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Joh-Carnella N, Bauman G, Yock TI, Zelcer S, Youkhanna S, Cacciotti C. Case report: Pediatric low-grade gliomas: a fine balance between treatment options, timing of therapy, symptom management and quality of life. Front Oncol 2024; 14:1366251. [PMID: 38912055 PMCID: PMC11190070 DOI: 10.3389/fonc.2024.1366251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Pediatric low-grade gliomas (pLGG) are the most common brain tumor in children and encompass a wide range of histologies. Treatment may pose challenges, especially in those incompletely resected or those with multiple recurrence or progression. Case description We report the clinical course of a girl diagnosed with pilocytic astrocytoma and profound hydrocephalus at age 12 years treated with subtotal resection, vinblastine chemotherapy, and focal proton radiotherapy. After radiotherapy the tumor increased in enhancement temporarily with subsequent resolution consistent with pseudoprogression. Despite improvement in imaging and radiographic local control, the patient continues to have challenges with headaches, visual and auditory concerns, stroke-like symptoms, and poor quality of life. Conclusion pLGG have excellent long-term survival; thus, treatments should focus on maintaining disease control and limiting long-term toxicities. Various treatment options exist including surgery, chemotherapy, targeted agents, and radiation therapy. Given the morbidity associated with pLGG, individualized treatment approaches are necessary, with a multi-disciplinary approach to care focused on minimizing treatment side effects, and promoting optimal quality of life for patients.
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Affiliation(s)
| | - Glenn Bauman
- Division of Radiation Oncology, Department of Oncology, London Health Sciences Centre & Western University, London, ON, Canada
| | - Torunn I. Yock
- Department of Pediatric Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - Shayna Zelcer
- Division of Hematology/Oncology, Department of Pediatrics, London Health Sciences Centre & Western University, London, ON, Canada
| | - Sabin Youkhanna
- Department Radiation Oncology, London Regional Cancer Centre, London, ON, Canada
| | - Chantel Cacciotti
- Division of Hematology/Oncology, Department of Pediatrics, London Health Sciences Centre & Western University, London, ON, Canada
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2
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Hou J, King TZ, Chen H, Wang Q, Xie Y, Mao H, Wang L, Cheng L. Concurrent brain structural and functional alterations in the thalamus of adult survivors of childhood brain tumors: a multimodal MRI study. Brain Res Bull 2024; 211:110937. [PMID: 38570077 DOI: 10.1016/j.brainresbull.2024.110937] [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: 06/28/2023] [Revised: 03/20/2024] [Accepted: 03/31/2024] [Indexed: 04/05/2024]
Abstract
Adult survivors of childhood brain tumors often present with cognitive deficits that affect their quality of life. Studying brain structure and function in brain tumor survivors can help understand the underlying mechanisms of their cognitive deficits to improve long-term prognosis of these patients. This study analyzed voxel-based morphometry (VBM) derived from T1-weighted MRI and the amplitude of low-frequency fluctuation (ALFF) from resting-state functional magnetic resonance imaging (rs-fMRI) to examine the structural and functional alterations in 35 brain tumor survivors using 35 matching healthy individuals as controls. Compared with healthy controls, brain tumor survivors had decreased gray matter volumes (GMV) in the thalamus and increased GMV in the superior frontal gyrus. Functionally, brain tumor survivors had lower ALFF values in the inferior temporal gyrus and medial prefrontal area and higher ALFF values in the thalamus. Importantly, we found concurrent but negatively correlated structural and functional alterations in the thalamus based on observed significant differences in GMV and ALFF values. These findings on concurrent brain structural and functional alterations provide new insights towards a better understanding of the cognitive deficits in brain tumor survivors.
