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Dietvorst S, Narayan A, Agbor C, Hennigan D, Gorodezki D, Bianchi F, Mallucci C, Frassanito P, Padayachy L, Schuhmann MU. Role of intraoperative ultrasound and MRI to aid grade of resection of pediatric low-grade gliomas: accumulated experience from 4 centers. Childs Nerv Syst 2024:10.1007/s00381-024-06532-3. [PMID: 39012356 DOI: 10.1007/s00381-024-06532-3] [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: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE Pediatric low-grade gliomas (pLGG) are the most common brain tumors in children and achieving complete resection (CR) in pLGG is the most important prognostic factor. There are multiple intraoperative tools to optimize the extent of resection (EOR). This article investigates and discusses the role of intraoperative ultrasound (iUS) and intraoperative magnetic resonance imaging (iMRI) in the surgical treatment of pLGG. METHODS The tumor registries at Tuebingen, Rome and Pretoria were searched for pLGG with the use of iUS and data on EOR. The tumor registries at Liverpool and Tuebingen were searched for pLGG with the use of iMRI where preoperative CR was the surgical intent. Different iUS and iMRI machines were used in the 4 centers. RESULTS We included 111 operations which used iUS and 182 operations using iMRI. Both modalities facilitated intended CR in hemispheric supra- and infratentorial location in almost all cases. In more deep-seated tumor location like supratentorial midline tumors, iMRI has advantages over iUS to visualize residual tumor. Functional limitations limiting CR arising from eloquent involved or neighboring brain tissue apply to both modalities in the same way. In the long-term follow-up, both iUS and iMRI show that achieving a complete resection on intraoperative imaging significantly lowers recurrence of disease (chi-square test, p < 0.01). CONCLUSION iUS and iMRI have specific pros and cons, but both have been proven to improve achieving CR in pLGG. Due to advances in image quality, cost- and time-efficiency, and efforts to improve the user interface, iUS has emerged as the most accessible surgical adjunct to date to aid and guide tumor resection. Since the EOR has the most important effect on long-term outcome and disease control of pLGG in most locations, we strongly recommend taking all possible efforts to use iUS in any surgery, independent of intended resection extent and iMRI if locally available.
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Affiliation(s)
- Sofie Dietvorst
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Eaton Road, Liverpool, L12 2AP, UK.
| | - Armen Narayan
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - Cyril Agbor
- Brain Tumor and Translational Neuroscience Centre, Department of Neurosurgery, University of Pretoria, Pretoria, South Africa
| | - Dawn Hennigan
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Eaton Road, Liverpool, L12 2AP, UK
| | - David Gorodezki
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Tuebingen, Germany
| | - Federico Bianchi
- Pediatric Neurosurgery, Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Eaton Road, Liverpool, L12 2AP, UK
| | - Paolo Frassanito
- Pediatric Neurosurgery, Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Llewellyn Padayachy
- Brain Tumor and Translational Neuroscience Centre, Department of Neurosurgery, University of Pretoria, Pretoria, South Africa
- Pediatric Neurosurgery Unit, Department of Neurosurgery, Steve Biko Academic Hospital Pretoria, Pretoria, South Africa
| | - Martin Ulrich Schuhmann
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany
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Gan HW, Morillon P, Albanese A, Aquilina K, Chandler C, Chang YC, Drimtzias E, Farndon S, Jacques TS, Korbonits M, Kuczynski A, Limond J, Robinson L, Simmons I, Thomas N, Thomas S, Thorp N, Vargha-Khadem F, Warren D, Zebian B, Mallucci C, Spoudeas HA. National UK guidelines for the management of paediatric craniopharyngioma. Lancet Diabetes Endocrinol 2023; 11:694-706. [PMID: 37549682 DOI: 10.1016/s2213-8587(23)00162-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 08/09/2023]
Abstract
Although rare, craniopharyngiomas constitute up to 80% of tumours in the hypothalamic-pituitary region in childhood. Despite being benign, the close proximity of these tumours to the visual pathways, hypothalamus, and pituitary gland means that both treatment of the tumour and the tumour itself can cause pronounced long-term neuroendocrine morbidity against a background of high overall survival. To date, the optimal management strategy for these tumours remains undefined, with practice varying between centres. In light of these discrepancies, as part of a national endeavour to create evidence-based and consensus-based guidance for the management of rare paediatric endocrine tumours in the UK, we aimed to develop guidelines, which are presented in this Review. These guidelines were developed under the auspices of the UK Children's Cancer and Leukaemia Group and the British Society for Paediatric Endocrinology and Diabetes, with the oversight and endorsement of the Royal College of Paediatrics and Child Health using Appraisal of Guidelines for Research & Evaluation II methodology to standardise care for children and young people with craniopharyngiomas.
