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Rufus P, Chatterjee S. Second-look surgery in postoperative pediatric low-grade glioma. Childs Nerv Syst 2024:10.1007/s00381-024-06516-3. [PMID: 38970692 DOI: 10.1007/s00381-024-06516-3] [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: 04/10/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE To review the literature on second-look surgery in pediatric low-grade gliomas (LGG) with a view to presenting both sides of the picture of re-exploration. METHODS Collection of material from recent literature on pediatric LGG. This was a retrospective review of these publications. RESULTS There are a number of publications recommending second-look surgery in selected cases, provided morbidity of the second surgery is minimum, and indeed some in which there is improvement in the neurodeficit after the second resection. CONCLUSION There seems a fair balance of articles recommending and dissuading the practice of second-look surgery, but in our limited experience we have found it useful in selected patients.
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Yan H, Weng D, Li D, Gu Y, Ma W, Liu Q. Prior knowledge-guided multilevel graph neural network for tumor risk prediction and interpretation via multi-omics data integration. Brief Bioinform 2024; 25:bbae184. [PMID: 38670157 PMCID: PMC11052635 DOI: 10.1093/bib/bbae184] [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: 01/19/2024] [Revised: 03/11/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
The interrelation and complementary nature of multi-omics data can provide valuable insights into the intricate molecular mechanisms underlying diseases. However, challenges such as limited sample size, high data dimensionality and differences in omics modalities pose significant obstacles to fully harnessing the potential of these data. The prior knowledge such as gene regulatory network and pathway information harbors useful gene-gene interaction and gene functional module information. To effectively integrate multi-omics data and make full use of the prior knowledge, here, we propose a Multilevel-graph neural network (GNN): a hierarchically designed deep learning algorithm that sequentially leverages multi-omics data, gene regulatory networks and pathway information to extract features and enhance accuracy in predicting survival risk. Our method achieved better accuracy compared with existing methods. Furthermore, key factors nonlinearly associated with the tumor pathogenesis are prioritized by employing two interpretation algorithms (i.e. GNN-Explainer and IGscore) for neural networks, at gene and pathway level, respectively. The top genes and pathways exhibit strong associations with disease in survival analyses, many of which such as SEC61G and CYP27B1 are previously reported in the literature.
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Affiliation(s)
- Hongxi Yan
- Department of Computer Science, Beihang University, XueYuan Road, 100191, BeiJing, China
| | - Dawei Weng
- School of Biomedical Engineering, Capital Medical University, 10 You An Men WaiXi Tou Tiao, 100069, Beijing, China
| | - Dongguo Li
- School of Biomedical Engineering, Capital Medical University, 10 You An Men WaiXi Tou Tiao, 100069, Beijing, China
| | - Yu Gu
- School of Biomedical Engineering, Capital Medical University, 10 You An Men WaiXi Tou Tiao, 100069, Beijing, China
| | - Wenji Ma
- Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 South Chongqing Road, 200025, Shanghai, China
| | - Qingjie Liu
- Department of Computer Science, Beihang University, XueYuan Road, 100191, BeiJing, China
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Bouffet E, Hansford JR, Garrè ML, Hara J, Plant-Fox A, Aerts I, Locatelli F, van der Lugt J, Papusha L, Sahm F, Tabori U, Cohen KJ, Packer RJ, Witt O, Sandalic L, Bento Pereira da Silva A, Russo M, Hargrave DR. Dabrafenib plus Trametinib in Pediatric Glioma with BRAF V600 Mutations. N Engl J Med 2023; 389:1108-1120. [PMID: 37733309 DOI: 10.1056/nejmoa2303815] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
BACKGROUND Detection of the BRAF V600E mutation in pediatric low-grade glioma has been associated with a lower response to standard chemotherapy. In previous trials, dabrafenib (both as monotherapy and in combination with trametinib) has shown efficacy in recurrent pediatric low-grade glioma with BRAF V600 mutations, findings that warrant further evaluation of this combination as first-line therapy. METHODS In this phase 2 trial, patients with pediatric low-grade glioma with BRAF V600 mutations who were scheduled to receive first-line therapy were randomly assigned in a 2:1 ratio to receive dabrafenib plus trametinib or standard chemotherapy (carboplatin plus vincristine). The primary outcome was the independently assessed overall response (complete or partial response) according to the Response Assessment in Neuro-Oncology criteria. Also assessed were the clinical benefit (complete or partial response or stable disease for ≥24 weeks) and progression-free survival. RESULTS A total of 110 patients underwent randomization (73 to receive dabrafenib plus trametinib and 37 to receive standard chemotherapy). At a median follow-up of 18.9 months, an overall response occurred in 47% of the patients treated with dabrafenib plus trametinib and in 11% of those treated with chemotherapy (risk ratio, 4.31; 95% confidence interval [CI], 1.7 to 11.2; P<0.001). Clinical benefit was observed in 86% of the patients receiving dabrafenib plus trametinib and in 46% receiving chemotherapy (risk ratio, 1.88; 95% CI, 1.3 to 2.7). The median progression-free survival was significantly longer with dabrafenib plus trametinib than with chemotherapy (20.1 months vs. 7.4 months; hazard ratio, 0.31; 95% CI, 0.17 to 0.55; P<0.001). Grade 3 or higher adverse events occurred in 47% of the patients receiving dabrafenib plus trametinib and in 94% of those receiving chemotherapy. CONCLUSIONS Among pediatric patients with low-grade glioma with BRAF V600 mutations, dabrafenib plus trametinib resulted in significantly more responses, longer progression-free survival, and a better safety profile than standard chemotherapy as first-line therapy. (Funded by Novartis; ClinicalTrials.gov number, NCT02684058.).
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Affiliation(s)
- Eric Bouffet
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Jordan R Hansford
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Maria Luisa Garrè
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Junichi Hara
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Ashley Plant-Fox
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Isabelle Aerts
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Franco Locatelli
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Jasper van der Lugt
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Ludmila Papusha
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Felix Sahm
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Uri Tabori
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Kenneth J Cohen
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Roger J Packer
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Olaf Witt
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Larissa Sandalic
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Ana Bento Pereira da Silva
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Mark Russo
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
| | - Darren R Hargrave
- From the Hospital for Sick Children, University of Toronto, Toronto (E.B., U.T.); the Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, and the Women's and Children's Hospital, South Australia Health and Medical Research Institute, South Australian immunoGENomics Cancer Institute, and the University of Adelaide, Adelaide - all in Australia (J.R.H.); IRCCS Giannina Gaslini Institute, Genoa (M.L.G.), and IRCCS Bambino Gesù Children's Hospital, Catholic University of the Sacred Heart, Rome (F.L.) - both in Italy; Osaka City General Hospital, Osaka, Japan (J.H.); the Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago (A.P.-F.); Institut Curie, SIREDO Oncology Center, Paris Sciences et Lettres Research University, Paris (I.A.); the Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands (J.L.); Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow (L.P.); the Department of Neuropathology and Clinical Cooperation Unit Neuropathology (F.S.) and the Hopp Children's Cancer Center, German Consortium for Translational Cancer Research, and National Center for Tumor Diseases, German Cancer Research Center, Heidelberg University Hospital, Heidelberg, Germany (F.S., O.W.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore (K.J.C.); Children's National Hospital, Washington, D.C. (R.J.P.); Novartis Pharma, Basel, Switzerland (L.S., A.B.P.S.); Novartis Pharmaceuticals, East Hanover, NJ (M.R.); and the University College London Great Ormond Street Institute of Child Health, London (D.R.H.)
