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Dias SF, Richards O, Elliot M, Chumas P. Pediatric-Like Brain Tumors in Adults. Adv Tech Stand Neurosurg 2024; 50:147-183. [PMID: 38592530 DOI: 10.1007/978-3-031-53578-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Pediatric brain tumors are different to those found in adults in pathological type, anatomical site, molecular signature, and probable tumor drivers. Although these tumors usually occur in childhood, they also rarely present in adult patients, either as a de novo diagnosis or as a delayed recurrence of a pediatric tumor in the setting of a patient that has transitioned into adult services.Due to the rarity of pediatric-like tumors in adults, the literature on these tumor types in adults is often limited to small case series, and treatment decisions are often based on the management plans taken from pediatric studies. However, the biology of these tumors is often different from the same tumors found in children. Likewise, adult patients are often unable to tolerate the side effects of the aggressive treatments used in children-for which there is little or no evidence of efficacy in adults. In this chapter, we review the literature and summarize the clinical, pathological, molecular profile, and response to treatment for the following pediatric tumor types-medulloblastoma, ependymoma, craniopharyngioma, pilocytic astrocytoma, subependymal giant cell astrocytoma, germ cell tumors, choroid plexus tumors, midline glioma, and pleomorphic xanthoastrocytoma-with emphasis on the differences to the adult population.
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Affiliation(s)
- Sandra Fernandes Dias
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Division of Pediatric Neurosurgery, University Children's Hospital of Zurich - Eleonor Foundation, Zurich, Switzerland
| | - Oliver Richards
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Martin Elliot
- Department of Paediatric Oncology and Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Ntenti C, Lallas K, Papazisis G. Clinical, Histological, and Molecular Prognostic Factors in Childhood Medulloblastoma: Where Do We Stand? Diagnostics (Basel) 2023; 13:diagnostics13111915. [PMID: 37296767 DOI: 10.3390/diagnostics13111915] [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: 03/30/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
Medulloblastomas, highly aggressive neoplasms of the central nervous system (CNS) that present significant heterogeneity in clinical presentation, disease course, and treatment outcomes, are common in childhood. Moreover, patients who survive may be diagnosed with subsequent malignancies during their life or could develop treatment-related medical conditions. Genetic and transcriptomic studies have classified MBs into four subgroups: wingless type (WNT), Sonic Hedgehog (SHH), Group 3, and Group 4, with distinct histological and molecular profiles. However, recent molecular findings resulted in the WHO updating their guidelines and stratifying medulloblastomas into further molecular subgroups, changing the clinical stratification and treatment management. In this review, we discuss most of the histological, clinical, and molecular prognostic factors, as well the feasibility of their application, for better characterization, prognostication, and treatment of medulloblastomas.
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Affiliation(s)
- Charikleia Ntenti
- First Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Konstantinos Lallas
- Department of Medical Oncology, School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
| | - Georgios Papazisis
- Clinical Research Unit, Special Unit for Biomedical Research and Education (BRESU), School of Medicine, Aristotle University of Thessaloniki, 54621 Thessaloniki, Greece
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Liu X, Li J, Hao X, Sun H, Zhang Y, Zhang L, Jia L, Tian Y, Sun W. LC–MS-Based Urine Metabolomics Analysis for the Diagnosis and Monitoring of Medulloblastoma. Front Oncol 2022; 12:949513. [PMID: 35936679 PMCID: PMC9353006 DOI: 10.3389/fonc.2022.949513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Medulloblastoma (MB) is the most common type of brain cancer in pediatric patients. Body fluid biomarkers will be helpful for clinical diagnosis and treatment. In this study, liquid chromatography–mass spectrometry (LC–MS)-based metabolomics was used to identify specific urine metabolites of MB in a cohort, including 118 healthy controls, 111 MB patients, 31 patients with malignant brain cancer, 51 patients with benign brain disease, 29 MB patients 1 week postsurgery and 80 MB patients 1 month postsurgery. The results showed an apparent separation for MB vs. healthy controls, MB vs. benign brain diseases, and MB vs. other malignant brain tumors, with AUCs values of 0.947/0.906, 0.900/0.873, and 0.842/0.885, respectively, in the discovery/validation group. Among all differentially identified metabolites, 4 metabolites (tetrahydrocortisone, cortolone, urothion and 20-oxo-leukotriene E4) were specific to MB. The analysis of these 4 metabolites in pre- and postoperative MB urine samples showed that their levels returned to a healthy state after the operation (especially after one month), showing the potential specificity of these metabolites for MB. Finally, the combination of two metabolites, tetrahydrocortisone and cortolone, showed diagnostic accuracy for distinguishing MB from non-MB, with an AUC value of 0.851. Our data showed that urine metabolomics might be used for MB diagnosis and monitoring.
