1
|
Wilson JS, Main C, Thorp N, Taylor RE, Majothi S, Kearns PR, English M, Dandapani M, Phillips R, Wheatley K, Pizer B. The effectiveness and safety of proton beam radiation therapy in children and young adults with Central Nervous System (CNS) tumours: a systematic review. J Neurooncol 2024; 167:1-34. [PMID: 38294638 PMCID: PMC10978619 DOI: 10.1007/s11060-023-04510-4] [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: 09/12/2023] [Accepted: 11/14/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Central nervous system (CNS) tumours account for around 25% of childhood neoplasms. With multi-modal therapy, 5-year survival is at around 75% in the UK. Conventional photon radiotherapy has made significant contributions to survival, but can be associated with long-term side effects. Proton beam radiotherapy (PBT) reduces the volume of irradiated tissue outside the tumour target volume which may potentially reduce toxicity. Our aim was to assess the effectiveness and safety of PBT and make recommendations for future research for this evolving treatment. METHODS A systematic review assessing the effects of PBT for treating CNS tumours in children/young adults was undertaken using methods recommended by Cochrane and reported using PRISMA guidelines. Any study design was included where clinical and toxicity outcomes were reported. Searches were to May 2021, with a narrative synthesis employed. RESULTS Thirty-one case series studies involving 1731 patients from 10 PBT centres were included. Eleven studies involved children with medulloblastoma / primitive neuroectodermal tumours (n = 712), five ependymoma (n = 398), four atypical teratoid/rhabdoid tumour (n = 72), six craniopharyngioma (n = 272), three low-grade gliomas (n = 233), one germ cell tumours (n = 22) and one pineoblastoma (n = 22). Clinical outcomes were the most frequently reported with overall survival values ranging from 100 to 28% depending on the tumour type. Endocrine outcomes were the most frequently reported toxicity outcomes with quality of life the least reported. CONCLUSIONS This review highlights areas of uncertainty in this research area. A well-defined, well-funded research agenda is needed to best maximise the potential of PBT. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42016036802.
Collapse
Affiliation(s)
- Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
- The Christie Hospital Foundation Trust Proton Beam Therapy Centre, Manchester, UK
| | | | - Saimma Majothi
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin English
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Madhumita Dandapani
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
| |
Collapse
|
2
|
The Role of Neuroaxis Irradiation in the Treatment of Intraspinal Ewing Sarcoma: A Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14051209. [PMID: 35267515 PMCID: PMC8909708 DOI: 10.3390/cancers14051209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
The role of cranio-spinal irradiation (CSI) for primary extraosseous intraspinal Ewing sarcoma (EwS) remains unclear. Here, we evaluate clinical and survival outcomes in patients with primary intraspinal EwS treated with CSI as part of multimodal primary therapy regimens. We abstracted patient information, including details on treatment application, efficacy, and tolerance from the literature and our hospital database for a cohort of 24 primary intraspinal EwS patients treated with CSI. Median age was 25.5 years, median CSI dose was 36 Gy and mean boost dose was 12.8 Gy. Sixteen patients (66.7%) achieved complete radiological remission, another 5 patients demonstrated partial response and 1 patient showed no response to treatment. Compared to a cohort of patients treated with focal radiotherapy, CSI patients were more likely to have multifocal disease at time of diagnosis (p = 0.001) and intradural tumor location (p < 0.001). Despite over-representation of these unfavorable characteristics, there was no survival difference between groups (p = 0.58). While CSI shows promising results in the treatment of primary intraspinal EwS, treatment should be considered individually based on tumor and patient characteristics in the absence of prospective trials.