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Cipri S, Del Baldo G, Fabozzi F, Boccuto L, Carai A, Mastronuzzi A. Unlocking the power of precision medicine for pediatric low-grade gliomas: molecular characterization for targeted therapies with enhanced safety and efficacy. Front Oncol 2023; 13:1204829. [PMID: 37397394 PMCID: PMC10311254 DOI: 10.3389/fonc.2023.1204829] [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: 04/12/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
In the past decade significant advancements have been made in the discovery of targetable lesions in pediatric low-grade gliomas (pLGGs). These tumors account for 30-50% of all pediatric brain tumors with generally a favorable prognosis. The latest 2021 WHO classification of pLGGs places a strong emphasis on molecular characterization for significant implications on prognosis, diagnosis, management, and the potential target treatment. With the technological advances and new applications in molecular diagnostics, the molecular characterization of pLGGs has revealed that tumors that appear similar under a microscope can have different genetic and molecular characteristics. Therefore, the new classification system divides pLGGs into several distinct subtypes based on these characteristics, enabling a more accurate strategy for diagnosis and personalized therapy based on the specific genetic and molecular abnormalities present in each tumor. This approach holds great promise for improving outcomes for patients with pLGGs, highlighting the importance of the recent breakthroughs in the discovery of targetable lesions.
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Affiliation(s)
- Selene Cipri
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giada Del Baldo
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Fabozzi
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Luigi Boccuto
- Healthcare Genetics Program, School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Andrea Carai
- Department of Neurosciences, Neurosurgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Gorodezki D, Zipfel J, Queudeville M, Sosa J, Holzer U, Kern J, Bevot A, Schittenhelm J, Nägele T, Ebinger M, Schuhmann MU. Resection extent and BRAF V600E mutation status determine postoperative tumor growth velocity in pediatric low-grade glioma: results from a single-center cohort analysis. J Neurooncol 2022; 160:567-576. [PMID: 36319795 PMCID: PMC9758245 DOI: 10.1007/s11060-022-04176-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Despite excellent long-term overall survival rates, pediatric low-grade gliomas (pLGG) show high variety of clinical behavior regarding progress or senescence post incomplete resection (IR). This study retrospectively analyzes tumor growth velocity (TGV) of pLGG before surgery and after IR to investigate the impact of surgical extent, tumor location and molecular BRAF status on postoperative residual tumor growth behavior. METHODS Of a total of 172 patients with pLGG receiving surgical treatment, 107 underwent IR (66%). Fifty-three vs 94 patients could be included in the pre- and post-operative cohort, respectively, and were observed over a mean follow-up time of 40.2 vs 60.1 months. Sequential three-dimensional MRI-based tumor volumetry of a total of 407 MRI scans was performed to calculate pre- and postoperative TGV. RESULTS Mean preoperative TGV of 0.264 cm3/month showed significant deceleration of tumor growth to 0.085 cm3/month, 0.024 cm3/month and -0.016 cm3/month after 1st, 2nd, and 3rd IR, respectively (p < 0.001). Results remained significant after excluding patients undergoing (neo)adjuvant treatment. Resection extent showed correlation with postoperative reduction of TGV (R = 0.97, p < 0.001). ROC analysis identified a residual cut-off tumor volume > 2.03 cm3 associated with a higher risk of progress post IR (sensitivity 78,6%, specificity 76.3%, AUC 0.88). Postoperative TGV of BRAF V600E-mutant LGG was significantly higher than of BRAF wild-type LGG (0.123 cm3/month vs. 0.016 cm3/month, p = 0.047). CONCLUSION This data suggests that extensive surgical resection may impact pediatric LGG growth kinetics post incomplete resection by inducing a significant deceleration of tumor growth. BRAF-V600E mutation may be a risk factor for higher postoperative TGV.
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Affiliation(s)
- David Gorodezki
- Department of Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany.
| | - Julian Zipfel
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Manon Queudeville
- Department of Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
- Clinic for Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jordana Sosa
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Ursula Holzer
- Department of Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Jan Kern
- Department of Neuropediatrics and Developmental Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Andrea Bevot
- Department of Neuropediatrics and Developmental Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Nägele
- Department of Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Martin Ebinger
- Department of Hematology and Oncology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Martin U Schuhmann
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
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Lohkamp LN, Parkin P, Puran A, Bartels UK, Bouffet E, Tabori U, Rutka JT. Optic Pathway Glioma in Children with Neurofibromatosis Type 1: A Multidisciplinary Entity, Posing Dilemmas in Diagnosis and Management Multidisciplinary Management of Optic Pathway Glioma in Children with Neurofibromatosis Type 1. Front Surg 2022; 9:886697. [PMID: 35592129 PMCID: PMC9111519 DOI: 10.3389/fsurg.2022.886697] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Neurofibromatosis type 1 (NF1) has an incidence of 1 in 2,000 to 3,000 individuals and in 15% is associated with optic pathway glioma (OPG). Given the variability in clinical presentation and related morbidity, a multidisciplinary approach for diagnosis and management of children with NF1 and OPG is required, but often lacks coordination and regular information exchange. Herein we summarize our experience and describe the care pathways/network provided by a multidisciplinary team. The role of the distinct team members is elucidated as well as the care amendments made over time. Methods We performed a retrospective single-center observational study, including children treated at our institution between 1990 and 2021. Inclusion criteria were clinical diagnosis of NF1, radiographic and/or histopathological diagnosis of OPG and age below 18 years. Patients being treated elsewhere were excluded from the study. Data was abstracted from each child’s health record using a standardized data collection form. Characteristics of children with NF1 and OPG were described using means (SD) and percentages. Outcomes were determined using Kaplan-Meier estimates. Results From 1990 to 2021, 1,337 children were followed in our institution. Of those, 195 were diagnosed with OPG (14.6%), including 94 (48.21%) females and 101 (51.79%) males. Comprehensive data were available in 150 patients. The mean (SD) age at diagnosis was 5.31(4.08) years (range: 0.8–17.04 years). Sixty-two (41.3%) patients remained stable and did not undergo treatment, whereas 88 (58.7%) patients required at least one treatment. The mean (SD) duration of follow up was 8.14 (5.46) years (range: 0.1–25.9 years; median 6.8 years). Overall survival was of 23.6 years (±1.08), comprising 5 deaths. A dedicated NF clinic, including pediatricians and a nurse, provides regular follow up and plays a central role in the management of children with NF1, identifying those at risk of OPG, coordinating referrals to Neuroradiology and other specialists as indicated. All children are assessed annually by Ophthalmology. Comprehensive care was provided by a multidisciplinary team consisting of Dermatology, Genetics, Neuro-oncology, Neuroradiology, Neurosurgery, Ophthalmology and Pediatrics. Conclusions The care of children with NF1 and OPG is optimized with a multidisciplinary team approach, coordinated by a central specialty clinic.
