gonadotropin (β-HCG) level, were analyzed. Results The median maximum diameter and volume of pineal lesions was 27 mm (range 10-55 mm) and 6.5cm3 (range 0.4-74.1 cm3), respectively. At median 8 days after irradiation, the median percentage of tumor remission was 55% (range 10-100%). The median maximum width of FN and the median minimum width of TCC were 11.6 mm and 39.0 mm, and 8.0 mm and 31.4 mm, before and after irradiation, respectively. The improvement of both parameters reached significant level (p < 0.001). However, none clinical factor was found to have correlation with their improvement. In 14 patients with paired data of pre- and post-irradiation MD, its change did not reach the significant level for both eyes. All patients successfully received subsequent chemoradiotherapy without surgical intervention. Conclusions Emergency irradiation of 3.4 Gy/2f was an effective non-invasive measure to relief hydrocephalus in pineal germinoma patients.
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Affiliation(s)
- Bo Li
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China
| | - Youqi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yanwei Liu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China
| | - Shuai Liu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China
| | - Xiaoguang Qiu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China
| | - Shiqi Luo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070 China
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Norris GA, Garcia J, Hankinson TC, Handler M, Foreman N, Mirsky D, Stence N, Dorris K, Green AL. Diagnostic accuracy of neuroimaging in pediatric optic chiasm/sellar/suprasellar tumors. Pediatr Blood Cancer 2019; 66:e27680. [PMID: 30848081 DOI: 10.1002/pbc.27680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 01/07/2023]
Abstract
Preoperative diagnosis for tumors arising in the optic chiasm/sellar/suprasellar region in children is helpful to determine surgical necessity and approach, given the high operative risk in this area. We evaluated the ability to differentiate tumor type by preoperative neuroimaging. Thirty-eight of 53 tumors were correctly diagnosed by neuroimaging based on final pathologic diagnosis (prediction accuracy 72%). Prediction accuracies were 87% (20/23) for craniopharyngioma, 79% (11/14) for optic pathway glioma, 64% (7/11) for germ cell tumor, and 0% (0/5) for Langerhans cell histiocytosis. Diagnosis of optic chiasm/sellar/suprasellar tumors in children by imaging alone should be considered when biopsy is considered high risk.
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Affiliation(s)
- Gregory A Norris
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jacquelyn Garcia
- Division of Pediatric Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Todd C Hankinson
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.,Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado
| | - Michael Handler
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.,Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado
| | - Nicholas Foreman
- Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado.,Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - David Mirsky
- Division of Pediatric Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Nicholas Stence
- Division of Pediatric Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Kathleen Dorris
- Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado.,Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Adam L Green
- Morgan Adams Foundation Pediatric Brain Tumor Research Foundation, Aurora, Colorado.,Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Tsang D, Laperriere N. Re-irradiation for Paediatric Tumours. Clin Oncol (R Coll Radiol) 2019; 31:191-198. [DOI: 10.1016/j.clon.2018.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/29/2018] [Accepted: 06/11/2018] [Indexed: 12/25/2022]
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Neurocognitive function, performance status, and quality of life in pediatric intracranial germ cell tumor survivors. J Neurooncol 2018; 141:393-401. [DOI: 10.1007/s11060-018-03045-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/02/2018] [Indexed: 02/07/2023]
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Mesquita Filho PM, Santos FP, Köhler LR, Manfroi G, De Carli F, Augusto de Araujo M, Schwingel D. Suprasellar Germinomas: 2 Case Reports and Literature Review. World Neurosurg 2018; 117:165-171. [PMID: 29913291 DOI: 10.1016/j.wneu.2018.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Germinomas are rare malignant central nervous system tumors, a type of germ cell tumor, according to the 2016 World Health Organization Classification of Brain Tumors. Most of these tumors develop along the midline, most often from the pineal gland, followed by tumors arising in the suprasellar cisterns. Suprasellar germinomas commonly manifest with diabetes insipidus, visual impairment, and hypothalamic-pituitary failure. We present a literature review from the PubMed database and report 2 cases of suprasellar germinomas. CASE DESCRIPTION Both pediatric patients presented with progressive visual loss; one did not show endocrinologic impairment, and the other presented with hypothyroidism, diabetes insipidus, and generalized edema. Magnetic resonance imaging showed expansive suprasellar masses in both cases, confirmed as germinomas at histopathologic examination. The patients were treated with the same surgical approach, although their outcomes were different because of endocrinologic and post surgical complications. CONCLUSIONS Suprasellar germinomas are highly curable lesions when diagnosed early. The treatment remains controversial and should be individualized, but the association of chemotherapy and radiotherapy allows reduce adverse effects and shows great results.