Collapse
|
3
|
Primary extra-skeletal Ewing's sarcoma presenting as an epidural Soft Tissue Lesion causing cauda equina syndrome in an adolescent girl: a case report. Spinal Cord Ser Cases 2022; 8:13. [PMID: 35075107 PMCID: PMC8786895 DOI: 10.1038/s41394-021-00474-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/05/2021] [Accepted: 12/29/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Primary epidural Ewing's sarcoma in the lumbar spinal canal is a rare condition and very few cases are reported in the literature. CASE REPORT A fifteen-year-old girl presented with low backache associated with sudden onset of weakness and radiculopathy of both lower limbs for 10 days, bowel and bladder involvement for 3 days. Physical examination revealed grade 0/5 power and absent sensations below L4 dermatomal level and perianal region (ASIA A). Plantar reflex was mute bilaterally. Magnetic resonance imaging revealed an extradural lesion within the spinal canal at the L3-L4 level. The patient underwent an emergency posterior decompression, extradural lesion excision and instrumented stabilization L3-L5. Based on histopathological examination of the tissue specimen, we diagnosed the lesion as Ewing sarcoma. DISCUSSION Primary extra-skeletal Ewing's sarcoma presenting as an epidural lesion in the lumbar spine is a rare clinical entity that should be considered as a differential for spinal epidural lesions. Treatment for such cases is almost always an early surgical intervention due to its rapid onset and compressive neurological symptoms. Wide decompression with instrumented fusion and excision of the lesion followed by chemo and radiotherapy are recommended.
Collapse
|
4
|
Patil AS, Gupta PP, Iratwar SW. Primary Spinal Extradural Extraosseous Primitive Neuroectodermal Tumor/Ewing's Sarcoma: A Critical Analysis and Review. Asian J Neurosurg 2021; 16:276-280. [PMID: 34268151 PMCID: PMC8244703 DOI: 10.4103/ajns.ajns_340_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/08/2020] [Accepted: 02/15/2021] [Indexed: 11/06/2022] Open
Abstract
Primary spinal extradural Ewing's sarcoma/primitive neuroectodermal tumor (PNET) is rare malignant tumor of childhood and early adulthood. The World Health Organization classifies PNET as an undifferentiated round cell tumor arising from primitive neuroepithelial cell. It can be central or peripheral PNET depending on site of presentation. Usually, the presenting symptoms are chronic back pain and myelopathy. Overall prognosis and survival are dismal in spite of total surgical resection and adjuvant therapy. Because of the rarity and malignant behavior, definite management of spinal PNET has never been described. After review of medical record at Acharaya Vinoba Bhave Rural Hospital, Sawangi, India, we identified four patients of spinal PNET and were included in our study. Age at diagnosis ranging from 15 to 26 years old with mean age of 20 years old. All four cases were epidural in location, two of which were of Askin type tumor with spinal cord compression. Rural population with low literacy and financial constraints were the key reasons of late presentations at our hospital. Counseling and proper education regarding the disease are a must for early case detection and early treatment of those living in rural areas and suffers from financial constraints. Due to rarity of the disease and its poor prognosis, a well-organized multicentric controlled trial is required to formulate a standard guidelines in the management of this disease.
Collapse
|
5
|
Automatic feathering algorithm for VMAT craniospinal irradiation: A comprehensive comparison with other VMAT planning strategies. Med Dosim 2020; 46:103-110. [PMID: 32967789 DOI: 10.1016/j.meddos.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/22/2020] [Accepted: 09/11/2020] [Indexed: 01/06/2023]
Abstract
In craniospinal irradiation, field matching is very sensitive to intrafraction positional uncertainties in cranio-caudal direction, which could lead to severe overdoses/underdoses inside the planning target volume. During the last decade, significant efforts were made to develop volumetric-modulated arc therapy strategies, which were less sensitive to setup uncertainties. In this study, a treatment planning system-integrated method, named automatic feathering (AF) algorithm, was compared against other volumetric-modulated arc therapy strategies. Three patients were retrospectively included. Five different planning techniques were compared, including overlap (O), staggered overlap (SO), gradient optimization (GO), overlap with AF algorithm turned on (O-AF), and staggered overlap with AF algorithm turned on (SO-AF). Three overlapping lengths were considered (5 cm, 7.5 cm, and 10 cm). The middle isocenter was shifted of ±1 mm, ±3 mm, and ±5 mm to simulate setup uncertainties. Plan robustness against simulated uncertainties was evaluated by calculating near maximum and near minimum dose differences between shifted and nonshifted plans (ΔD2%, ΔD98%). Dose differences among combinations of techniques and junction lengths were tested using Wilcoxon signed-rank test. Higher ΔD2% and ΔD98% were obtained using the overlap technique (ΔD2% = 15.4%, ΔD98% = 15.0%). O-AF and SO-AF provided comparable plan robustness to GO technique. Their performance improved significantly for grater overlapping length. For 10-cm overlap and 5-mm shift, GO, O-AF, and SO-AF yielded to the better plan robustness (5.7% < ΔD2% < 6.0%, 6.1% < ΔD98% < 7.6%). SO provided an intermediate plan robustness (9.8% < ΔD2% < 10.8%, 8.9% < ΔD98% < 10.3%). The addition of AF to the overlap technique significantly improves plan robustness especially if larger overlapping lengths are used. Using the AF algorithm, plans become as robust as plans optimized with more sophisticated and time-consuming approaches (like GO).