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Affiliation(s)
- Laura-Nanna Lohkamp
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
- Correspondence: Laura-Nanna Lohkamp
| | - Patricia Parkin
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Allan Puran
- Division of Paediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ute Katharina Bartels
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric Bouffet
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Uri Tabori
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Thomas Rutka
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Kasatkin V, Deviaterikova A, Shurupova M, Karelin A. The feasibility and efficacy of short-term visual-motor training in pediatric posterior fossa tumor survivors. Eur J Phys Rehabil Med 2022; 58:51-59. [PMID: 34247471 PMCID: PMC9980593 DOI: 10.23736/s1973-9087.21.06854-4] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pediatric posterior fossa tumor (PFT) survivors experience a range of cognitive and motor impairments that require timely rehabilitation of these functions. In Russia, rehabilitation services are only just beginning to be formed; therefore, it is necessary to test rehabilitation protocols for children surviving cancer. AIM To evaluate the efficacy of short-term cognitive and motor training (CMT) aimed on visual-motor integration in PFT survivors using training devices. DESIGN "Single center" quasi randomized controlled experiment. SETTING Outpatients of the Russkoe Pole Rehabilitation Center. POPULATION The 63 children cancer survivors between the ages of 6 and 17 years. METHODS The baseline level of cognitive and motor functions was assessed in all participants. Then the sample of patients split into two subgroups of equal sex, age, and diagnosis. The intervention subgroup received six sessions of CMT for two weeks, and the other subgroup underwent 'empty' two weeks with no intervention. Reassessment of motor and cognitive functions was conducted in all participants. Then the subgroups changed: the first subgroup underwent 'empty' two weeks, and the second subgroup completed the CMT, and further reassessment was provided. RESULTS The primary results demonstrate an increase in gross and fine motor skills, motor coordination, visual-motor integration, and visual processing after CMT. Secondary results show that the age at onset is an important factor in the subsequent decline in cognitive, motor functions, and eye movements. Children with medulloblastoma perform worse on motor tests than children with astrocytoma. A tumor in the IV ventricle is the most harmful, and a tumor in the cerebellar hemispheres is the least harmful to a child's cognitive and motor development. CONCLUSIONS This study shows the effectiveness of a short-term CMT program for children who survived PFT. The study also found that cognitive, motor, and visual-motor functions are affected by the tumor's localization, malignancy, and the child's age at onset. CLINICAL REHABILITATION IMPACT Short-term rehabilitation methods can be useful in pediatric oncological practice. Reconstruction of cognitive functions can occur during the training of more "simple" functions, such as hand-eye integration. The study makes a significant contribution to the methods of short-term rehabilitation in children who survived cancer.
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Affiliation(s)
- Vladimir Kasatkin
- Department of Neurocognitive, Psychophysiological Research and Physical Rehabilitation, Russian Field Rehabilitation Center, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Alena Deviaterikova
- Department of Neurocognitive, Psychophysiological Research and Physical Rehabilitation, Russian Field Rehabilitation Center, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia - .,Department of Visual Perception, Russian Academy of Education, Moscow, Russia
| | - Marina Shurupova
- Department of Neurocognitive, Psychophysiological Research and Physical Rehabilitation, Russian Field Rehabilitation Center, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia.,Department of Medical Rehabilitation, Federal Center of Brain and Neurotechnologies, Moscow, Russia.,Department of High Nervous Activity, Lomonosov Moscow State University, Moscow, Russia
| | - Alexander Karelin
- Department of Neurocognitive, Psychophysiological Research and Physical Rehabilitation, Russian Field Rehabilitation Center, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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Graph Theoretical Analysis of Brain Network Characteristics in Brain Tumor Patients: A Systematic Review. Neuropsychol Rev 2021; 32:651-675. [PMID: 34235627 DOI: 10.1007/s11065-021-09512-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 04/23/2021] [Indexed: 10/20/2022]
Abstract
Graph theory is a branch of mathematics that allows for the characterization of complex networks, and has rapidly grown in popularity in network neuroscience in recent years. Researchers have begun to use graph theory to describe the brain networks of individuals with brain tumors to shed light on disrupted networks. This systematic review summarizes the current literature on graph theoretical analysis of magnetic resonance imaging data in the brain tumor population with particular attention paid to treatment effects and other clinical factors. Included papers were published through June 24th, 2020. Searches were conducted on Pubmed, PsycInfo, and Web of Science using the search terms (graph theory OR graph analysis) AND (brain tumor OR brain tumour OR brain neoplasm) AND (MRI OR EEG OR MEG). Studies were eligible for inclusion if they: evaluated participants with a primary brain tumor, used graph theoretical analyses on structural or functional MRI data, MEG, or EEG, were in English, and were an empirical research study. Seventeen papers met criteria for inclusion. Results suggest alterations in network properties are often found in people with brain tumors, although the directions of differences are inconsistent and few studies reported effect sizes. The most consistent finding suggests increased network segregation. Changes are most prominent with more intense treatment, in hub regions, and with factors such as faster tumor growth. The use of graph theory to study brain tumor patients is in its infancy, though some conclusions can be drawn. Future studies should focus on treatment factors, changes over time, and correlations with functional outcomes to better identify those in need of early intervention.
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Tan JY, Wijesinghe IVS, Alfarizal Kamarudin MN, Parhar I. Paediatric Gliomas: BRAF and Histone H3 as Biomarkers, Therapy and Perspective of Liquid Biopsies. Cancers (Basel) 2021; 13:cancers13040607. [PMID: 33557011 PMCID: PMC7913734 DOI: 10.3390/cancers13040607] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Gliomas are major causes of worldwide cancer-associated deaths in children. Generally, paediatric gliomas can be classified into low-grade and high-grade gliomas. They differ significantly from adult gliomas in terms of prevalence, molecular alterations, molecular mechanisms and predominant histological types. The aims of this review article are: (i) to discuss the current updates of biomarkers in paediatric low-grade and high-grade gliomas including their diagnostic and prognostic values, and (ii) to discuss potential targeted therapies in treating paediatric low-grade and high-grade gliomas. Our findings revealed that liquid biopsy is less invasive than tissue biopsy in obtaining the samples for biomarker detections in children. In addition, future clinical trials should consider blood-brain barrier (BBB) penetration of therapeutic drugs in paediatric population. Abstract Paediatric gliomas categorised as low- or high-grade vary markedly from their adult counterparts, and denoted as the second most prevalent childhood cancers after leukaemia. As compared to adult gliomas, the studies of diagnostic and prognostic biomarkers, as well as the development of therapy in paediatric gliomas, are still in their infancy. A body of evidence demonstrates that B-Raf Proto-Oncogene or V-Raf Murine Sarcoma Viral Oncogene Homolog B (BRAF) and histone H3 mutations are valuable biomarkers for paediatric low-grade gliomas (pLGGs) and high-grade gliomas (pHGGs). Various diagnostic methods involving fluorescence in situ hybridisation, whole-genomic sequencing, PCR, next-generation sequencing and NanoString are currently used for detecting BRAF and histone H3 mutations. Additionally, liquid biopsies are gaining popularity as an alternative to tumour materials in detecting these biomarkers, but still, they cannot fully replace solid biopsies due to several limitations. Although histone H3 mutations are reliable prognosis biomarkers in pHGGs, children with these mutations have a dismal prognosis. Conversely, the role of BRAF alterations as prognostic biomarkers in pLGGs is still in doubt due to contradictory findings. The BRAF V600E mutation is seen in the majority of pLGGs (as seen in pleomorphic xanthoastrocytoma and gangliomas). By contrast, the H3K27M mutation is found in the majority of paediatric diffuse intrinsic pontine glioma and other midline gliomas in pHGGs. pLGG patients with a BRAF V600E mutation often have a lower progression-free survival rate in comparison to wild-type pLGGs when treated with conventional therapies. BRAF inhibitors (Dabrafenib and Vemurafenib), however, show higher overall survival and tumour response in BRAF V600E mutated pLGGs than conventional therapies in some studies. To date, targeted therapy and precision medicine are promising avenues for paediatric gliomas with BRAF V600E and diffuse intrinsic pontine glioma with the H3K27M mutations. Given these shortcomings in the current treatments of paediatric gliomas, there is a dire need for novel therapies that yield a better therapeutic response. The present review discusses the diagnostic tools and the perspective of liquid biopsies in the detection of BRAF V600E and H3K27M mutations. An in-depth understanding of these biomarkers and the therapeutics associated with the respective challenges will bridge the gap between paediatric glioma patients and the development of effective therapies.