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Affiliation(s)
- Hoong-Wei Gan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK.
| | - Paul Morillon
- King's College Hospital NHS Foundation Trust, London, UK
| | - Assunta Albanese
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kristian Aquilina
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chris Chandler
- King's College Hospital NHS Foundation Trust, London, UK
| | - Yen-Ching Chang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Evangelos Drimtzias
- St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah Farndon
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Thomas S Jacques
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Márta Korbonits
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adam Kuczynski
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jennifer Limond
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Louise Robinson
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian Simmons
- St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Thomas
- King's College Hospital NHS Foundation Trust, London, UK
| | - Sophie Thomas
- Nottingham Children's Hospital, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Thorp
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, UK
| | - Faraneh Vargha-Khadem
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Daniel Warren
- St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Bassel Zebian
- King's College Hospital NHS Foundation Trust, London, UK
| | - Conor Mallucci
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Comparison of intraoperative and post-operative 3-T MRI performed at 24-72 h following brain tumour resection in children. Neuroradiology 2021; 63:1367-1376. [PMID: 33629130 DOI: 10.1007/s00234-021-02671-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Intraoperative MRI (ioMRI) is a valuable tool aiding paediatric brain tumour resection. There is no published evidence comparing the effectiveness of the final intraoperative MRI and early post-operative (24-72 h) MRI as baseline scans following brain tumour resection. We aimed to evaluate whether the final ioMRI scan could serve as the post-operative baseline scan after paediatric brain tumour resections. METHODS This prospective study compared the final ioMRI scan with the immediate post-operative MRI scan performed 24-72 h post-surgery. We included 20 patients aged 6.6-21 years undergoing brain tumour resection using ioMRI and were suitable for MRI scan without general anaesthesia. The scans were independently evaluated by experienced local and external paediatric neuroradiologists. Identical sequences in the final ioMRI and the 24-72-h MRI were compared to assess the extent of resection, imaging characteristics of residual tumour, the surgical field, extent of surgically induced contrast enhancement, and diffusion abnormalities. RESULTS In 20 patients undergoing intraoperative and early post-operative MRI, there was no difference between ioMRI and 24-72-h post-op scans in identifying residual tumour. Surgically induced contrast enhancement was similar in both groups. There were more abnormalities on diffusion imaging and a greater degree of oedema around the surgical cavity on the 24-72-h scan. CONCLUSION The final 3-T ioMRI scan may be used as a baseline post-operative scan provided standard imaging guidelines are followed and is evaluated jointly by the operating neurosurgeon and neuroradiologist. Advantages of final ioMRI as a baseline scan are identified.