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Affiliation(s)
- Jinfeng Hou
- School of Life and Environmental Sciences, Guilin University of Electronic Technology, Guilin 541004, China; Nanning Research Institute, Guilin University of Electronic Technology, Nanning 530000, China
| | - Tricia Z King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Hongbo Chen
- School of Life and Environmental Sciences, Guilin University of Electronic Technology, Guilin 541004, China; Guangxi Colleges and Universities Key Laboratory of Biomedical Sensors and Intelligent Instruments, Guilin 541004, China; Guangxi Human Physiological Information Non-Invasive Detection Engineering Technology Research Center, Guilin 541004, China; Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guilin 541004, China
| | - Qian Wang
- School of Life and Environmental Sciences, Guilin University of Electronic Technology, Guilin 541004, China; Nanning Research Institute, Guilin University of Electronic Technology, Nanning 530000, China
| | - You Xie
- Guilin Municipal Hospital of Traditional Chinese Medicine, Guilin 541004, China
| | - Hui Mao
- Department of Radiology and Imaging Science, Emory University, Atlanta, GA, USA
| | - Liya Wang
- Department of Radiology, The Fist Affiliated Hospital of Nanchang University, Shenzhen Hezheng Hospital, Shenzhen, Guangdong 518109, China.
| | - Luqi Cheng
- School of Life and Environmental Sciences, Guilin University of Electronic Technology, Guilin 541004, China; Guangxi Colleges and Universities Key Laboratory of Biomedical Sensors and Intelligent Instruments, Guilin 541004, China; Guangxi Human Physiological Information Non-Invasive Detection Engineering Technology Research Center, Guilin 541004, China; Guangxi Key Laboratory of Metabolic Reprogramming and Intelligent Medical Engineering for Chronic Diseases, Guilin 541004, China; Zhejiang Lab, Hangzhou 311100, China.
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3
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Jalali R, Maitre P. Radiotherapy-Induced Neurocognitive Dysfunction in Brain Tumor Survivors: Burden and Rehabilitation. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 130:197-206. [PMID: 37548740 DOI: 10.1007/978-3-030-12887-6_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Radiotherapy-induced neurocognitive dysfunction after cranial irradiation has an incidence of 40-100%. It may affect both children and adults, and represents a significant burden not only on ill individuals and their caregivers but also on the health care system and society in general. Multiple patient-, tumor-, and treatment-related factors may contribute to development of this complication, but its pathophysiological mechanisms are still not understood clearly. It is hoped that introduction of more advanced techniques for conformal irradiation, optimized dosimetry, and specific prophylactic measures will decrease the risk of neurocognitive decline in brain tumor survivors in the future.
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Affiliation(s)
- Rakesh Jalali
- Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India.
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4
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Otth M, Wyss J, Scheinemann K. Long-Term Follow-Up of Pediatric CNS Tumor Survivors—A Selection of Relevant Long-Term Issues. CHILDREN 2022; 9:children9040447. [PMID: 35455491 PMCID: PMC9029633 DOI: 10.3390/children9040447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 11/25/2022]
Abstract
Introduction: Survivors of pediatric central nervous system (CNS) tumors are at high risk for late effects and long-term morbidity. The quality of survival became increasingly important, as advances in diagnostics, multimodal treatment strategies, and supportive care have led to significant increases in long-term survival. Aim: This review aims to provide a global overview of the potential late effects and long-term follow-up care of CNS tumor survivors, directed to trainees and practitioners with less targeted training in pediatric oncology. Late effects in CNS tumor survivors: A specific focus on CNS tumor survivors relies on cognitive and psychosocial late effects, as they may have an impact on education, professional career, independent living, and quality of life. Further important late effects in CNS tumor survivors include endocrine, metabolic, cardiovascular, and cerebrovascular diseases. Conclusions: Comprehensive long-term follow-up care is essential for pediatric CNS tumor survivors to improve their quality of survival and quality of life. An individualized approach, taking all potential late effects into account, and carried out by an interdisciplinary team, is recommended, and should continue into adulthood. Existing recommendations and guidelines on long-term follow-up care guide the multidisciplinary teams.
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Affiliation(s)
- Maria Otth
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau AG, 5001 Aarau, Switzerland; (J.W.); (K.S.)
- Department of Oncology, Hematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children’s Hospital Zurich—Eleonore Foundation, 8032 Zurich, Switzerland
- Correspondence:
| | - Johanna Wyss
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau AG, 5001 Aarau, Switzerland; (J.W.); (K.S.)
- Division of Oncology and Hematology, University Children’s Hospital Basel (UKBB), 4056 Basel, Switzerland
| | - Katrin Scheinemann
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau AG, 5001 Aarau, Switzerland; (J.W.); (K.S.)