Collapse
|
6
|
Adult Primary Spinal Epidural Extraosseous Ewing's Sarcoma: A Case Report and Review of the Literature. Case Rep Neurol Med 2016; 2016:1217428. [PMID: 27610254 PMCID: PMC5005550 DOI: 10.1155/2016/1217428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/17/2016] [Indexed: 01/09/2023] Open
Abstract
Background. Extraosseous Ewing's sarcoma in the spinal epidural space is a rare malignancy, especially in adults. Case Presentation. A 40-year-old male presented with back pain and urinary hesitancy. MRI revealed a thoracic extradural mass with no osseous involvement. He underwent surgery for gross total resection of the mass, which was diagnosed as Ewing's sarcoma. He was subsequently treated with chemoradiotherapy. He remains disease-free 1 year after surgery. Review of the literature indicated only 45 previously reported cases of spinal epidural extraosseous Ewing's sarcoma in adults. Conclusions. Extraosseous Ewing's sarcoma in the spinal epidural space is a rare clinical entity that should be included in the differential for spinal epidural masses. Its treatment is multidisciplinary but frequently requires surgical intervention due to compressive neurologic symptoms. Gross total resection appears to correlate with improved outcomes.
Collapse
|
7
|
Main C, Dandapani M, Pritchard M, Dodds R, Stevens SP, Thorp N, Taylor RE, Wheatley K, Pizer B, Morrall M, Phillips R, English M, Kearns PR, Wilne S, Wilson JS. The effectiveness and safety of proton beam radiation therapy in children with malignant central nervous system (CNS) tumours: protocol for a systematic review. Syst Rev 2016; 5:124. [PMID: 27460473 PMCID: PMC4962509 DOI: 10.1186/s13643-016-0285-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study is to use a systematic review framework to identify and synthesise the evidence on the use of proton beam therapy (PBT) for the treatment of children with CNS tumours and where possible compare this to the use of photon radiotherapy (RT). METHODS Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Twelve electronic databases have been searched, and further citation, hand searching and reference checking will be employed. Studies assessing the effects of PBT used either alone or as part of a multimodality treatment regimen in children with CNS tumours will be included. Relevant economic evaluations will also be identified. The outcomes are survival (overall, progression-free, event-free, disease-free), local and regional control rates, short- and long-term adverse events, functional status measures and quality of survival. Two reviewers will independently screen and select studies for inclusion in the review. All interventional study designs will be eligible for inclusion in the review. However, initial scoping searches indicate the evidence base is likely to be limited to case series studies, with no studies of a higher quality being identified. Quality assessment will be undertaken using pre-specified criteria and tailored to study design if applicable. Studies will be combined using a narrative synthesis, with differences in results between studies highlighted and discussed in relation to the patient population, intervention and study quality. Where appropriate, if no studies of a comparative design are identified, outcomes will be compared against a range of estimates from the literature for similar populations and treatment regimens from the best available evidence from studies that include the use of advanced conventional photon therapy. DISCUSSION The evidence base for the use of PBT in children with CNS tumours is likely to be relatively sparse, highly heterogeneous and potentially of a low quality with small sample sizes. Furthermore, selection and publication biases may limit the internal and external validity of studies. However, any tentative results from the review on potential treatment effects can be used to plan better quality research studies that are of a design appropriate for outcome comparison with conventional therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015029583.