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Affiliation(s)
- Xiaoyan Liu
- Core Instrument Facility, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jing Li
- Core Instrument Facility, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xiaolei Hao
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haidan Sun
- Core Instrument Facility, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Yang Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liwei Zhang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lulu Jia
- Department of Pharmacy, Clinical Research Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- *Correspondence: Wei Sun, ; Yongji Tian, ; Lulu Jia,
| | - Yongji Tian
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Wei Sun, ; Yongji Tian, ; Lulu Jia,
| | - Wei Sun
- Core Instrument Facility, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
- *Correspondence: Wei Sun, ; Yongji Tian, ; Lulu Jia,
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Yamauchi T, Kitai R, Arai H, Kidoguchi M, Isozaki M, Kodera T, Yamauchi T, Kikuta KI. Bevacizumab, irinotecan, and temozolomide with re-irradiation in adult recurrent medulloblastoma: A first case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Quinones MC, Bélanger K, Lemieux Blanchard É, Lemieux B, Bahary JP, Masucci LG, Roberge D, Menard C, Lambert C, Berthelet F, Moumdjian R, Florescu M. Adult Medulloblastoma Demographic, Tumor and Treatment Impact since 2006: A Canadian University Experience. ACTA ACUST UNITED AC 2021; 28:3104-3114. [PMID: 34436037 PMCID: PMC8395420 DOI: 10.3390/curroncol28040271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
Medulloblastoma is an aggressive primary brain tumor that is extremely rare in adults; therefore, prospective studies are limited. We reviewed the information of all MB patients treated at the CHUM between 2006 and 2017. We divided our cohort by age and further divided adult patients (53%) in two groups, those diagnosed between 2006–2012 and 2013–2017. In our adult population, median follow up was 26 months and SHH-activated MB comprised 39% of tumors. Adult 5yOS was 80% and first-line therapy led to a 5yPFS of 77%. The absence of radiosensitizing chemotherapy (100% vs. 50%; p = 0.033) negatively influenced 5yPFS. 96% of adult patients received radiotherapy and 48% of them received concomitant radiosensitizing chemotherapy. Complete surgical resection was performed on 85% of adults, but the extent of resection did not have a discernable impact on survival and did not change with time. Adjuvant chemotherapy did not clearly affect prognosis (5yOS 80% vs. 67%, p = 0.155; 5yPFS 78% vs. 67%, p = 0.114). From 2006–2012, the most common chemotherapy regimen (69%) was Cisplatinum, Lomustine and Vincristine, which was replaced in 2013 by Cisplatinum, Etoposide and Cyclophosphamide (77%) with a trend for worse survival. Nine patients recurred and seven of these (78%) were treated with palliative chemotherapy. In conclusion, we did not identify prognostic demographic or tumor factors in our adult MB population. The presence of radiosensitizing chemotherapy was associated with a more favorable PFS. Cisplatinum, Lomustine and Vincristine regimen might be a better adjuvant chemotherapy regimen.