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
- Department of Pediatrics, McMaster University Hamilton, Hamilton, ON L8S 4K1, Canada
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5
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Lanini I, Tringali D, Lauro Grotto R. Psychological Needs and Resources of the Staff in a Pediatric Neurosurgery Ward: A Phenomenological-Hermeneutic Study. Front Psychol 2022; 12:751651. [PMID: 35046865 PMCID: PMC8761729 DOI: 10.3389/fpsyg.2021.751651] [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: 08/01/2021] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
Brain tumors are a common form of solid tumors in children and, unfortunately, they are characterized by a very uncertain prognosis. The treatment of this pathology often includes one or more very invasive surgical procedures, quite often in the very first steps of the treatment. Cases of brain tumors in children represent one of the greatest challenges for health care professionals in the domain of pediatric neurosurgery. This is clearly due to the complexity of the therapeutic plan, but also to the nature of the bond that is established between the child, the parents, and the members of the staff during the often-dramatic initial phase of the illness. In this phenomenological-hermeneutic study, we explore both the emotional and organizational needs, as well as the available professional and personal resources of the staff in the Neurosurgery ward of the Meyer Children’s Hospital in Florence (Italy). The ward staff, composed of 7 surgeons, a pediatric neuro-oncologist, 12 nurses, and 4 auxiliary health care professionals, underwent in-depth interviews that were recorded (with the consensus of the participants). The recordings were then transcribed and submitted to content analysis according to COREQ standards. A complex picture of emotional as well as organizational demands emerged from the data. Shared experiences were pointed out, together with more specific and idiosyncratic contents characteristic of different professional roles. The focus of the present paper was twofold, first, we considered the needs that are overtly expressed by the staff, and then we discussed the main sources of their motivational drives. We found that the latter is mainly found in the quality of the therapeutic bond that is established with the children and the family members, together with the deep interest in one’s own professional activity and the effective complementarity and integration of the personal and professional qualities of the staff members within the multidisciplinary caring group.
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Affiliation(s)
- Iacopo Lanini
- Department of Health Sciences, University of Florence, Florence, Italy.,Laboratory for Multidisciplinary Analysis of Relationships in Health Care, UNISER, Pistoia, Italy
| | - Debora Tringali
- Laboratory for Multidisciplinary Analysis of Relationships in Health Care, UNISER, Pistoia, Italy.,Associazione LAPO O.N.L.U.S., Florence, Italy
| | - Rosapia Lauro Grotto
- Department of Health Sciences, University of Florence, Florence, Italy.,Laboratory for Multidisciplinary Analysis of Relationships in Health Care, UNISER, Pistoia, Italy
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Ålykkja A, Ruud E, Larsen MH, Vatne TM, Lie HC. Available, but not always accessible: A nationwide, qualitative study of multidisciplinary healthcare providers' experiences with follow-up care after paediatric brain tumour. Eur J Cancer Care (Engl) 2020; 30:e13375. [PMID: 33236388 DOI: 10.1111/ecc.13375] [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: 10/11/2019] [Revised: 07/13/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Paediatric brain tumour (PBT) survivors face high risks of disabling long-term and late effects. Whether survivors' needs are met in a system with publicly funded services, but in the absence of a formal long-term follow-up model, is uncertain. Empirically based recommendations for a national model are needed. We explored multidisciplinary healthcare providers' (HCP) experiences with providing such care. METHODS We conducted five focus-group interviews and five individual interviews with a nationally representative sample of 33 Norwegian HCPs. Focus-group interviews and individual interviews were analysed using systematic text condensation. RESULTS Three main themes were identified: (a) 'Providing care above and beyond system constraints', describing a perceived discrepancy between HCPs' knowledge of, and their ability to meet, the survivors' needs. (b) 'System barriers to providing optimal follow-up care', describing a perceived lack of routines for communication and coordination between the HCPs and existing care services. (c) 'Nurses and shared-care to improve care', including empowering nurses and establishing routines for collaborations and areas of responsibilities. CONCLUSION The current healthcare system was perceived not to fully meet the survivors' needs. Nurse-led care models, including standardised patient-care pathways, were suggested to increase the accessibility of already-existing services and thus to improve long-term follow-up care.