Collapse
Affiliation(s)
- Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | | | | | | | - Simon P. Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
| | | | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Robert Phillips
- Leeds General Infirmary, Leeds, UK
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Martin English
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Pamela R. Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Sophie Wilne
- Queen’s Medical Centre, Nottingham University Hospitals’ NHS Trust, Nottingham, UK
| | - Jayne S. Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| |
Collapse
|
8
|
Clinical presentation and long-term outcome of primary spinal peripheral primitive neuroectodermal tumors. J Neurooncol 2015; 124:455-63. [PMID: 26186903 DOI: 10.1007/s11060-015-1859-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/12/2015] [Indexed: 12/25/2022]
Abstract
Primary spinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare entities that predominantly occur in children and young adults. Few studies have reported more than three cases. There are no current optimum treatment strategies due to the paucity of data. Here, we present 13 patients (nine females and four males) with primary intraspinal pPNETs who were surgically treated from April 2008 to February 2014. Histopathologic findings revealed the expression of CD99 in all cases. Limb weakness was the most common initial symptom (11/13, 85 %). The tumors were located mainly at the cervical level (6/13, 46 %) and in the epidural space (10/13, 77 %). The radiological diagnosis was neurinoma or meningioma in most cases (10/13, 77 %). Gross total resection was achieved in 77 % (10/13) of patients. During a mean follow-up of 25.5 months, local relapse occurred in 8 (61.5 %) patients and distant metastases occurred in 8 (61.5 %) patients. The overall 1-year survival rate was 77 % (10/13), and the overall 2-year survival rate was 54 % (7/13). The 2-year survival rate was 57.1 % in patients with adjuvant chemotherapy and 50 % in those without chemotherapy. Gross total resection and adjuvant radiotherapy with or without chemotherapy demonstrated a longer survival period (1-year survival rate: 100 %; 2-year survival rate: 86 %). Our data showed that primary spinal pPNETs are extremely rare and aggressive tumors with a poor prognosis. Radical resection is advocated. Gross total resection combined with adjuvant radiation may help to significantly improve patient survival period. Chemotherapy may also help to slightly prolong patient life.
Collapse
|
9
|
Jalaj S, Lee SY, McGaw C, John BK, Li Z, Awad ZT, Scolapio JS, Munoz JC. Proton radiotherapy dose perturbations caused by esophageal stents of varying material composition are negligible in an experimental model. Endosc Int Open 2015; 3:E46-50. [PMID: 26134771 PMCID: PMC4423262 DOI: 10.1055/s-0034-1390709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 09/08/2014] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Self-expanding metal and plastic esophageal stents (SEMS and SEPS, respectively) are used in conjunction with chemoradiation for palliation of malignant dysphagia. To date, the dosimetric effects of stents undergoing proton radiotherapy are not known. STUDY AIM To investigate the proton radiotherapy dose perturbations caused by esophageal stents of varying designs and materials undergoing external beam treatment for esophageal cancer. PATIENTS AND METHODS Simulated clinical protocol. Solid acrylic phantom was used to mimic the esophageal tissue environment. Stents made of nitinol, stainless steel and polyester were tested. Proton beam dose of 2 Gy-E was delivered to each stent in a single anterior to posterior field. Film and image based evidence of dose perturbation were main outcomes measured. RESULTS Only the stainless steel and plastic stents demonstrated slight overall dose attenuations (- 0.5 % and - 0.4 %, respectively). All the nitinol-based stents demonstrated minimal overall dose perturbations ranging from 0.0 % to 1.2 %. Negligible dose perturbations were observed on each of the stent surfaces proximal to the radiation source, ranging from - 0.8 % (stainless steel stent) to 1.0 % (nitinol stent). Negligible dose effects were also observed on the distal surfaces of each stent ranging from - 0.5 % (plastic and stainless steel stents) to 1.0 % (nitinol stent). CONCLUSION Proton radiotherapy dose perturbations caused by stents of varying designs and material composition are negligible. Negligible dose perturbation is in keeping with the inherent advantage of proton therapy over traditional radiotherapy composed of photons - given its relative large mass, protons have little side scatter.