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Affiliation(s)
| | | | | | - Ishwar Parhar
- Correspondence: ; Tel.: +603-5514-6304; Fax: +603-5515-6341
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10
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Hargrave DR, Bouffet E, Tabori U, Broniscer A, Cohen KJ, Hansford JR, Geoerger B, Hingorani P, Dunkel IJ, Russo MW, Tseng L, Dasgupta K, Gasal E, Whitlock JA, Kieran MW. Efficacy and Safety of Dabrafenib in Pediatric Patients with BRAF V600 Mutation-Positive Relapsed or Refractory Low-Grade Glioma: Results from a Phase I/IIa Study. Clin Cancer Res 2020; 25:7303-7311. [PMID: 31811016 DOI: 10.1158/1078-0432.ccr-19-2177] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/19/2019] [Accepted: 10/17/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Pediatric low-grade glioma (pLGG) is the most prevalent childhood brain tumor. Patients with BRAF V600 mutation-positive pLGG may benefit from treatment with dabrafenib. Part 2 of a phase I/IIa study, open-label study (NCT01677741) explores the activity and safety of dabrafenib treatment in these patients. PATIENTS AND METHODS Patients ages 1 to <18 years who had BRAF V600-mutant solid tumors (≥1 evaluable lesion) with recurrent, refractory, or progressive disease after ≥1 standard therapy were treated with oral dabrafenib 3.0 to 5.25 mg/kg/day (part 1) or at the recommended phase II dose (RP2D; part 2). Primary objectives were to determine the RP2D (part 1, results presented in a companion paper) and assess clinical activity (part 2). Here, we report the clinical activity, including objective response rates (ORRs) using Response Assessment in Neuro-Oncology criteria and safety across parts 1 and 2. RESULTS Overall, 32 patients with pLGG were enrolled (part 1, n = 15; part 2, n = 17). Minimum follow-up was 26.2 months. Among all patients, the ORR was 44% [95% confidence interval (CI), 26-62] by independent review. The 1-year progression-free survival rate was 85% (95% CI, 64-94). Treatment-related adverse events (AE) were reported in 29 patients (91%); the most common was fatigue (34%). Grade 3/4 treatment-related AEs were reported in 9 patients (28%). CONCLUSIONS Dabrafenib demonstrated meaningful clinical activity and acceptable tolerability in patients with BRAF V600-mutant pLGG.
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Affiliation(s)
- Darren R Hargrave
- Pediatric Oncology Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Eric Bouffet
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Uri Tabori
- Arthur and Sonia Labatt Brain Tumor Research Center, Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alberto Broniscer
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kenneth J Cohen
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Division of Pediatric Oncology, Baltimore, Maryland
| | - Jordan R Hansford
- Department of Pediatrics, The Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
| | - Birgit Geoerger
- Department of Childhood and Adolescent Oncology, Gustave Roussy Cancer Center, Université Paris-Saclay, Villejuif, France
| | - Pooja Hingorani
- Phoenix Children's Hospital, Center for Cancer and Blood Disorders, Phoenix, Arizona
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mark W Russo
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Lillian Tseng
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | | | - Eduard Gasal
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - James A Whitlock
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Mark W Kieran
- Harvard Medical School, Boston Children's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
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11
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Ryall S, Zapotocky M, Fukuoka K, Nobre L, Guerreiro Stucklin A, Bennett J, Siddaway R, Li C, Pajovic S, Arnoldo A, Kowalski PE, Johnson M, Sheth J, Lassaletta A, Tatevossian RG, Orisme W, Qaddoumi I, Surrey LF, Li MM, Waanders AJ, Gilheeney S, Rosenblum M, Bale T, Tsang DS, Laperriere N, Kulkarni A, Ibrahim GM, Drake J, Dirks P, Taylor MD, Rutka JT, Laughlin S, Shroff M, Shago M, Hazrati LN, D'Arcy C, Ramaswamy V, Bartels U, Huang A, Bouffet E, Karajannis MA, Santi M, Ellison DW, Tabori U, Hawkins C. Integrated Molecular and Clinical Analysis of 1,000 Pediatric Low-Grade Gliomas. Cancer Cell 2020; 37:569-583.e5. [PMID: 32289278 PMCID: PMC7169997 DOI: 10.1016/j.ccell.2020.03.011] [Citation(s) in RCA: 250] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/27/2020] [Accepted: 03/12/2020] [Indexed: 12/28/2022]
Abstract
Pediatric low-grade gliomas (pLGG) are frequently driven by genetic alterations in the RAS-mitogen-activated protein kinase (RAS/MAPK) pathway yet show unexplained variability in their clinical outcome. To address this, we characterized a cohort of >1,000 clinically annotated pLGG. Eighty-four percent of cases harbored a driver alteration, while those without an identified alteration also often exhibited upregulation of the RAS/MAPK pathway. pLGG could be broadly classified based on their alteration type. Rearrangement-driven tumors were diagnosed at a younger age, enriched for WHO grade I histology, infrequently progressed, and rarely resulted in death as compared with SNV-driven tumors. Further sub-classification of clinical-molecular correlates stratified pLGG into risk categories. These data highlight the biological and clinical differences between pLGG subtypes and opens avenues for future treatment refinement.
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Affiliation(s)
- Scott Ryall
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Michal Zapotocky
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Kohei Fukuoka
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Liana Nobre
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ana Guerreiro Stucklin
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Julie Bennett
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert Siddaway
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Christopher Li
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Sanja Pajovic
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - Anthony Arnoldo
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Paul E Kowalski
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Monique Johnson
- Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Javal Sheth
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alvaro Lassaletta
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatric Hematology and Oncology, Hospital Universitario Niño Jesús, Madrid, Spain
| | - Ruth G Tatevossian
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wilda Orisme
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lea F Surrey
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marilyn M Li
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angela J Waanders
- Department of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Data Driven Discovery in Biomedicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics, Feinberg School of Medicine Northwestern University, Chicago, IL, USA
| | - Stephen Gilheeney
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tejus Bale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Abhaya Kulkarni
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, The Hospital for Sick Children, Toronto ON, Canada
| | - George M Ibrahim
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, The Hospital for Sick Children, Toronto ON, Canada
| | - James Drake
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, The Hospital for Sick Children, Toronto ON, Canada
| | - Peter Dirks
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, The Hospital for Sick Children, Toronto ON, Canada
| | - Michael D Taylor
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, The Hospital for Sick Children, Toronto ON, Canada
| | - James T Rutka
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Neurosurgery, The Hospital for Sick Children, Toronto ON, Canada
| | - Suzanne Laughlin
- Department of Radiology, The Hospital for Sick Children, Toronto ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Manohar Shroff
- Department of Radiology, The Hospital for Sick Children, Toronto ON, Canada; Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Mary Shago
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lili-Naz Hazrati
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pathology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Colleen D'Arcy
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pathology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Anatomical Pathology, The Alfred Hospital, Prahran, VIC, Australia
| | - Vijay Ramaswamy
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Ute Bartels
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Annie Huang
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric Bouffet
- Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Mariarita Santi
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Genomic Diagnostics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David W Ellison
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Uri Tabori
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Cynthia Hawkins
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pathology, The Hospital for Sick Children, Toronto, ON, Canada.
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12
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Ryall S, Tabori U, Hawkins C. Pediatric low-grade glioma in the era of molecular diagnostics. Acta Neuropathol Commun 2020; 8:30. [PMID: 32164789 PMCID: PMC7066826 DOI: 10.1186/s40478-020-00902-z] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/21/2020] [Indexed: 12/17/2022] Open
Abstract
Low grade gliomas are the most frequent brain tumors in children and encompass a spectrum of histologic entities which are currently assigned World Health Organisation grades I and II. They differ substantially from their adult counterparts in both their underlying genetic alterations and in the infrequency with which they transform to higher grade tumors. Nonetheless, children with low grade glioma are a therapeutic challenge due to the heterogeneity in their clinical behavior – in particular, those with incomplete surgical resection often suffer repeat progressions with resultant morbidity and, in some cases, mortality. The identification of up-regulation of the RAS–mitogen-activated protein kinase (RAS/MAPK) pathway as a near universal feature of these tumors has led to the development of targeted therapeutics aimed at improving responses while mitigating patient morbidity. Here, we review how molecular information can help to further define the entities which fall under the umbrella of pediatric-type low-grade glioma. In doing so we discuss the specific molecular drivers of pediatric low grade glioma and how to effectively test for them, review the newest therapeutic agents and their utility in treating this disease, and propose a risk-based stratification system that considers both clinical and molecular parameters to aid clinicians in making treatment decisions.