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Affiliation(s)
- Anette Ålykkja
- Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine University of Oslo, Oslo, Norway
| | - Ellen Ruud
- Department of Paediatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Hamilton Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine University of Oslo, Oslo, Norway.,Lovisenberg Diaconal University College, Oslo, Norway
| | | | - Hanne C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine University of Oslo, Oslo, Norway
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7
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Huang W, Sundquist K, Sundquist J, Ji J. Psychiatric disorders in offspring of childhood or adolescent central nervous system tumor survivors: a national cohort study. Cancer Med 2020; 10:675-683. [PMID: 33135321 PMCID: PMC7877351 DOI: 10.1002/cam4.3591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Children experience a higher risk of psychiatric problems when their parents are diagnosed with cancer. However, the psychological effect among offspring who are born after parental cancer diagnosed in childhood or adolescence is unknown. We aimed to investigate the risk of psychiatric disorders in children of survivors with childhood or adolescent central nervous system (CNS) tumors. METHODS By combining several nationwide Swedish registers, we identified all children who had at least one parent previously diagnosed with CNS tumor below the age of 20. Five children without parental CNS tumor were randomly selected for the matching. Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence interval (CI). RESULTS The incidence rate of psychiatric disorders was 8.46 per 1000 person-years in children of CNS tumor survivors, whereas the rate was 7.47 in the matched comparisons, yielding an adjusted HR of 1.10 (95% CI = 0.94, 1.28). Boys of survivors had a higher risk of psychiatric disorders (adjusted HR = 1.29, 95% CI = 1.04, 1.59). The risk of the specific types of psychiatric disorders in children of tumor survivors was comparable with that in the matched comparisons, except for mental retardation. Children of survivors experienced 2.36 times higher risk of mental retardation (95% CI = 1.21, 4.58), mainly of mild mental retardation (adjusted HR = 2.99, 95% CI = 1.40, 6.38). CONCLUSION Children of survivors with CNS tumor in early life did not experience a significantly increased risk of overall psychiatric disorders, with the exception of an elevated risk of mental retardation that was mainly mild.
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Affiliation(s)
- Wuqing Huang
- Center for Primary Health Care ResearchLund University/Region SkåneLundSweden
| | - Kristina Sundquist
- Center for Primary Health Care ResearchLund University/Region SkåneLundSweden
- Department of Family Medicine and Community HealthDepartment of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Center for Community‐based Healthcare Research and Education (CoHRE)Department of Functional PathologySchool of MedicineShimane UniversityMatsueJapan
| | - Jan Sundquist
- Center for Primary Health Care ResearchLund University/Region SkåneLundSweden
- Department of Family Medicine and Community HealthDepartment of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Center for Community‐based Healthcare Research and Education (CoHRE)Department of Functional PathologySchool of MedicineShimane UniversityMatsueJapan
| | - Jianguang Ji
- Center for Primary Health Care ResearchLund University/Region SkåneLundSweden
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8
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Prince EW, Whelan R, Mirsky DM, Stence N, Staulcup S, Klimo P, Anderson RCE, Niazi TN, Grant G, Souweidane M, Johnston JM, Jackson EM, Limbrick DD, Smith A, Drapeau A, Chern JJ, Kilburn L, Ginn K, Naftel R, Dudley R, Tyler-Kabara E, Jallo G, Handler MH, Jones K, Donson AM, Foreman NK, Hankinson TC. Robust deep learning classification of adamantinomatous craniopharyngioma from limited preoperative radiographic images. Sci Rep 2020; 10:16885. [PMID: 33037266 PMCID: PMC7547020 DOI: 10.1038/s41598-020-73278-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/25/2020] [Indexed: 11/09/2022] Open
Abstract
Deep learning (DL) is a widely applied mathematical modeling technique. Classically, DL models utilize large volumes of training data, which are not available in many healthcare contexts. For patients with brain tumors, non-invasive diagnosis would represent a substantial clinical advance, potentially sparing patients from the risks associated with surgical intervention on the brain. Such an approach will depend upon highly accurate models built using the limited datasets that are available. Herein, we present a novel genetic algorithm (GA) that identifies optimal architecture parameters using feature embeddings from state-of-the-art image classification networks to identify the pediatric brain tumor, adamantinomatous craniopharyngioma (ACP). We optimized classification models for preoperative Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and combined CT and MRI datasets with demonstrated test accuracies of 85.3%, 83.3%, and 87.8%, respectively. Notably, our GA improved baseline model performance by up to 38%. This work advances DL and its applications within healthcare by identifying optimized networks in small-scale data contexts. The proposed system is easily implementable and scalable for non-invasive computer-aided diagnosis, even for uncommon diseases.