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Affiliation(s)
- Paulo Moacir Mesquita Filho
- Department of Neurosurgery, Hospital da Cidade de Passo Fundo, Passo Fundo, Brazil; Neurology and Neurosurgery Service (SNN), Passo Fundo, Brazil; Academic League of SNN (LASNN), Passo Fundo, Brazil; Medical School, University of Passo Fundo, Passo Fundo, Brazil
| | - Fabio Pires Santos
- Department of ENT Surgery, Hospital da Cidade de Passo Fundo, Passo Fundo, Brazil; Medical School, University of Passo Fundo, Passo Fundo, Brazil
| | - Luiza Rech Köhler
- Academic League of SNN (LASNN), Passo Fundo, Brazil; Medical School, University of Passo Fundo, Passo Fundo, Brazil.
| | - Gregori Manfroi
- Academic League of SNN (LASNN), Passo Fundo, Brazil; Medical School, University of Passo Fundo, Passo Fundo, Brazil
| | - Fernanda De Carli
- Academic League of SNN (LASNN), Passo Fundo, Brazil; Medical School, University of Passo Fundo, Passo Fundo, Brazil
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Phi JH, Wang KC, Kim SK. Intracranial Germ Cell Tumor in the Molecular Era. J Korean Neurosurg Soc 2018; 61:333-342. [PMID: 29742886 PMCID: PMC5957323 DOI: 10.3340/jkns.2018.0056] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/02/2018] [Accepted: 04/16/2018] [Indexed: 12/15/2022] Open
Abstract
Intracranial germ cell tumors (iGCTs) are a heterogeneous group of tumors with peculiar characteristics clearly distinguished from other brain tumors of neuroepithelial origin. Diverse histology, similarity to gonadal GCT, predilection to one sex, and geographic difference in incidence all present enigmas and fascinating challenges. The treatment of iGCT has advanced for germinoma to date; thus, clinical attention has shifted from survival to long-term quality of life. However, for non-germinomatous GCT, current protocols provide only modest improvement and more innovative therapies are needed. Recently, next-generation sequencing studies have revealed the genomic landscape of iGCT. Novel mutations in the KIT-RAS-MAPK and AKT-MTOR pathways were identified. More importantly, methylation profiling revealed a new method to assess the pathogenesis of iGCT. Molecular research will unleash new knowledge on the origin of iGCT and solve the many mysteries that have lingered on this peculiar neoplasm for a long time.
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Affiliation(s)
- Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu-Chang Wang
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Liu B, Arakawa Y, Yokogawa R, Tokunaga S, Terada Y, Murata D, Matsui Y, Fujimoto KI, Fukui N, Tanji M, Mineharu Y, Minamiguchi S, Miyamoto S. PD-1/PD-L1 expression in a series of intracranial germinoma and its association with Foxp3+ and CD8+ infiltrating lymphocytes. PLoS One 2018; 13:e0194594. [PMID: 29617441 PMCID: PMC5884516 DOI: 10.1371/journal.pone.0194594] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/06/2018] [Indexed: 12/14/2022] Open
Abstract
One histopathological characteristic of intracranial germinoma is abundant tumor-infiltrating lymphocytes (TILs) showing a two-cell pattern with large undifferentiated tumor cells. The programmed cell death 1 (PD-1)/programmed cell death 1 ligand (PD-L) axis has recently been recognized as an anti-tumor immune system. To evaluate intratumor immune status in intracranial germinoma, we examined expressions of PD-1 and PD-L1 (clone 28-8) and subtypes of TILs. Expressions of PD-1 and PD-L1 were detected immunohistochemically in 25 formalin-fixed, paraffin-embedded tumor specimens from 24 patients with intracranial germinoma consisting of 22 primary and 3 recurrent tumors. To evaluate subtypes of TILs, quantification of lymphocytes with CD3, CD8, CD4, and Foxp3 was performed. Statistical analyses were performed among PD-1, PD-L1 and subtypes of TILs. In 25 tumor tissue, expressions of PD-1 in TILs and PD-L1 in tumor cells were identified in 96% (24/25) and 92% (23/25), respectively. Expression of PD-1 was associated with CD3+ TIL density. Expression of PD-1 correlated with Foxp3+ TIL density and CD8+ TIL density, but not with CD4+ TIL density. Furthermore, expression of PD-1 correlated strongly with Foxp3+/CD4+ ratio. Taken together, increase of PD-1+ expression is associated with accumulation of Foxp3+ and CD8+ TILs. These findings intimate that PD-1/PD-L1 axis might shape the immune infiltration suggesting a modulation of the immune response and subsequent tumor growth in intracranial germinoma. Anti-PD-1 and anti-PD-L1 are potential immune therapeutic strategies in intracranial germinoma.
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Affiliation(s)
- Bin Liu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- * E-mail:
| | - Ryuta Yokogawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinya Tokunaga
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukinori Terada
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Daiki Murata
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuzumi Matsui
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ko-ichi Fujimoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuyuki Fukui
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masahiro Tanji
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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