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13
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Dhawan S, Patil CG, Chen C, Venteicher AS. Early versus delayed postoperative radiotherapy for treatment of low-grade gliomas. Cochrane Database Syst Rev 2020; 1:CD009229. [PMID: 31958162 PMCID: PMC6984627 DOI: 10.1002/14651858.cd009229.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This is an update of the review originally published in 2011 and first updated in 2015. In most people with low-grade gliomas (LGG), the primary treatment regimen remains a combination of surgery followed by postoperative radiotherapy. However, the optimal timing of radiotherapy is controversial. It is unclear whether to use radiotherapy in the early postoperative period, or whether radiotherapy should be delayed until tumour progression occurs. OBJECTIVES To assess the effects of early postoperative radiotherapy versus radiotherapy delayed until tumour progression for low-grade intracranial gliomas in people who had initial biopsy or surgical resection. SEARCH METHODS Original searches were run up to September 2014. An updated literature search from September 2014 through November 2019 was performed on the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 11), MEDLINE via Ovid (September 2014 to November week 2 2019), and Embase via Ovid (September 2014 to 2019 week 46) to identify trials for inclusion in this Cochrane review update. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared early versus delayed radiotherapy following biopsy or surgical resection for the treatment of people with newly diagnosed intracranial LGG (astrocytoma, oligodendroglioma, mixed oligoastrocytoma, astroblastoma, xanthoastrocytoma, or ganglioglioma). Radiotherapy may include conformal external beam radiotherapy (EBRT) with linear accelerator or cobalt-60 sources, intensity-modulated radiotherapy (IMRT), or stereotactic radiosurgery (SRS). DATA COLLECTION AND ANALYSIS Three review authors independently assessed the trials for inclusion and risk of bias, and extracted study data. We resolved any differences between review authors by discussion. Adverse effects were also extracted from the study report. We performed meta-analyses using a random-effects model with inverse variance weighting. MAIN RESULTS We included one large, multi-institutional, prospective RCT, involving 311 participants; the risk of bias in this study was unclear. This study found that early postoperative radiotherapy was associated with an increase in time to progression compared to observation (and delayed radiotherapy upon disease progression) for people with LGG but did not significantly improve overall survival (OS). The median progression-free survival (PFS) was 5.3 years in the early radiotherapy group and 3.4 years in the delayed radiotherapy group (hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.45 to 0.77; P < 0.0001; 311 participants; 1 trial; low-quality evidence). The median OS in the early radiotherapy group was 7.4 years, while the delayed radiotherapy group experienced a median overall survival of 7.2 years (HR 0.97, 95% CI 0.71 to 1.33; P = 0.872; 311 participants; 1 trial; low-quality evidence). The total dose of radiotherapy given was 54 Gy; five fractions of 1.8 Gy per week were given for six weeks. Adverse effects following radiotherapy consisted of skin reactions, otitis media, mild headache, nausea, and vomiting. Rescue therapy was provided to 65% of the participants randomised to delayed radiotherapy. People in both cohorts who were free from tumour progression showed no differences in cognitive deficit, focal deficit, performance status, and headache after one year. However, participants randomised to the early radiotherapy group experienced significantly fewer seizures than participants in the delayed postoperative radiotherapy group at one year (25% versus 41%, P = 0.0329, respectively). AUTHORS' CONCLUSIONS Given the high risk of bias in the included study, the results of this analysis must be interpreted with caution. Early radiation therapy was associated with the following adverse effects: skin reactions, otitis media, mild headache, nausea, and vomiting. People with LGG who underwent early radiotherapy showed an increase in time to progression compared with people who were observed and had radiotherapy at the time of progression. There was no significant difference in overall survival between people who had early versus delayed radiotherapy; however, this finding may be due to the effectiveness of rescue therapy with radiation in the control arm. People who underwent early radiation had better seizure control at one year than people who underwent delayed radiation. There were no cases of radiation-induced malignant transformation of LGG. However, it remained unclear whether there were differences in memory, executive function, cognitive function, or quality of life between the two groups since these measures were not evaluated.
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Affiliation(s)
- Sanjay Dhawan
- University of MinnesotaDepartment of Neurosurgery420 Delaware St. SE, D429 MayoMinneapolisMinnesotaUSA55455
| | - Chirag G Patil
- Maxine Dunitz Neurosurgical InstituteDepartment of NeurosurgeryCedars‐Sinai Medical Center8631 West Third Street, Suite 800ELos AngelesCAUSA90048
| | - Clark Chen
- University of MinnesotaDepartment of Neurosurgery420 Delaware St. SE, D429 MayoMinneapolisMinnesotaUSA55455
| | - Andrew S Venteicher
- University of MinnesotaDepartment of Neurosurgery420 Delaware St. SE, D429 MayoMinneapolisMinnesotaUSA55455
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14
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Wang X, Chen XZ, Shi L, Dai JP. Glioma grading and IDH1 mutational status: assessment by intravoxel incoherent motion MRI. Clin Radiol 2019; 74:651.e7-651.e14. [DOI: 10.1016/j.crad.2019.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/22/2019] [Indexed: 01/07/2023]
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15
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Al-Hajri A, Al-Mughairi S, Somani A, An S, Liu J, Miserocchi A, McEvoy AW, Yousry T, Hoskote C, Thom M. Pathology-MRI Correlations in Diffuse Low-Grade Epilepsy Associated Tumors. J Neuropathol Exp Neurol 2017; 76:1023-1033. [PMID: 29040640 PMCID: PMC5939705 DOI: 10.1093/jnen/nlx090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/19/2017] [Indexed: 11/14/2022] Open
Abstract
It is recognized that IDH mutation negative, low-grade epilepsy associated tumors (LEAT) can show diffuse growth patterns and lack the diagnostic hallmarks of either classical dysembryoplastic neuroepithelial tumors (DNT) or typical ganglioglioma. “Nonspecific or diffuse DNT” and more recently “polymorphous low-grade neuroepithelial tumor of the young” have been terms used for these entities. There are few reports on the MRI recognition of these diffuse glioneuronal tumors (dGNT), which is important in planning the extent of surgical resection. In 27 LEATs T1, T2, FLAIR, and postcontrast T1 MRI were evaluated and the pathology reviewed, including immunostaining for NeuN, CD34, MAP2, and IDH1. Each case was then independently classified by pathology or MRI as simple DNT, complex DNT, or dGNT. There was agreement in 23/27 (85%; Kappa score 0.62; p < 0.01). In 4 cases, there was discrepancy in the diagnosis of simple versus complex DNT but 100% agreement achieved for dGNT. DNT showed significantly more expansion of the cortex, cystic change and ventricle extension than dGNT. dGNT showed significantly more subcortical T2w hyperintensity and focal cortical atrophy which correlated on pathology with CD34 expression, cortical neuronal loss and white matter rarefaction. There was no distinct cortical dysplasia component identified by MRI or pathology in any case. This study highlights that dGNT can be reliably discriminated on MRI from DNT.