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Affiliation(s)
- Eric W Prince
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, 80045, USA. .,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA. .,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, 80045, USA.
| | - Ros Whelan
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA
| | - David M Mirsky
- Division of Pediatric Radiology, Children's Hospital Colorado, Aurora, 80045, USA
| | - Nicholas Stence
- Division of Pediatric Radiology, Children's Hospital Colorado, Aurora, 80045, USA
| | - Susan Staulcup
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health and Sciences Center, Memphis, 38163, USA.,Semmes Murphy Clinic, St. Jude Children's Research Hospital, Memphis, 38105, USA
| | | | - Toba N Niazi
- Department of Pediatric Neurosurgery, Nicklaus Children's Hospital, Miami, 33155, USA
| | - Gerald Grant
- Department of Pediatric Neurosurgery, Lucile Packard Children's Hospital at Stanford University, Palo Alto, 94305, USA
| | - Mark Souweidane
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, 10065, USA.,Department of Neurological Surgery, Weill Cornell Medical College, New York, 10065, USA
| | - James M Johnston
- Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, 35233, USA
| | - Eric M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, 21205, USA
| | - David D Limbrick
- Department of Pediatrics, Washington University School of Medicine, St. Louis, 63110, USA
| | - Amy Smith
- Department of Pediatric Hematology-Oncology, Arnold Palmer Hospital, Orlando, 32806, USA
| | - Annie Drapeau
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, 43205, USA
| | - Joshua J Chern
- Departments of Pediatrics and Neurosurgery, Emory University School of Medicine, Atlanta, 30322, USA
| | - Lindsay Kilburn
- Children's National Health System, Brain Tumor Institute, Washington, DC, 20010, USA
| | - Kevin Ginn
- Division of Pediatric Hematology and Oncology, Children's Mercy Hospital, Kansas City, 64108, USA
| | - Robert Naftel
- Department of Neurological Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, 37212, USA
| | - Roy Dudley
- Department of Neurosurgery, McGill University, Montreal, H3A 2B4, Canada
| | | | - George Jallo
- Institute of Brain Protection Sciences, Johns Hopkins All Children's Hospital, St Petersburg, 33701, USA
| | - Michael H Handler
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, 80045, USA.,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA
| | - Kenneth Jones
- University of Oklahoma Health Sciences Center, Oklahoma City, 73104, USA
| | - Andrew M Donson
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, 80045, USA.,Division of Pediatric Neurooncology, Children's Hospital Colorado, Aurora, 80045, USA
| | - Nicholas K Foreman
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, 80045, USA.,Division of Pediatric Neurooncology, Children's Hospital Colorado, Aurora, 80045, USA
| | - Todd C Hankinson
- Division of Pediatric Neurosurgery, Children's Hospital Colorado, Aurora, 80045, USA.,Department of Neurosurgery, University of Colorado School of Medicine, Aurora, 80045, USA.,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Aurora, 80045, USA
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9
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Dymova MA, Taskaev SY, Richter VA, Kuligina EV. Boron neutron capture therapy: Current status and future perspectives. Cancer Commun (Lond) 2020; 40:406-421. [PMID: 32805063 PMCID: PMC7494062 DOI: 10.1002/cac2.12089] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/09/2020] [Accepted: 08/09/2020] [Indexed: 12/11/2022] Open
Abstract
The development of new accelerators has given a new impetus to the development of new drugs and treatment technologies using boron neutron capture therapy (BNCT). We analyzed the current status and future directions of BNCT for cancer treatment, as well as the main issues related to its introduction. This review highlights the principles of BNCT and the key milestones in its development: new boron delivery drugs and different types of charged particle accelerators are described; several important aspects of BNCT implementation are discussed. BCNT could be used alone or in combination with chemotherapy and radiotherapy, and it is evaluated in light of the outlined issues. For the speedy implementation of BCNT in medical practice, it is necessary to develop more selective boron delivery agents and to generate an epithermal neutron beam with definite characteristics. Pharmacological companies and research laboratories should have access to accelerators for large-scale screening of new, more specific boron delivery agents.