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Affiliation(s)
| | - Karl Bélanger
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Émilie Lemieux Blanchard
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Bernard Lemieux
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Jean-Paul Bahary
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Laura G. Masucci
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - David Roberge
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Cynthia Menard
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Carole Lambert
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - France Berthelet
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Robert Moumdjian
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Marie Florescu
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
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Abstract
Limited evidence exists regarding the association between dietary calcium intake and risk of glioma. The objective of this study was to determine the relationship between dietary calcium intake and risk of glioma in Iranian adults. In this hospital-based case-control study, we enrolled 128 newly-diagnosed cases of glioma and 256 age- and sex-matched controls. Patients with pathologically confirmed glioma (without any other cancers) were selected. Dietary intakes of study participants were collected through a validated 126-item food-frequency questionnaire. Dietary calcium intake was computed from dairy products in the questionnaire. Participants were categorized into quartiles of dietary calcium intake. Binary logistic regression was used to examine the association between dietary calcium intake and glioma. Higher dietary intake of calcium was associated with younger age, long duration of cell phone use, and frequent canned foods intake. After taking age, sex, and energy intake into account, participants with the greatest dietary calcium intake had 84% lower odds of glioma than those with the lowest intake [odds ratio (OR): 0.16; 95% confidence interval (CI), 0.07-0.37]. Further adjustment for other potential confounders including nutrient intakes did not significantly alter the association (OR: 0.22; 95% CI, 0.08-0.64). Even after additional adjustment for BMI, we found a significant inverse association between dietary calcium intake and odds of glioma (OR: 0.23; 95% CI, 0.08-0.65). We found an inverse protective association between high dietary calcium intake and odds of glioma. Further prospective cohort studies are needed to confirm these findings.
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Real-world data for pediatric medulloblastoma: can we improve outcomes? Eur J Pediatr 2021; 180:127-136. [PMID: 32564147 DOI: 10.1007/s00431-020-03722-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/08/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
Medulloblastoma (MB) is a malignant embryonal tumor that develops especially in childhood, with overall survival (OS) at 5 years of up to 70%. The objective of this study is to analyze treatment delivery variables in a retrospective cohort and evaluate the impact of these treatment quality parameters on survival. From 2000 to 2018, 40 pediatric patients with medulloblastoma, treated according to current international protocols, were retrospectively analyzed. Treatment delivery quality indicators were analyzed including the extent of surgery, radiotherapy (RT) parameters, and chemotherapy variables, related with time and dose-intensity deviations. With a median follow-up of 74 months (range, 6-195), OS at 5 years was 74 ± 7%, 81 ± 8% for standard-risk, and 55 ± 16% for high-risk patients (p = 0.090). Disease-free survival at 5 years was not significantly affected by extent of surgery (p = 0.428) and RT-related variables such as surgery-RT interval (p = 0.776) neither RT duration (p = 0.172) or maintenance chemotherapy compliance (p = 0.634). Multivariate analysis identified risk groups predictive of worse DFS (p = 0.032) and leptomeningeal dissemination associated with inferior OS (p = 0.029).Conclusion: Treatment delivery optimization has improved survival rates of patients with MB. Despite this, in our study, we have not established a clear influence of the considered radiotherapy and chemotherapy treatment quality parameters on outcomes. What is Known: • Improvement in treatment modalities during the last decades has reached a 5-year OS of up to 70% in these patients. • Extent of resection and radiotherapy parameters such as interval between surgery-radiotherapy and radiotherapy duration has been described as probable survival prognostic factors. What is New: • Differences in medulloblastoma survival rates between prospective studies and retrospective series. • The impact on survival of the three main treatment variables, surgery, radiotherapy and chemotherapy, susceptible to improvement.
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Haque W, Verma V, Brian Butler E, Teh BS. Prognostic role of chemotherapy, radiotherapy dose, and extent of surgical resection in adult medulloblastoma. J Clin Neurosci 2020; 76:154-160. [DOI: 10.1016/j.jocn.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/02/2020] [Indexed: 12/31/2022]
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Abstract
AbstractNo study is available that has assessed the association of dietary diversity score (DDS) and alternative healthy eating index (AHEI) with glioma. The present study aimed to assess this association in Iranian adults. Overall, 128 pathologically confirmed cases of glioma were enrolled from hospitals and 256 age- and sex-matched controls were recruited from other wards of the hospital between 2009 and 2011. Dietary assessment was done using a validated block-format 123-item semi-quantitative FFQ. Dietary indices including DDS and AHEI-2010 were constructed according to standard methods. After controlling for potential confounders, a significant inverse association was found between DDS and risk of glioma (OR 0·42, 95 % CI 0·19, 0·94). Such finding was also seen when further adjustment was made for BMI; such that participants in the highest quartile of DDS were 56 % less likely to have glioma compared with those in the lowest quartile (OR 0·44, 95 % CI, 0·20, 0·97). In addition, a significant inverse association was found between adherence to AHEI and glioma; such that in the fully adjusted model, participants in the fourth quartile of AHEI had 74 % lower risk of glioma compared with those in the first quartile (OR 0·26, 95 % CI 0·12, 0·56). In conclusion, we found that greater adherence to the healthy, as measured by AHEI, and diverse, as measured by DDS, diets was associated with decreased odds of glioma.