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Affiliation(s)
- Aliya Al-Hajri
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Salim Al-Mughairi
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Alyma Somani
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Shu An
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Joan Liu
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Anna Miserocchi
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Andrew W. McEvoy
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Tarek Yousry
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Chandrashekar Hoskote
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
| | - Maria Thom
- From The Lysholm Department of Neuroradiology in National Hospital for Neurology and Neurosurgery, London, UK (AA-H, SAM, TY, CH); Division of Neuropathology, National Hospital for Neurology and Neurosurgery, London, UK (AS, SA, JL, MT); Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, UK (AS, JL, AME, MT); and Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK (AM, AME)
- Send correspondence to: Maria Thom, MRCPath, FRCPath Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; E-mail:
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16
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Lassaletta A, Scheinemann K, Zelcer SM, Hukin J, Wilson BA, Jabado N, Carret AS, Lafay-Cousin L, Larouche V, Hawkins CE, Pond GR, Poskitt K, Keene D, Johnston DL, Eisenstat DD, Krishnatry R, Mistry M, Arnoldo A, Ramaswamy V, Huang A, Bartels U, Tabori U, Bouffet E. Phase II Weekly Vinblastine for Chemotherapy-Naïve Children With Progressive Low-Grade Glioma: A Canadian Pediatric Brain Tumor Consortium Study. J Clin Oncol 2017; 34:3537-3543. [PMID: 27573663 DOI: 10.1200/jco.2016.68.1585] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Vinblastine monotherapy has shown promising activity and a low-toxicity profile in patients with pediatric low-grade glioma (PLGG) who experienced treatment failure after initial treatment with chemotherapy and/or radiation. The aim of this study was to assess the activity of vinblastine in therapy-naïve children. Patients and Methods Patients < 18 years old with unresectable and/or progressive therapy-naïve PLGG were eligible. Vinblastine was administered once per week at a dose of 6 mg/m2 intravenously over a period of 70 weeks. Vision, quality of life, neurofibromatosis type 1 (NF1) status, and BRAF mutation/fusion status were also determined and correlated with outcome. Results Fifty-four patients were enrolled onto the study, with a median age of 8 years (range, 0.7 to 17.2 years). Most patients had chiasmatic/hypothalamic tumors (55.5%), and 13 patients (24.1%) had NF1. The most common histology was pilocytic astrocytoma (46.3%). Seventeen patients were diagnosed using radiologic criteria alone. Best response to chemotherapy was centrally reviewed with a response rate (complete, partial, or minor response) of 25.9%. Disease stabilization (complete, partial, or minor response or stable disease) was achieved in 47 patients (87.0%). Visual improvement was observed in 20% of patients with optic pathway glioma. Five-year overall survival and progression-free survival (PFS) rates were 94.4% (95% CI, 88.5% to 100%) and 53.2% (95% CI, 41.3% to 68.5%), respectively, for the entire cohort. Patients with NF1 had a significantly better PFS (85.1%; 95% CI, 68.0% to 100%) when compared with patients without NF1 (42.0%; 95% CI, 29.1% to 60.7%; P = .012). Age< 3 years or > 10 years was not associated with poor outcome. Treatment was well tolerated, and quality of life was not affected during treatment. In this trial, there was no correlation between BRAF alterations and outcome. Conclusion Vinblastine administered once per week is well tolerated in children with treatment naïve PLGG. Overall survival and PFS are comparable to current therapies, with a favorable toxicity profile and a maintained quality of life.
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Affiliation(s)
- Alvaro Lassaletta
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Katrin Scheinemann
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Shayna M Zelcer
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Juliette Hukin
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Beverley A Wilson
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Nada Jabado
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Anne Sophie Carret
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Lucie Lafay-Cousin
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Valerie Larouche
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Cynthia E Hawkins
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory Russell Pond
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ken Poskitt
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel Keene
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Donna L Johnston
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - David D Eisenstat
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Rahul Krishnatry
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Mistry
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony Arnoldo
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Vijay Ramaswamy
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Annie Huang
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ute Bartels
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Uri Tabori
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Bouffet
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
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17
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Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery 2017; 81:397-415. [PMID: 28486641 PMCID: PMC5581219 DOI: 10.1093/neuros/nyx103] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
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Affiliation(s)
- Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Marc C. Mabray
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
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18
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Badiyan SN, Ulmer S, Ahlhelm FJ, Fredh ASM, Kliebsch U, Calaminus G, Bolsi A, Albertini F, Leiser D, Timmermann B, Malyapa RS, Schneider R, Lomax AJ, Weber DC. Clinical and Radiologic Outcomes in Adults and Children Treated with Pencil-Beam Scanning Proton Therapy for Low-Grade Glioma. Int J Part Ther 2017; 3:450-460. [PMID: 31772995 PMCID: PMC6871558 DOI: 10.14338/ijpt-16-00031.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/29/2017] [Indexed: 09/21/2023] Open
Abstract
PURPOSE We assessed clinical and radiologic outcomes in adults and children with low-grade glioma (LGG) of the brain treated with pencil-beam scanning (PBS) proton therapy (PT). MATERIALS AND METHODS Between 1997 and 2014, 28 patients were treated with PBS PT, 20 (71%) of whom were younger than 18 years. Median age at start of PT was 12.3 years (range, 2.2-53.0 years). Nine patients (32%) underwent at least a subtotal resection; 12 (43%) underwent biopsy; and 7 (25%) were diagnosed radiographically. Twelve patients (43%) had grade II and 9 (32%) had grade I gliomas. Eleven patients (39%) received chemotherapy before PT. A median dose of 54 Gy (relative biologic effectiveness) was administered. Radiologic response to PT was determined using the Response Evaluation Criteria in Solid Tumors (RECIST). Eight domains of quality of life (QoL) for 16 pediatric patients were assessed prospectively by patients' parents using the pediatric QoL proxy questionnaire. Progression-free survival and overall survival (OS) were estimated by the Kaplan-Meier method. Median follow-up was 42.1 months for living patients. RESULTS Ten patients (36%) developed local, clinical failure. Three patients (11%) died, all of tumor progression. Radiographic tumor response by RECIST was evaluable in 11 patients: 9 (82%) with stable disease, 1 (9%) with partial response, and 1 (9%) with complete response to PT. Three-year OS and progression-free survival were 83.4% and 56.0%, respectively. No ≥ grade III acute toxicities were observed. Grade III, late radiation necrosis developed in 1 patient (4%). No appreciable change in pediatric QoL proxy scores in children was noted in any of the 8 domains at any time point. CONCLUSION Treatment with PBS PT is effective for LGG, with minimal acute toxicity and, in children, no appreciable decline in QoL. More patients and longer follow-up are needed to determine the long-term efficacy and toxicity of PT for LGG.