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Affiliation(s)
- Mayya Alexandrovna Dymova
- Laboratory of BiotechnologyInstitute of Chemical Biology and Fundamental MedicineSiberian Branch of the Russian Academy of SciencesLavrentjeva Av. 8Novosibirsk630090Russia
| | - Sergey Yurjevich Taskaev
- Budker Institute of Nuclear PhysicsSiberian Branch of the Russian Academy of SciencesLavrentjeva Av. 11Novosibirsk630090Russia
- Laboratory of Boron Neutron Capture TherapyNovosibirsk State UniversityPirogova str. 1Novosibirsk630090Russia
| | - Vladimir Alexandrovich Richter
- Laboratory of BiotechnologyInstitute of Chemical Biology and Fundamental MedicineSiberian Branch of the Russian Academy of SciencesLavrentjeva Av. 8Novosibirsk630090Russia
| | - Elena Vladimirovna Kuligina
- Laboratory of BiotechnologyInstitute of Chemical Biology and Fundamental MedicineSiberian Branch of the Russian Academy of SciencesLavrentjeva Av. 8Novosibirsk630090Russia
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10
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van Markus-Doornbosch F, van der Holst M, de Kloet AJ, Vliet Vlieland TPM, Meesters JJL. Fatigue, Participation and Quality of Life in Adolescents and Young Adults with Acquired Brain Injury in an Outpatient Rehabilitation Cohort. Dev Neurorehabil 2020; 23:328-335. [PMID: 31746261 DOI: 10.1080/17518423.2019.1692948] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To study the association between fatigue and participation and QoL after acquired brain injury (ABI) in adolescents and young adults (AYAs). MATERIALS & METHODS Cross-sectional study with AYAs aged 14-25 years, diagnosed with ABI. The PedsQL™ Multidimensional Fatigue Scale, Child & Adolescent Scale of Participation, and PedsQL™4.0 Generic Core Scales were administered. RESULTS Sixty-four AYAs participated in the study, 47 with traumatic brain injury (TBI). Median age at admission was 17.6 yrs, 0.8 yrs since injury. High levels of fatigue (median 44.4 (IQR 34.7, 59.7)), limited participation (median 82.5 (IQR 68.8, 92.3)), and diminished QoL (median 63.0 (IQR 47.8, 78.3)) were reported. More fatigue was significantly associated with more participation restrictions (β 0.64, 95%CI 0.44, 0.85) and diminished QoL (β 0.87, 95%CI 0.72, 1.02). CONCLUSIONS AYAs with ABI reported high levels of fatigue, limited participation and diminished quality of life with a significant association between fatigue and both participation and QoL. Targeting fatigue in rehabilitation treatment could potentially improve participation and QoL.
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Affiliation(s)
| | - Menno van der Holst
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands
| | - Arend J de Kloet
- Basalt Rehabilitation , The Hague, The Netherlands.,The Hague University of Applied Sciences , The Hague, The Netherlands
| | - Thea P M Vliet Vlieland
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands
| | - Jorit J L Meesters
- Basalt Rehabilitation , The Hague, The Netherlands.,Leiden University Medical Center , Leiden, The Netherlands.,The Hague University of Applied Sciences , The Hague, The Netherlands
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11
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Abstract
PURPOSE OF REVIEW We provide an overview of the current landscape of drug development relevant to childhood cancers. We present recent and ongoing efforts to identify therapeutic targets in pediatric cancers. We describe efforts to improve the approach to clinical trials and highlight the role regulatory changes and multistakeholder platforms play in advancing pediatric cancer drug development. RECENT FINDINGS Expanding knowledge of the genetic landscape of pediatric malignancies through clinical genomics studies has yielded an increasing number of potential targets for intervention. In parallel, new therapies for children with cancer have shifted from cytotoxic agents to targeted therapy, with examples of striking activity in patients with tumors driven by oncogenic kinase fusions. Innovative trial designs and recent governmental policies provide opportunities for accelerating development of targeted therapies in pediatric oncology. SUMMARY Novel treatment strategies in pediatric oncology increasingly utilize molecularly targeted agents either as monotherapy or in combination with conventional cytotoxic agents. The interplay between new target identification, efforts to improve clinical trial design and new government regulations relevant to pediatric cancer drug development has the potential to advance novel agents into frontline care of children with cancer.