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Jacob J, Feuvret L, Mazeron JJ, Simon JM, Canova CH, Riet FG, Blais E, Jenny C, Maingon P. Radioterapia dei tumori cerebrali primitivi dell’adulto. Neurologia 2019. [DOI: 10.1016/s1634-7072(18)41587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Nalita N, Ratanalert S, Kanjanapradit K, Chotsampancharoen T, Tunthanathip T. Survival and Prognostic Factors in Pediatric Patients with Medulloblastoma in Southern Thailand. J Pediatr Neurosci 2018; 13:150-157. [PMID: 30090127 PMCID: PMC6057209 DOI: 10.4103/jpn.jpn_111_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The current prognosis of medulloblastoma in children is better because of technological advancements and improvements in treatment strategies and genetic investigations. However, there is a lack of studies that focus on medulloblastoma in Thailand. The aims of our study were to conduct a survival analysis and to identify the prognostic factors of pediatric medulloblastoma. MATERIALS AND METHODS Fifty-five children, with medulloblastoma, were eligible for analysis between 1991 and 2015. We retrospectively reviewed both the clinical and the histological data. Survival curves were constructed using the Kaplan-Meier method. For comparisons of dichotomous factors, between groups, the log-rank test was used to determine survival. The Cox proportional hazard regression model was used to identify the univariate and multivariate survival predictors. RESULTS The mortality rate was 49.1% in this study. The median follow-up time was 68.8 months (range: 1-294 months). The 5-year overall survival rate and median survival time were 53.8% (95% CI 38.7-66.7) and 80 months (95% CI 23-230), respectively. Univariate analysis revealed children <3 years of age, hemispheric tumor location, high risk according to risk stratification, and patients who did not receive radiation therapy affected the prognosis. In multivariable analysis, hemispheric tumors (hazard ratio [HR] 2.54 [95% CI 1.11-5.80]; P = 0.01)and high risk groups (HR 3.86 [95% CI 1.28-11.60]; P = 0.01) influenced death. Finally, using conditional inference trees, the study showed that hemispheric tumor locations are truly aggressive in behavior, whereas risk stratification is associated with the prognosis of midline tumors. CONCLUSIONS Hemispheric medulloblastoma and high-risk groups according to risk stratification were associated with poor prognosis.
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Affiliation(s)
- Navaporn Nalita
- Division of Neurological Surgery, Department of Surgery, Prince of Songkla University, Songkhla, Thailand
| | - Sanguansin Ratanalert
- Division of Neurological Surgery, Department of Surgery, Prince of Songkla University, Songkhla, Thailand
| | - Kanet Kanjanapradit
- Department of Pathology, Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
| | | | - Thara Tunthanathip
- Division of Neurological Surgery, Department of Surgery, Prince of Songkla University, Songkhla, Thailand
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Yoon JH, Park KD, Kang HJ, Kim H, Lee JW, Kim SK, Wang KC, Park SH, Kim IH, Shin HY. Treatment of pediatric average-risk medulloblastoma using craniospinal irradiation less than 2500 cGy and chemotherapy: single center experience in Korea. World J Pediatr 2017; 13:367-373. [PMID: 28550392 DOI: 10.1007/s12519-017-0044-3] [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: 05/16/2016] [Accepted: 09/30/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Although craniospinal irradiation (CSI) of 2340 cGy plus tumor booster with chemotherapy have been established as a standard treatment of childhood average-risk (AvR) medulloblastoma (MBL) in Western counties, there are a few recent reports in outcomes of AvR MBL using this strategy in Korean and other Asian children. We investigated the outcome of the Korean children with AvR MBL who were treated with CSI <2500 cGy and chemotherapy. METHODS Between January 2001 and December 2010, clinical characteristics and outcomes of 42 patients who were diagnosed with AvR MBL postoperatively and treated with radiation including CSI <2500 cGy and chemotherapy in Seoul National University Children's Hospital were analyzed. RESULTS Their median age was 9 years (range: 3-18.8), and 29 were male. Histological subtypes were classic type in 28 patients, nodular/desmoplastic in 7, and large cell/anaplastic (LCA) in 7. All the patients received adjuvant radiotherapy (CSI with median 2340 cGy and booster) and multiagent chemotherapy as the first-line treatment. With a median follow-up of 54 months, 12 patients experienced relapse or progression of the tumor. The 3- and 5-year disease-free survival (DFS) rates were 78.0%±6.5% and 75.0%±6.9%, respectively, and overall survival (OS) rates were 85.3%±5.6% and 76.8%±6.9%, respectively. The LCA subtype was associated with poorer DFS (P=0.023) and OS (P=0.008), compared with non-LCA subtypes. CONCLUSIONS The outcomes of children and adolescents with AvR MBL treated with radiation including CSI <2500 cGy and chemotherapy, are compatible to those in Western countries; however, the LCA subtype has a poor outcome with this strategy.