Collapse
Affiliation(s)
- Sujai Jalaj
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States,Corresponding author Sujai Jalaj, MD Division of Gastroenterology, Department of MedicineUniversity of Florida, Jacksonville College of Medicine655 West 8th Street, B0138-C290Jacksonville, FL 32209+1–904–244–2165
| | - Sang Yeob Lee
- Department of Radiation Oncology, University of Florida, Proton Therapy Institute, Jacksonville, Florida, United States
| | - Camille McGaw
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
| | - Bijo K John
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida, Proton Therapy Institute, Jacksonville, Florida, United States
| | - Ziad T Awad
- Department of Surgery, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
| | - James S Scolapio
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
| | - Juan C Munoz
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
| |
Collapse
|
10
|
Primary spinal primitive neuroectodermal tumour: report of two cases mimicking neurofibroma and review of the literature. Neurol Neurochir Pol 2012; 46:480-8. [PMID: 23161193 DOI: 10.5114/ninp.2012.31360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary spinal primitive neuroectodermal tumours (PNETs) are a rare entity. Most of them occur in children and young adults. To date, 47 cases of primary spinal PNET have been reported in the literature. We present two cases of primary spinal PNET. In both cases, the tumours were thoracic extradural ones with intrathoracic extension through intervertebral foramina resembling neurofibroma. These tumours are highly aggressive with rapid growth as evidenced by the short history in both of our cases. Both cases underwent gross total removal of the intraspinal and thoracic components. Postoperatively, both patients underwent cranio-spinal radiotherapy. A review of the literature shows that the overall prognosis of PNETs of the spinal cord is very poor even with adequate surgery, radiotherapy and chemotherapy. One patient died after 4 months and the other one is still alive 8 months after surgery, radiotherapy and chemotherapy.
Collapse
|
11
|
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) are rare tumors. Most of these tumors occur in children and young adults. To date, 47 cases of primary spinal PNET have been reported in the literature. These tumors are highly aggressive with rapid growth. Review of the literature shows that the overall prognosis of PNETs of spinal cord is very poor even with adequate surgery, radiotherapy and chemotherapy. All the cases reported to date are reviewed in terms of surgical treatment, adjuvant therapy and outcome and the experience with two of these cases are described. Both cases were thoracic extradural ones with intrathoracic extension through intervertebral foramina resembling neurofibroma. Both cases underwent gross total removal of intraspinal and thoracic component. Post-operatively both underwent cranio-spinal radiotherapy. One patient died after a post-operative period of 4 months and the other one is still alive 8 months after surgery, radiotherapy and chemotherapy.
Collapse
Affiliation(s)
- Ashis Patnaik
- Department of Neurosurgery, SCB Medical College & Hospital, Cuttack, Odisha, India.
| | | | | | | |
Collapse
|
12
|
Saeedinia S, Nouri M, Alimohammadi M, Moradi H, Amirjamshidi A. Primary spinal extradural Ewing's sarcoma (primitive neuroectodermal tumor): Report of a case and meta-analysis of the reported cases in the literature. Surg Neurol Int 2012; 3:55. [PMID: 22629492 PMCID: PMC3356992 DOI: 10.4103/2152-7806.96154] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 03/22/2012] [Indexed: 11/25/2022] Open
Abstract
Background: Primary spinal primitive neuroectodermal tumors (PNET) and/or spinal extraskeletal Ewing's sarcoma family tumors (ESET) are rare lesions appearing in the spinal extradural space. One hundred forty-one primary spinal PNETs, including 29 intramedullary lesions, have been reported in the literature. Encountering a case of primary epidural EES/peripheral PNET (pPNET) in sacral level, which is the fifth one occurring at this level in the literature, we have tried to conduct a meta-analysis of the reported cases. Case Description: A 44-year-old lady with epidural EES/pPNET is reported here. She was once operated for L5/S1 herniated disc, which did not ameliorate her symptoms. The clinical, imaging, surgical, and histopathologic characteristics of our case are presented and wide search of the literature is also done. All the reports were level 3 or less evidences and most of the series had missing parts. 106 cases of primary intraspinal (extradural/extramedullary-intradural) EES/pPNET and 29 cases of primary intramedullary PNET (CNS-PNET) have been reported in the literature. The most common clinical presentation in both entities was muscle weakness proportionate to the tumor location. Distant metastasis occurred in 38 of 99 (38%) cases of primary intraspinal EES/pPNET, while the rate of metastasis was 48% in patients with PNETs occurring in the intramedullary region (P > 0.05). One-year survival rate of the patients who underwent chemo-radiation after total or subtotal resection was better than those who did not receive chemotherapy or radiotherapy, or did not have total or subtotal resection. However, this difference was not repeated in 2-year survival rate in any of the tumor groups. Conclusion: It seems that total or subtotal removal of the tumor and adjuvant chemo- and radiation therapy can improve the outcome in these patients.