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Affiliation(s)
- Shahed N. Badiyan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Frank J. Ahlhelm
- Department of Radiology, Cantonal Hospital Baden, Baden, Switzerland
| | - Anna S. M. Fredh
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Münster, Münster, Germany
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | | | - Beate Timmermann
- Clinic for Particle Therapy, West German Proton Center, University Hospital Essen, Germany
| | - Robert S. Malyapa
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ralf Schneider
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Antony J. Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, Swiss Institute of Technology, Zurich, Switzerland
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
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19
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Byrne S, Connor S, Lascelles K, Siddiqui A, Hargrave D, Ferner RE. Clinical presentation and prognostic indicators in 100 adults and children with neurofibromatosis 1 associated non-optic pathway brain gliomas. J Neurooncol 2017; 133:609-614. [PMID: 28593402 PMCID: PMC5537330 DOI: 10.1007/s11060-017-2475-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 05/14/2017] [Indexed: 01/10/2023]
Abstract
Type 1 Neurofibromatosis (NF1) is a common autosomal dominant condition, with a major impact on the nervous system, eye, bone, and skin, and a predisposition to malignancy. At present it is not possible to predict clinically or on imaging, whether a brain tumour will remain indolent or undergo high-grade change. There are no consensus guidelines on the follow-up of non-optic pathway glioma (non-OPG) tumours in NF1. One hundred patients from the National NF1 Service with generalised NF1 and a diagnosis of non-OPG glioma were followed up for a median time of 63 months after glioma detection. Forty-two patients underwent surgical intervention. Ninety-one percent (38) of those requiring surgery did so within 5 years of diagnosis of glioma. Serial neuroimaging was undertaken in 88 patients. In 66 (75%), the lesion on the scan was stable or had improved at follow-up. High-grade lesions were present in five patients and were strongly associated with tumours in the thalamus (p = 0.001). Five patients died during follow-up. The diagnosis of high-grade glioma had a HR of 99.7 (95% CI 11.1-898.9, p < 000.1) on multivariate Cox regression to evaluate predictive factors related to death. In our cohort of 100 patients with NF1, we have shown that tumours in the thalamus are more likely to be associated with radiological progression, high-grade tumours, and surgical intervention. As a result of this finding, heightened surveillance with more frequent imaging should be considered in thalamic involvement. We have also demonstrated that over 40% of patients underwent surgery, and did so within 5 years of tumour diagnosis. Serial imaging should be undertaken for at the very least, 5 years from tumour detection.
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Affiliation(s)
- Susan Byrne
- National Neurofibromatosis Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK. .,Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, London, UK. .,Department of Paediatric Neurology, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK. .,Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, UK.
| | - Steve Connor
- Department of Neuroradiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Karine Lascelles
- National Neurofibromatosis Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Department of Paediatric Neurology, Evelina Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ata Siddiqui
- Department of Neuroradiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Darren Hargrave
- Department of Paediatric Oncology, Great Ormond Street Hospital, London, UK
| | - Rosalie E Ferner
- National Neurofibromatosis Service, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology, and Neuroscience, Kings College London, London, UK
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20
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Boesten T, Gerber NU, Kandels D, Azizi AA, Schmidt R, Warmuth-Metz M, Pietsch T, Kortmann RD, Gnekow A, Grotzer MA. Management of primary thalamic low-grade glioma in pediatric patients: results of the multicenter treatment studies HIT-LGG 1996 and SIOP-LGG 2004. Neurooncol Pract 2016; 4:29-39. [PMID: 31385995 DOI: 10.1093/nop/npw007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Indexed: 11/14/2022] Open
Abstract
Background Thalamic low-grade glioma (LGG) poses a special therapeutic challenge, as complete resection is often not possible. To determine the survival outcomes of mono- and bithalamic LGG, we analyzed a large cohort of pediatric patients. Methods From 1996 until 2012, 2618 patients were registered in the HIT-LGG 1996 and the SIOP-LGG 2004 studies. A total of 102 of these 2618 patients (3.9%) were diagnosed with a thalamic LGG with a median age at diagnosis of 8.0 years (range, 0.4-17.5 years); 87 patients (85%) had monothalamic and 15 patients (15%) had bithalamic LGG. Results Ninety patients received at least one surgical procedure. Thirty-one patients received radiotherapy and 24 patients received chemotherapy as a first-line, nonsurgical treatment indicated by radiological tumor progression or severe/progressive clinical symptoms. Patients with monothalamic tumors showed a 10-year overall survival (OS) rate of 91%, whereas patients with bithalamic tumors only reached 65% (P = .001). Bithalamic tumors more frequently showed diffuse histology than monothalamic tumors. Patients with diffuse astrocytoma had a lower 10-year OS (68%) than those with pilocytic astrocytoma (93%). The 10-year progression-free survival rate after the start of first nonsurgical treatment was 53% in the radiotherapy group and 34% in the chemotherapy group. Conclusions Thalamic glioma was manageable using a strategy that included surgery, observation, chemotherapy, and/or radiotherapy. Radiotherapy could be successfully deferred or obviated in a number of patients. Survival was high in among patients with monothalamic tumors. The worse prognosis associated with bithalamic tumors correlates with the higher rate of diffuse histology in this subgroup, precluding total or near-total resection.
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Affiliation(s)
- Tineke Boesten
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
| | - Nicolas U Gerber
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
| | - Daniela Kandels
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
| | - Amedeo A Azizi
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
| | - Rene Schmidt
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
| | - Monika Warmuth-Metz
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
| | - Torsten Pietsch
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
| | - Rolf-Dieter Kortmann
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
| | - Astrid Gnekow
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
| | - Michael A Grotzer
- Department of Oncology, University Children's Hospital, Zurich, Switzerland (T.B., N.U.G., M.A.G.); Hospital for Children and Adolescents, Klinikum Augsburg, Augsburg, Germany (D.K., A.G.); Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria (A.A.A.); Institute of Biostatistics and Clinical Research, University of Muenster, Germany (R.S.); Department of Neuroradiology, University of Wuerzburg, Germany (M.W.); Institute of Neuropathology, University of Bonn, Germany (T.P.); Department of Radiation Oncology, University of Leipzig, Leipzig, Germany (R.K.)
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Fernández MB, Alonso VP. Conventional chemotherapy and perspectives for molecular-based oncological treatment in pediatric hemispheric low-grade gliomas. Childs Nerv Syst 2016; 32:1939-45. [PMID: 27659836 DOI: 10.1007/s00381-016-3132-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 05/26/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Pediatric low-grade gliomas (PLGG) are the most common primary central nervous system tumor in children. Patients in whom gross total resection can be achieved have an excellent overall (OS) and event-free survival (EFS) and do not require adjuvant therapy. However, children with unresectable tumors often experience multiple progressions and require additional treatment. CONVENTIONAL CHEMOTHERAPY Radiotherapy results in long-term tumor control, but it is associated with significant toxicity, making chemotherapy the preferred therapeutic option. Several chemotherapy combinations have been found to be successful in PLGG, but 5-year EFS has been below 60 % with most of them. MOLECULAR-BASED TREATMENT Recent molecular advances have led to a better understanding of the molecular pathways involved in the biology of LGG, allowing the development of promising tumor-specific, molecularly targeted therapies.
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Affiliation(s)
| | - Vanesa Pérez Alonso
- Department of Pediatric Hemato-Oncology, Hospital 12 de Octubre, Madrid, Spain
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22
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An integrative molecular and genomic analysis of pediatric hemispheric low-grade gliomas: an update. Childs Nerv Syst 2016; 32:1789-97. [PMID: 27659822 DOI: 10.1007/s00381-016-3163-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 06/27/2016] [Indexed: 12/13/2022]
Abstract
Hemispheric low-grade gliomas account for the second most common location in pediatric low-grade gliomas (PLGGs) after the cerebellum. The pathological spectrum includes gangliogliomas, dysembryoplastic neuroepithelial tumors (DNETs), diffuse astrocytomas, pilocytic astrocytomas, and pleomorphic xanthoastrocytomas (PXAs), among others. Clinically, hemispheric PLGGs represent a well-recognized cause of intractable epilepsy in children and adolescents. With an excellent long-term outcome, surgery remains the cornerstone and patients with gross total resection typically do not need any further therapies. The recent literature about hemispheric PLGGs was reviewed to provide an up-to-date overview of the molecular and cell biology of these tumors. Hemispheric PLGGs can harbor multiple alterations involving BRAFV600E, FGFR, NTRK, MYB/MYBL1, IDH, and BRAF-KIAA1549 fusions. However, the clinical significance of most of these alterations is still to be defined. The role of RAS/MAPK mutations and other alterations in hemispheric PLGGs is of interest from diagnostic, prognostic, and therapeutic perspectives. Molecular testing for these tumors should be encouraged, since the findings can have an important impact not only in prognosis but also in therapeutic strategies.