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Affiliation(s)
- Jong Hyung Yoon
- Department of Pediatrics, Cancer Research Institute, New York, USA.,Department of Pediatrics, Hallym University College of medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Kyung Duk Park
- Department of Pediatrics, Cancer Research Institute, New York, USA
| | - Hyoung Jin Kang
- Department of Pediatrics, Cancer Research Institute, New York, USA
| | - Hyery Kim
- Department of Pediatrics, Cancer Research Institute, New York, USA
| | - Ji Won Lee
- Department of Pediatrics, Cancer Research Institute, New York, USA
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu-Chang Wang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Young Shin
- Department of Pediatrics, Cancer Research Institute, New York, USA. .,Division of Hematology/Oncology, Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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Chevignard M, Câmara-Costa H, Doz F, Dellatolas G. Core deficits and quality of survival after childhood medulloblastoma: a review. Neurooncol Pract 2016; 4:82-97. [PMID: 31385962 DOI: 10.1093/nop/npw013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Medulloblastoma is the most common malignant central nervous system tumor in children. Treatment most often includes surgical resection, craniospinal irradiation, and adjuvant chemotherapy. Although survival has improved dramatically, the tumor and its treatments have devastating long-term side effects that negatively impact quality of survival (QoS). The objective was to review the literature on QoS following childhood medulloblastoma. Methods This narrative review is based on a Medline database search and examination of the reference lists of papers selected. Results Frequent problems after medulloblastoma treatment include medical complications, such as long-term neurological and sensory (hearing loss) impairments; endocrine deficits, including growth problems; and secondary tumors. Neurocognitive impairment is repeatedly reported, with decreasing cognitive performances over time. Although all cognitive domains may be affected, low processing speed, attention difficulties, and working memory difficulties are described as the core cognitive deficits resulting from both cerebellar damage and the negative effect of radiation on white matter development. Long-term psychosocial limitations include low academic achievement, unemployment, and poor community integration with social isolation. Important negative prognostic factors include young age at diagnosis, conventional craniospinal radiotherapy, presence of postoperative cerebellar mutism, and perioperative complications. The influence of environmental factors, such as family background and interventions, remains understudied. Conclusion Future studies should focus on the respective impact of radiation, cerebellar damage, genomic and molecular subgroup parameters, and environmental factors on cognitive and psychosocial outcomes. Long-term (probably lifelong) follow-up into adulthood is required in order to monitor development and implement timely, suitable, multi-disciplinary rehabilitation interventions and special education or support when necessary.
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Affiliation(s)
- Mathilde Chevignard
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
| | - Hugo Câmara-Costa
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
| | - François Doz
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
| | - Georges Dellatolas
- Rehabilitation Department for children with acquired neurological injury, Saint Maurice Hospitals, Saint Maurice, France (M.C.); Sorbonne Universités, UPMC University Paris 06, CNRS UMR 7371, INSERM UMR S 1146, Laboratoire d'Imagerie Biomédicale (LIB), F-75005, Paris, France (M.C.); Groupe de Recherche Clinique Handicap Cognitif et Réadaptation; UPMC Paris 6, Paris, France (M.C.); Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.(H.C.-C, G.D.); Institut Curie and University Paris Descartes, Sorbonne Paris Cité, France (F.D.)