Collapse
Affiliation(s)
- Saeed Saeedinia
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | |
Collapse
|
13
|
Yan Y, Xu T, Chen J, Hu G, Lu Y. Intraspinal Ewing's sarcoma/primitive neuroectodermal tumors. J Clin Neurosci 2011; 18:601-6. [PMID: 21414790 DOI: 10.1016/j.jocn.2010.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 09/15/2010] [Accepted: 09/22/2010] [Indexed: 10/18/2022]
Abstract
Intraspinal Ewing's sarcoma (ES) and primitive neuroectodermal tumors (PNET) are very rare, and the characteristics and prognoses of the disease remain unclear. We present an illustrative patient with an intradural, extramedullary PNET arising within the cervical spinal canal, with clinical and radiological manifestations of leptomeningeal spread, and review the reports of a further 77 patients with intraspinal ES/PNET. Cox regression analyses showed that tumor location (extradural, intradural) (p=0.002, RR=4.217, 95% confidence interval [CI] 1.668-10.664) and spinal segment location (cervical, thoracic, lumbar, or sacral) (p=0.017, RR=2.040, 95% CI 1.133-3.673) were independent factors in the prognosis of intraspinal ES/PNET. We concluded that a peripheral PNET may originate within the spinal canal and exhibit leptomeningeal spread similar to that seen in central PNET, and that a patient with an intradural ES/PNET high in the spinal canal is more likely to have a poor prognosis.
Collapse
Affiliation(s)
- Yong Yan
- Department of Neurosurgery, Changzheng Hospital, Neurosurgery Research Institution of Shanghai, 415 Fengyang Street, Huangpu District, Shanghai 200003, China
| | | | | | | | | |
Collapse
|
14
|
Ellis JA, Rothrock RJ, Moise G, McCormick PC, Tanji K, Canoll P, Kaiser MG, McCormick PC. Primitive neuroectodermal tumors of the spine: a comprehensive review with illustrative clinical cases. Neurosurg Focus 2011; 30:E1. [PMID: 21194274 DOI: 10.3171/2010.10.focus10217] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) are uncommon malignancies that are increasingly reported in the literature. Spinal PNETs, like their cranial counterparts, are aggressive tumors and patients with these tumors typically have short survival times despite maximal surgery, chemotherapy, and radiation. Because no standard management guidelines exist for treating these tumors, a multitude of therapeutic strategies have been employed with varying success. In this study the authors perform a comprehensive review of the literature on primary spinal PNETs and provide 2 new cases that highlight the salient features of their clinical management.
Collapse
Affiliation(s)
- Jason A Ellis
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York, USA.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Fogliata A, Bergström S, Cafaro I, Clivio A, Cozzi L, Dipasquale G, Hållström P, Mancosu P, Navarria P, Nicolini G, Parietti E, Pesce GA, Richetti A, Scorsetti M, Vanetti E, Weber DC. Cranio-spinal irradiation with volumetric modulated arc therapy: A multi-institutional treatment experience. Radiother Oncol 2011; 99:79-85. [PMID: 21421273 DOI: 10.1016/j.radonc.2011.01.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 01/26/2011] [Accepted: 01/31/2011] [Indexed: 11/27/2022]
|
16
|
Alexander HS, Koleda C, Hunn MK. Peripheral Primitive Neuroectodermal Tumour (pPNET) in the cervical spine. J Clin Neurosci 2009; 17:259-61. [PMID: 20036553 DOI: 10.1016/j.jocn.2009.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 05/06/2009] [Indexed: 11/18/2022]
Abstract
Primary spinal primitive neuroectodermal tumours are rare. We present a 45-year-old man with a peripheral primitive neuroectodermal tumour arising in the cervical spine. We believe this to be the first report of this type of tumour in the cervical spine.