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23
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Han X, Suo S, Sun Y, Zu J, Qu J, Zhou Y, Chen Z, Xu J. Apparent diffusion coefficient measurement in glioma: Influence of region-of-interest determination methods on apparent diffusion coefficient values, interobserver variability, time efficiency, and diagnostic ability. J Magn Reson Imaging 2016; 45:722-730. [PMID: 27527072 DOI: 10.1002/jmri.25405] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/15/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Xu Han
- Department of Radiology, Ren Ji Hospital, School of Medicine; Shanghai Jiao Tong University; Shanghai P.R. China
| | - Shiteng Suo
- Department of Radiology, Ren Ji Hospital, School of Medicine; Shanghai Jiao Tong University; Shanghai P.R. China
| | - Yawen Sun
- Department of Radiology, Ren Ji Hospital, School of Medicine; Shanghai Jiao Tong University; Shanghai P.R. China
| | - Jinyan Zu
- Department of Radiology, Ren Ji Hospital, School of Medicine; Shanghai Jiao Tong University; Shanghai P.R. China
| | | | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine; Shanghai Jiao Tong University; Shanghai P.R. China
| | - Zengai Chen
- Department of Radiology, Ren Ji Hospital, School of Medicine; Shanghai Jiao Tong University; Shanghai P.R. China
| | - Jianrong Xu
- Department of Radiology, Ren Ji Hospital, School of Medicine; Shanghai Jiao Tong University; Shanghai P.R. China
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Garcia MA, Solomon DA, Haas-Kogan DA. Exploiting molecular biology for diagnosis and targeted management of pediatric low-grade gliomas. Future Oncol 2016; 12:1493-506. [PMID: 27072750 PMCID: PMC4915741 DOI: 10.2217/fon-2016-0039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/29/2016] [Indexed: 12/14/2022] Open
Abstract
The majority of brain tumors arising in children are low-grade gliomas. Although historically categorized together as pediatric low-grade gliomas (PLGGs), there is significant histologic and genetic diversity within this group. In general, prognosis for PLGGs is excellent, and limitation of sequelae from tumor and treatment is paramount. Advances in high-throughput genetic sequencing and gene expression profiling are fundamentally changing the way PLGGs are classified and managed. Here, we review the histologic subtypes and highlight how recent advances in elucidating the molecular pathogenesis of these tumors have refined diagnosis and prognostication. Additionally, we discuss how characterizing specific genetic alterations has paved the way for the rational use of targeted therapies that are currently in various phase clinical trials.
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Affiliation(s)
- Michael A Garcia
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - David A Solomon
- Division of Neuropathology, Department of Pathology, University of California, San Francisco, CA, USA
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Harvard Medical School, Dana-Farber Cancer Institute, Brigham & Women's Hospital, Boston Children's Hospital, MA, USA
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Abstract
Great progress has been made in many areas of pediatric oncology. However, tumors of the central nervous system (CNS) remain a significant challenge. A recent explosion of data has led to an opportunity to understand better the molecular basis of these diseases and is already providing a foundation for the pursuit of rationally chosen therapeutics targeting relevant molecular pathways. The molecular biology of pediatric brain tumors is shifting from a singular focus on basic scientific discovery to a platform upon which insights are being translated into therapies.
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Karaaslan B, Uçar M, Kulduk G, Börcek AÖ, Baykaner MK. Bilateral Optic Pathway Ganglioglioma: The Fifth Case in the Literature. Pediatr Neurosurg 2016; 51:48-54. [PMID: 26488468 DOI: 10.1159/000439541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/18/2015] [Indexed: 11/19/2022]
Abstract
Gangliogliomas are mixed tumors which contain both glial and neuronal elements. The optic pathway is a very rare location for gangliogliomas, with less than 23 cases reported in the literature. Bilateral involvement of the entire optic pathway was reported in only 4 cases before. Because of similar radiological appearance of other pathological entities such as gliomas and craniopharyngiomas, histopathological diagnosis is essential. We report a ganglioglioma case that involved both optic pathways. A 12-year-old patient suffering from visual deterioration for 6 months was evaluated. After a visual field test and radiological examinations, a microsurgical biopsy procedure was performed. Pathological examination revealed dysplastic/neoplastic ganglion cells and neoplastic glial cells, and the diagnosis was a World Health Organization (WHO) grade 1 ganglioglioma. The patient is scheduled for adjuvant radiotherapy with the hope of prevention of progression.
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Affiliation(s)
- Burak Karaaslan
- Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
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27
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Functional and neuropsychological late outcomes in posterior fossa tumors in children. Childs Nerv Syst 2015; 31:1877-90. [PMID: 26351237 DOI: 10.1007/s00381-015-2829-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 12/21/2022]
Abstract
Tumors of the posterior fossa (PF) account for up to 60 % of all childhood intracranial tumors. Over the last decades, the mortality rate of children with posterior fossa tumors has gradually decreased. While survival has been the primary objective in most reports, quality of survival increasingly appears to be an important indicator of a successful outcome. Children with a PF tumor can sustain damage to the cerebellum and other brain structures from the tumor itself, concomitant hydrocephalus, the consequences of treatment (surgery, chemotherapy, radiotherapy), or a combination of these factors. Together, these contribute to long-term sequelae in physical functioning, neuropsychological late outcomes (including academic outcome, working memory, perception and estimation of time, and selective attention, long-term neuromotor speech deficits, and executive functioning). Long-term quality of life can also be affected by endocrinological complication or the occurrence of secondary tumors. A significant proportion of survivors of PF tumors require long-term special education services and have reduced rates of high school graduation and employment. Interventions to improve neuropsychological functioning in childhood PF tumor survivors include (1) pharmacological interventions (such as methylphenidate, modafinil, or donepezil), (2) cognitive remediation, and (3) home-based computerized cognitive training. In order to achieve the best possible outcome for survivors, and ultimately minimize long-term complications, new interventions must be developed to prevent and ameliorate the neuro-toxic effects experienced by these children.
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28
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Intravoxel incoherent motion diffusion-weighted MR imaging of gliomas: efficacy in preoperative grading. Sci Rep 2014; 4:7208. [PMID: 25434593 PMCID: PMC4248278 DOI: 10.1038/srep07208] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/10/2014] [Indexed: 12/13/2022] Open
Abstract
The preoperative grading of gliomas, which is critical for guiding therapeutic strategies, remains unsatisfactory. We aimed to retrospectively assess the efficacy of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in the grading of gliomas. Forty-two newly diagnosed glioma patients underwent conventional MR imaging, DWI, and contrast-enhanced MR imaging. Parameters of apparent diffusion coefficient (ADC), slow diffusion coefficient (D), fast diffusion coefficient (D*), and fraction of fast ADC (f) were generated. They were tested for differences between low- and high-grade gliomas based on one-way ANOVA. Receiver-operating characteristic (ROC) analyses were conducted to determine the optimal thresholds as well as the sensitivity and specificity for grading. ADC, D, and f were higher in the low-grade gliomas, whereas D* tended to be lower (all P<0.05). The AUC, sensitivity, specificity and the cutoff value, respectively, for differentiating low- from high-grade gliomas for ADC, D and f, and differentiating high- from low-grade gliomas for D* were as follows: ADC, 0.926, 100%, 82.8%, and 0.7 × 10−3 mm2/sec; D, 0.942, 92.3%, 86.2%, and 0.623 × 10−3 mm2/sec; f, 0.902, 92.3%, 86.2%, and 35.3%; D*, 0.798, 79.3%, 84.6%, and 0.303 × 10−3 mm2/sec. The IVIM DWI demonstrates efficacy in differentiating the low- from high-grade gliomas.
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