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12
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Chatterjee A, Goda JS, Gupta T, Kamble R, Mokal S, Krishnatry R, Sarin R, Jalali R. A randomized trial of stereotactic versus conventional radiotherapy in young patients with low-grade brain tumors: occupational therapy-based neurocognitive data. Neurooncol Adv 2020; 2:vdaa130. [PMID: 33235996 PMCID: PMC7668487 DOI: 10.1093/noajnl/vdaa130] [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] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Radiotherapy for brain tumors in young patients is not only associated with improved survival but also long-term neurocognitive sequelae. We aimed to compare group differences in the executive neurocognitive outcomes in young patients with low-grade brain tumors treated with stereotactic conformal radiotherapy (SCRT) and conventional RT (ConvRT) techniques. METHODS This a phase 3 randomized trial that enrolled 200 young patients with benign brain tumors and low-grade gliomas. Patients were randomly allocated (1:1) to either SCRT or ConvRT arms and treated to a dose of 54 Gy in 30 fractions over 6 weeks. Lowenstein Occupational Therapy Cognitive Assessment battery was performed at preradiotherapy baseline, 6 months, and annually thereafter until 5 years. Executive functions measures included orientation, visual perception, spatial perception, motor praxis, visuomotor organization, thinking operations, and attention and concentration. The trajectory of these parameters was compared between the treatment arms over 5 years. RESULTS Two hundred patients were enrolled in the study (SCRT: 104 and ConvRT: 96). The median age was 13 years (interquartile range: 9-17); mean total neurocognitive scores over 5 years were significantly superior in SCRT arm as compared to ConvRT (difference in slope: 2.27, P = .024). Outcomes improved in the SCRT arm vis-à-vis ConvRT for the subdomain of visuomotor organization (difference in slope: 0.66, P < .001). Visuomotor organization scores significantly improved in majority of the substratification groups. Spatial perception improved in craniopharyngioma patients with SCRT technique as opposed to ConvRT. CONCLUSIONS SCRT achieved superior outcomes compared to ConvRT in certain executive neurocognitive functional domains. We provide high level of evidence in favor of SCRT. Trial Registration. ClinicalTrials.gov Identifier: NCT00517959.