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Novak J, Zarinabad N, Rose H, Arvanitis T, MacPherson L, Pinkey B, Oates A, Hales P, Grundy R, Auer D, Gutierrez DR, Jaspan T, Avula S, Abernethy L, Kaur R, Hargrave D, Mitra D, Bailey S, Davies N, Clark C, Peet A. Classification of paediatric brain tumours by diffusion weighted imaging and machine learning. Sci Rep 2021; 11:2987. [PMID: 33542327 PMCID: PMC7862387 DOI: 10.1038/s41598-021-82214-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/12/2021] [Indexed: 01/23/2023] Open
Abstract
To determine if apparent diffusion coefficients (ADC) can discriminate between posterior fossa brain tumours on a multicentre basis. A total of 124 paediatric patients with posterior fossa tumours (including 55 Medulloblastomas, 36 Pilocytic Astrocytomas and 26 Ependymomas) were scanned using diffusion weighted imaging across 12 different hospitals using a total of 18 different scanners. Apparent diffusion coefficient maps were produced and histogram data was extracted from tumour regions of interest. Total histograms and histogram metrics (mean, variance, skew, kurtosis and 10th, 20th and 50th quantiles) were used as data input for classifiers with accuracy determined by tenfold cross validation. Mean ADC values from the tumour regions of interest differed between tumour types, (ANOVA P < 0.001). A cut off value for mean ADC between Ependymomas and Medulloblastomas was found to be of 0.984 × 10−3 mm2 s−1 with sensitivity 80.8% and specificity 80.0%. Overall classification for the ADC histogram metrics were 85% using Naïve Bayes and 84% for Random Forest classifiers. The most commonly occurring posterior fossa paediatric brain tumours can be classified using Apparent Diffusion Coefficient histogram values to a high accuracy on a multicentre basis.
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Affiliation(s)
- Jan Novak
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham, UK.,Aston Neuroscience Institute, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Niloufar Zarinabad
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Heather Rose
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Theodoros Arvanitis
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Lesley MacPherson
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Benjamin Pinkey
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Adam Oates
- Radiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Patrick Hales
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Richard Grundy
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Dorothee Auer
- Sir Peter Mansfield Imaging Centre, University of Nottingham Biomedical Research Centre, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Daniel Rodriguez Gutierrez
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.,Medical Physics, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Tim Jaspan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK.,Neuroradiology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Laurence Abernethy
- Department of Radiology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Ramneek Kaur
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Darren Hargrave
- Haematology and Oncology Department, Great Ormond Street Children's Hospital, London, UK
| | - Dipayan Mitra
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Nigel Davies
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Radiation Protection Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christopher Clark
- Developmental Imaging & Biophysics Section, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, School of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,Oncology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
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Shankar A, Bomanji J, Hyare H. Hybrid PET-MRI Imaging in Paediatric and TYA Brain Tumours: Clinical Applications and Challenges. J Pers Med 2020; 10:jpm10040218. [PMID: 33182433 PMCID: PMC7711629 DOI: 10.3390/jpm10040218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Standard magnetic resonance imaging (MRI) remains the gold standard for brain tumour imaging in paediatric and teenage and young adult (TYA) patients. Combining positron emission tomography (PET) with MRI offers an opportunity to improve diagnostic accuracy. (2) Method: Our single-centre experience of 18F-fluorocholine (FCho) and 18fluoro-L-phenylalanine (FDOPA) PET–MRI in paediatric/TYA neuro-oncology patients is presented. (3) Results: Hybrid PET–MRI shows promise in the evaluation of gliomas and germ cell tumours in (i) assessing early treatment response and (ii) discriminating tumour from treatment-related changes. (4) Conclusions: Combined PET–MRI shows promise for improved diagnostic and therapeutic assessment in paediatric and TYA brain tumours.