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Faried A, Pribadi MA, Sumargo S, Arifin MZ, Hernowo BS. Adult medulloblastoma: A rare case report and literature review. Surg Neurol Int 2016; 7:S481-4. [PMID: 27512610 PMCID: PMC4960923 DOI: 10.4103/2152-7806.185782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/06/2016] [Indexed: 01/05/2023] Open
Abstract
Background: Medulloblastoma is a highly malignant embryonal tumor which commonly arises in the cerebellum. It is relatively rare and accounts for less than 2% of all primary brain tumors. The tumor primarily occurs in childhood; however, rarely, it may be found in adult population. In addition, medulloblastoma in adult population shows features which are quite distinct from the pediatric group. Case Description: We report the case of a 33-year-old man who presented to our institution with a history of blurred vision of both eyes for 5 months preceded by intermittent headache since the previous year. Preoperative investigation suggested a posterior fossa mass and we suspected an ependymoma. The patient underwent ventriculoperitoneal shunt and craniotomy tumor removal, followed by radiotherapy. Histopathological and immunohistochemical examination were performed, and the results showed a diagnosis of medulloblastoma. Conclusion: This case is exceptional because adult medulloblastoma occurrence in our center is extremely rare, and the diagnosis can only be established through histopathological and immunohistochemical studies.
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Affiliation(s)
- Ahmad Faried
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Muhammad A Pribadi
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Sheila Sumargo
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Muhammad Z Arifin
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Bethy S Hernowo
- Department of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
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15
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Huisman T. Posterior Fossa Tumors in Children: Differential Diagnosis and Advanced Imaging Techniques. Neuroradiol J 2016; 20:449-60. [DOI: 10.1177/197140090702000410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 07/23/2007] [Indexed: 11/16/2022] Open
Affiliation(s)
- T.A.G.M. Huisman
- Department of Diagnostic Imaging, University Children's Hospital Zurich; Zurich, Switzerland
- Department of Pediatric Radiology, Johns Hopkins Hospital; Baltimore, MD, USA
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16
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Adjuvant chemotherapy in adult medulloblastoma: is it an option for average-risk patients? J Neurooncol 2016; 128:235-40. [DOI: 10.1007/s11060-016-2097-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
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17
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[Therapeutic outcomes of medulloblastoma in Casablanca from 2000 to 2012]. Cancer Radiother 2015; 19:718-24. [PMID: 26563873 DOI: 10.1016/j.canrad.2015.05.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 02/05/2015] [Accepted: 05/20/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the therapeutic results, with the aim to contribute to improving the care of patients with medulloblastoma. PATIENTS AND METHODS A retrospective study of 69 cases of medulloblastoma collected in the university hospital Ibn Rochd of Casablanca between 2000 and 2012. RESULTS Fifty-three children with an average age of 9 years and 16 adults with an average age of 32.4 years were included in the study. Thirty-seven children and eight adults suffered from a high-risk tumour. The radiotherapy was received by all patients with a mean dose of 36 Gy to the whole brain and 54 Gy in the posterior fossa. All patients in the paediatric group and 10 patients in the adult group received concomitant chemotherapy, 44 children and four adults received adjuvant chemotherapy. Tumour recurrence was observed in 17 children after a mean follow-up period of 38 months. These recurrences were observed in five adults after a mean follow-up period of 42 months. The posterior fossa was the main site of relapses. Overall survival was 77.7% for the children and 61% for the adults. Overall survival was better (70% versus 25%) when the interval between radiotherapy and surgery was less than 40 days in the paediatric group. The recurrence rate was significantly higher for the high-risk group: 41% versus 13% for the standard risk. In the adult group, overall survival differences according to the risk group were significant (100% for the standard risk versus 37.5% for the high risk). CONCLUSION The overall survival and recurrences rate obtained are encouraging. The risk group and time between surgery and radiotherapy were prognostic factors with significant impact on survival depending on the age group. We recommend reducing these times to improve therapeutic results.