Collapse
MESH Headings
- Anti-Inflammatory Agents/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Cervical Vertebrae/pathology
- Cervical Vertebrae/surgery
- Decompression, Surgical
- Dura Mater/pathology
- Dura Mater/surgery
- Gadolinium
- Humans
- Laminectomy
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neoplasm Recurrence, Local/complications
- Neoplasm Recurrence, Local/radiotherapy
- Neuroectodermal Tumors, Primitive, Peripheral/complications
- Neuroectodermal Tumors, Primitive, Peripheral/pathology
- Neuroectodermal Tumors, Primitive, Peripheral/physiopathology
- Neurosurgical Procedures
- Palliative Care
- Peripheral Nervous System Neoplasms/complications
- Peripheral Nervous System Neoplasms/pathology
- Peripheral Nervous System Neoplasms/physiopathology
- Prognosis
- Quadriplegia/etiology
- Spinal Canal/pathology
- Spinal Canal/surgery
- Spinal Cord/pathology
- Spinal Cord/physiopathology
- Spinal Cord/surgery
- Spinal Cord Compression/etiology
- Spinal Cord Compression/pathology
- Spinal Cord Compression/physiopathology
- Spinal Nerve Roots/pathology
- Spinal Nerve Roots/physiopathology
- Spinal Nerve Roots/surgery
- Steroids/therapeutic use
- Subdural Space/pathology
- Subdural Space/surgery
- Survival Rate/trends
Collapse
Affiliation(s)
- H S Alexander
- Capital and Coast District Health Board, Newtown, Wellington 6021, New Zealand.
| | | | | |
Collapse
|
17
|
Hrabálek L, Kalita O, Svebisova H, Ehrmann J, Hajduch M, Trojanec R, Kala M. Dumbbell-shaped peripheral primitive neuroectodermal tumor of the spine--case report and review of the literature. J Neurooncol 2008; 92:211-7. [PMID: 19050994 DOI: 10.1007/s11060-008-9744-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 11/17/2008] [Indexed: 10/21/2022]
Abstract
Primary spinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare. Here, we present a case study of a 29-year-old male with a dumbbell-shaped pPNET at the T9-10 spine level, including details of his examination, surgical procedures applied, histological and genetic findings, and his subsequent treatment. We discuss the clinical course, the pathology and treatment for this disease, the surgical approach to thoracic dumbbell tumors and we review the literature. To our knowledge, this is the first report of a case of a dumbbell-shaped intradural and spinal peripheral PNET.
Collapse
|
18
|
Ozdemir N, Usta G, Minoglu M, Erbay AM, Bezircioglu H, Tunakan M. Primary primitive neuroectodermal tumor of the lumbar extradural space. J Neurosurg Pediatr 2008; 2:215-21. [PMID: 18759606 DOI: 10.3171/ped/2008/2/9/215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary spinal primitive neuroectodermal tumors (PNETs) of the extradural space are very rare; only 10 cases have been reported in the English language literature. The histopathological diagnosis of primary spinal PNETs has been discussed for many years. These tumors have a rapidly progressive course, and there is no current consensus on the optimal therapeutic approach for these patients. The authors present a case of primary PNET located in the lumbar extradural space in a 13-year-old girl and report the clinical, radiological, histopathological, and surgical findings. They compare their findings with those from the other 10 cases reported in the literature and review relevant literature.
Collapse
Affiliation(s)
- Nail Ozdemir
- Department of Neurosurgery, Izmir Ataturk Training and Research Hospital, Narlidere-Izmir, Turkey.
| | | | | | | | | | | |
Collapse
|
19
|
Parker W, Filion E, Roberge D, Freeman CR. Intensity-Modulated Radiotherapy for Craniospinal Irradiation: Target Volume Considerations, Dose Constraints, and Competing Risks. Int J Radiat Oncol Biol Phys 2007; 69:251-7. [PMID: 17707279 DOI: 10.1016/j.ijrobp.2007.04.052] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 04/23/2007] [Accepted: 04/24/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE To report the results of an analysis of dose received to tissues and organs outside the target volume, in the setting of spinal axis irradiation for the treatment of medulloblastoma, using three treatment techniques. METHODS AND MATERIALS Treatment plans (total dose, 23.4 Gy) for a standard two-dimensional (2D) technique, a three-dimensional (3D) technique using a 3D imaging-based target volume, and an intensity-modulated radiotherapy (IMRT) technique, were compared for 3 patients in terms of dose-volume statistics for target coverage, as well as organ at risk (OAR) and overall tissue sparing. RESULTS Planning target volume coverage and dose homogeneity was superior for the IMRT plans for V(95%) (IMRT, 100%; 3D, 96%; 2D, 98%) and V(107%) (IMRT, 3%; 3D, 38%; 2D, 37%). In terms of OAR sparing, the IMRT plan was better for all organs and whole-body contour when comparing V(10Gy), V(15Gy), and V(20Gy). The 3D plan was superior for V(5Gy) and below. For the heart and liver in particular, the IMRT plans provided considerable sparing in terms of V(10Gy) and above. In terms of the integral dose, the IMRT plans were superior for liver (IMRT, 21.9 J; 3D, 28.6 J; 2D, 38.6 J) and heart (IMRT, 9 J; 3D, 14.1J; 2D, 19.4 J), the 3D plan for the body contour (IMRT, 349 J; 3D, 337 J; 2D, 555 J). CONCLUSIONS Intensity-modulated radiotherapy is a valid treatment option for spinal axis irradiation. We have shown that IMRT results in sparing of organs at risk without a significant increase in integral dose.