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Affiliation(s)
- Abhishek Chatterjee
- Neuro Oncology Disease Management Group, Tata Memorial Centre, Parel, Mumbai, India.,Homi Bhaba National Institute, Trombay, Mumbai, Maharashtra, India
| | - Jayant S Goda
- Neuro Oncology Disease Management Group, Tata Memorial Centre, Parel, Mumbai, India.,Homi Bhaba National Institute, Trombay, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Neuro Oncology Disease Management Group, Tata Memorial Centre, Parel, Mumbai, India.,Homi Bhaba National Institute, Trombay, Mumbai, Maharashtra, India
| | - Rashmi Kamble
- Neuro Oncology Disease Management Group, Tata Memorial Centre, Parel, Mumbai, India.,Homi Bhaba National Institute, Trombay, Mumbai, Maharashtra, India
| | - Smruti Mokal
- Neuro Oncology Disease Management Group, Tata Memorial Centre, Parel, Mumbai, India.,Homi Bhaba National Institute, Trombay, Mumbai, Maharashtra, India
| | - Rahul Krishnatry
- Neuro Oncology Disease Management Group, Tata Memorial Centre, Parel, Mumbai, India.,Homi Bhaba National Institute, Trombay, Mumbai, Maharashtra, India
| | - Rajiv Sarin
- Neuro Oncology Disease Management Group, Tata Memorial Centre, Parel, Mumbai, India.,Homi Bhaba National Institute, Trombay, Mumbai, Maharashtra, India
| | - Rakesh Jalali
- Neuro Oncology Disease Management Group, Tata Memorial Centre, Parel, Mumbai, India.,Homi Bhaba National Institute, Trombay, Mumbai, Maharashtra, India
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13
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Abstract
PURPOSE OF REVIEW To review the recent advances in understanding how primary brain tumors affect vision in children. RECENT FINDINGS Children with primary brain tumors may have vision loss due to involvement of their afferent visual pathways or from papilledema. These vision deficits may go unrecognized until later in life, years after treatment of the primary lesion. Strabismus and cranial nerve palsies may occur as a result of brain tumors. Ophthalmologists can monitor and treat young children at risk for vision loss from amblyopia as a result of effects from their underlying lesion. Advances in imaging techniques have made it possible to quantify damage to the visual pathways with objective tests. SUMMARY Systematic referrals for evaluation by an ophthalmologist should occur early in the course of treatment of primary brain tumors as these evaluations may improve visual outcomes and quality of life.
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14
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Sato Y, Shinjyo N, Sato M, Nilsson MKL, Osato K, Zhu C, Pekna M, Kuhn HG, Blomgren K. Grafting Neural Stem and Progenitor Cells Into the Hippocampus of Juvenile, Irradiated Mice Normalizes Behavior Deficits. Front Neurol 2018; 9:715. [PMID: 30254600 PMCID: PMC6141740 DOI: 10.3389/fneur.2018.00715] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022] Open
Abstract
The pool of neural stem and progenitor cells (NSPCs) in the dentate gyrus of the hippocampus is reduced by ionizing radiation. This explains, at least partly, the learning deficits observed in patients after radiotherapy, particularly in pediatric cases. An 8 Gy single irradiation dose was delivered to the whole brains of postnatal day 9 (P9) C57BL/6 mice, and BrdU-labeled, syngeneic NSPCs (1.0 × 105 cells/injection) were grafted into each hippocampus on P21. Three months later, behavior tests were performed. Irradiation impaired novelty-induced exploration, place learning, reversal learning, and sugar preference, and it altered the movement pattern. Grafting of NSPCs ameliorated or even normalized the observed deficits. Less than 4% of grafted cells survived and were found in the dentate gyrus 5 months later. The irradiation-induced loss of endogenous, undifferentiated NSPCs in the dentate gyrus was completely restored by grafted NSPCs in the dorsal, but not the ventral, blade. The grafted NSPCs did not exert appreciable effects on the endogenous NSPCs; however, more than half of the grafted NSPCs differentiated. These results point to novel strategies aimed at ameliorating the debilitating late effects of cranial radiotherapy, particularly in children.
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Affiliation(s)
- Yoshiaki Sato
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Noriko Shinjyo
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Machiko Sato
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Narita Hospital, Nagoya, Japan
| | - Marie K L Nilsson
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Kazuhiro Osato
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Mie University, Tsu, Japan
| | - Changlian Zhu
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Marcela Pekna
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Hans G Kuhn
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Klas Blomgren
- Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatric Oncology, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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15
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Abstract
Central nervous tumors are the leading cause of death from cancer in the pediatric population. Advances in care for pediatric neuro-oncology patients have led to improved survival rates. As survivorship increases, care of the sequelae of the tumor and its treatment become more important for long-term quality of life. A significant portion of the brain is involved in vision. Pediatric brain tumors can distort, damage, and destroy portions of the brain involved in both the afferent and efferent vision pathways. This interruption of normal visual pathways can lead to permanent vision loss or other morbidities such as strabismus and nystagmus. This article reviews the presenting symptoms and signs of brain tumors in children and adolescents, as well as the effects of the tumor and its treatment on the afferent and efferent visual pathways. Strategies for monitoring during treatment, and management of sequelae are reviewed. Through systematic evaluation and monitoring of pediatric neuro-oncology patients, those at risk for vision loss or tumor progression can be identified.
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