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Affiliation(s)
- Ananth Shankar
- Children and Young People’s Cancer Services, University College London hospitals NHS Foundation Trust, London NW1 2PG, UK
- Correspondence: ; Tel.: +44-20-3447-9950
| | - Jamshed Bomanji
- Department of Nuclear Medicine, University College London hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Harpreet Hyare
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London WC1N 3BG, UK
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Wilson SR, Shinde S, Appleby I, Boscoe M, Conway D, Dryden C, Ferguson K, Gedroyc W, Kinsella SM, Nathanson MH, Thorne J, White M, Wright E. Guidelines for the safe provision of anaesthesia in magnetic resonance units 2019. Anaesthesia 2019; 74:638-650. [DOI: 10.1111/anae.14578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 01/02/2023]
Affiliation(s)
- S. R. Wilson
- Department of Neuro‐anaesthesia and Neurocritical Care National Hospital for Neurology and Neurosurgery LondonUK and Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland (Co‐Chair)
| | - S. Shinde
- Department of Anaesthesia North Bristol NHS Trust BristolUK and Vice President, Association of Anaesthetists (Co‐Chair)
| | - I. Appleby
- Department of Neuro‐anaesthesia and Neurocritical Care National Hospital for Neurology and Neurosurgery LondonUK and Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland
| | - M. Boscoe
- Royal College of Anaesthetists LondonUK and Society of Anaesthetists in Radiology
| | - D. Conway
- Department of Anaesthesia Chelsea and Westminster Hospital LondonUK and Trainee Committee, Association of Anaesthetists
| | - C. Dryden
- Jackson Rees Department of Paediatric Anaesthesia Alder Hey Children's Hospital LiverpoolUK and Association of Paediatric Anaesthetists of Great Britain and Ireland
| | - K. Ferguson
- Department of Anaesthesia Aberdeen Royal Infirmary Aberdeen UK and Association of Anaesthetists Safety Representative
| | - W. Gedroyc
- Imperial College LondonUK and Royal College of Radiologists
| | - S. M. Kinsella
- Department of Anaesthesia St Michaels Hospital BristolUK and Editor, Anaesthesia
| | - M. H. Nathanson
- Department of Anaesthesia Nottingham University Hospital NottinghamUK and Immediate Past Honorary Secretary, Association of Anaesthetists
| | - J. Thorne
- Department of Neurosurgery Salford Royal Foundation Trust SalfordUK and Society of British Neurological Surgeons
| | | | - E. Wright
- Jackson Rees Department of Paediatric Anaesthesia Alder Hey Children's Hospital Liverpool UK
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7
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Stevens SP, Main C, Bailey S, Pizer B, English M, Phillips R, Peet A, Avula S, Wilne S, Wheatley K, Kearns PR, Wilson JS. The utility of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with low-grade central nervous system (CNS) tumours: a systematic review. J Neurooncol 2018; 139:507-522. [PMID: 29948767 PMCID: PMC6132973 DOI: 10.1007/s11060-018-2901-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is routinely used as a surveillance tool to detect early asymptomatic tumour recurrence with a view to improving patient outcomes. This systematic review aimed to assess its utility in children with low-grade CNS tumours. METHODS Using standard systematic review methods, twelve databases were searched up to January 2017. RESULTS Seven retrospective case series studies (n = 370 patients) were included, with average follow-up ranging from 5.6 to 7 years. No randomised controlled trials (RCTs) were identified. Due to study heterogeneity only a descriptive synthesis could be undertaken. Imaging was most frequent in the first year post-surgery (with 2-4 scans) reducing to around half this frequency in year two and annually thereafter for the duration of follow-up. Diagnostic yield ranged from 0.25 to 2%. Recurrence rates ranged from 5 to 41%, with most recurrences asymptomatic (range 65-100%). Collectively, 56% of recurrences had occurred within the first year post-treatment (46% in the first 6-months), 68% by year two and 90% by year five. Following recurrence, 90% of patients underwent treatment changes, mainly repeat surgery (72%). Five-year OS ranged from 96 to 100%, while five-year recurrence-free survival ranged from 67 to 100%. None of the studies reported quality of life measures. CONCLUSION This systematic review highlights the paucity of evidence currently available to assess the utility of MRI surveillance despite it being routine clinical practice and costly to patients, their families and healthcare systems. This needs to be evaluated within the context of an RCT.
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Affiliation(s)
- Simon P Stevens
- 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
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Martin English
- Birmingham Women and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Shivaram Avula
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Keith Wheatley
- 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 and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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