Collapse
Affiliation(s)
- William Parker
- Department of Medical Physics, McGill University Health Centre, Montréal, QC, Canada.
| | | | | | | |
Collapse
|
20
|
Olsen DR, Bruland OS, Frykholm G, Norderhaug IN. Proton therapy - a systematic review of clinical effectiveness. Radiother Oncol 2007; 83:123-32. [PMID: 17499374 DOI: 10.1016/j.radonc.2007.03.001] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 02/22/2007] [Accepted: 03/01/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Proton therapy is an emerging treatment modality for cancer that may have distinct advantages over conventional radiotherapy. This relates to its ability to confine the high-dose treatment area to the tumour volume and thus minimizing radiation dose to surrounding normal tissue. Several proton facilities are currently operating or under planning world-wide - in the United States, Asia and Europe. Until now no systematic review assessing the clinical effectiveness of this treatment modality has been published. MATERIALS AND METHODS A systematic review of published studies that investigated clinical efficacy of proton therapy of cancer. RESULTS We included 54 publications: 4 randomized controlled trials (RCTs) reported in 5 publications, 5 comparative studies and 44 case series. Two RCTs addressed proton irradiation as a boost following conventional radiation therapy for prostate cancer, where one demonstrated improved biochemical local control for the highest dose group without increased serious complication rates. Proton therapy has been used to treat a large number of patients with ocular tumours, but except for one low quality RCT, no proper comparison with other treatment alternatives has been undertaken. Proton therapy offers the option to deliver higher radiation doses and/or better confinement of the treatment of intracranial tumours in children and adults, but reported studies are heterogeneous in design and do not allow for strict conclusions. CONCLUSION The evidence on clinical efficacy of proton therapy relies to a large extent on non-controlled studies, and thus is associated with low level of evidence according to standard heath technology assessment and evidence based medicine criteria.
Collapse
Affiliation(s)
- Dag Rune Olsen
- Rikshospitalet-Radiumhospitalet Medical Center, University of Oslo, Oslo, Norway.
| | | | | | | |
Collapse
|
21
|
Perry R, Gonzales I, Finlay J, Zacharoulis S. Primary peripheral primitive neuroectodermal tumors of the spinal cord: report of two cases and review of the literature. J Neurooncol 2007; 81:259-64. [PMID: 17203398 DOI: 10.1007/s11060-006-9178-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 04/10/2006] [Indexed: 10/23/2022]
Abstract
Primary intraspinal peripheral primitive neuroectodermal tumors (pPNETs) are extremely rare tumors with only seven reported cases in the literature. The histopathologic diagnosis of this tumor is complex and has led to a variety of treatment approaches. The distinction between central and peripheral type primary spinal cord PNETs has not always been made in the literature, leading to a paucity of data in this disease. We present here two young patients with primary intraspinal pPNET, their treatment and outcome. The first patient, a 27 year old male, presented with an intradural mass extending from L2 through L5, after multiple relapses, he is currently alive with disease after 72 months, the longest survival yet reported. The second patient, a 16 year old female, presented with an intradural mass at the cauda equina from L2 through L5, and is currently alive with responsive disease at 5 months after initial diagnosis. Here, we discuss the clinical course, the pathology and treatment for this disease and review the literature.
Collapse
Affiliation(s)
- R Perry
- Department of Pediatric Hematology/Oncology Childrens Hospital Los Angeles, University of Southern California, Keck School of Medicine, 4650 Sunset #54, Los Angeles, CA, 90027, USA.
| | | | | | | |
Collapse
|