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Wong TT, Liu YL, Ho DMT, Chang KP, Liang ML, Chen HH, Lee YY, Chang FC, Lin SC, Hsu TR, Chen KW, Kwang WK, Hou WY, Wang CY, Yen SH, Guo WY, Chen YW. Factors affecting survival of medulloblastoma in children: the changing concept of management. Childs Nerv Syst 2015; 31:1687-98. [PMID: 26351222 DOI: 10.1007/s00381-015-2884-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/10/2015] [Indexed: 01/21/2023]
Abstract
Medulloblastoma (MB) is a type of malignant tumor arising only in the cerebellum that was first defined by Cushing and Bailey in 1920s. In this review paper, we trace the evolution of risk stratification and the correlated changing concept of management in the past years. Outcome analysis of the hospital series of the Taipei Veterans General Hospital, Cheng Hsin General Hospital, and Taipei Medical University Hospital was performed to correlate prognostic indicators with reported studies. The purpose is to provide clues for age-specific and risk-adjusted optimal, effective, but beneficial and protective treatment strategies of these tumors in children.
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Affiliation(s)
- Tai-Tong Wong
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan.
- Pediatric Neurosurgery, Department of Neurosurgery, Taipei Medical University Hospital, 252 Wuxing St, Taipei, 11031, Taiwan.
| | - Yen-Lin Liu
- Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Donald Ming-Tak Ho
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Kai-Ping Chang
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Muh-Lii Liang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Hsin-Hung Chen
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Yi-Yen Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Shih-Chieh Lin
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Ting-Rong Hsu
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Kuo-Wei Chen
- Department of Internal Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Wei-Kang Kwang
- Department of Pathology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Wu-Yu Hou
- Department of Radiology, Chen Hsin General Hospital, Taipei, Taiwan
| | - Chung-Yih Wang
- Department of Radiation Oncology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Sang-Hue Yen
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wan-You Guo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, Taipei, Taiwan
| | - Yi-Wei Chen
- Department of Oncology, Taipei Veterans General Hospital and National Yang Ming University, School of Medicine, 201 Sec 2 Shi Pai Rd, Taipei, 11217, Taiwan.
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Kocakaya S, Beier CP, Beier D. Chemotherapy increases long-term survival in patients with adult medulloblastoma--a literature-based meta-analysis. Neuro Oncol 2015; 18:408-16. [PMID: 26359208 DOI: 10.1093/neuonc/nov185] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/06/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adult medulloblastoma is a potentially curable malignant entity with an incidence of 0.5-1 per million. Valid data on prognosis, treatment, and demographics are lacking, as most current knowledge stems from retrospective studies. Surgical resection followed by radiotherapy are accepted parts of treatment regimes; however, established prognostic factors and data clarifying the role of chemotherapy are missing. METHODS We investigated 227 publications from 1969-2013, with 907 identifiable, individual patients being available for meta-analysis. Demographic data, risk stratification, and treatment of these patients were similar to previous cohorts. RESULTS The median overall survival (mOS) was 65 months (95% CI: 54.6-75.3) , the 5-year overall survival was 50.9% with 16% of the patients dying more than 5 years after diagnosis. Incomplete resection, clinical and radiological signs for brainstem infiltration, and abstinence from radiotherapy were predictive of worse outcome. Metastatic disease at tumor recurrence was identified as a new prognostic factor, while neither metastasis at initial diagnosis nor desmoplastic/classic histology was correlated with survival. Patients receiving chemotherapy first-line survived significantly longer (mOS: 108 mo, 95% CI: 68.6-148.4) than patients treated with radiation alone (mOS: 57 mo, 95% CI: 39.6-74.4) or patients who received chemotherapy at tumor recurrence. This effect was not biased by tumor stage or decade of treatment. Importantly, (neo)adjuvant chemotherapy also significantly increased the chance for long-term survival (>5 y) compared with radiotherapy alone or chemotherapy at tumor recurrence. CONCLUSIONS This meta-analysis clarifies relevant prognostic factors and suggests that chemotherapy as part of first-line therapy improves overall survival and increases the proportion of patients with long-term survival.
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Affiliation(s)
- Selin Kocakaya
- Department of Neurology, RWTH Aachen, Aachen, Germany (S.K., C.P.B., D.B.); Department of Neurology, University Hospital Odense and Clinical Institute, University of Southern Denmark, Odense, Denmark (C.P.B., D.B.)
| | - Christoph Patrick Beier
- Department of Neurology, RWTH Aachen, Aachen, Germany (S.K., C.P.B., D.B.); Department of Neurology, University Hospital Odense and Clinical Institute, University of Southern Denmark, Odense, Denmark (C.P.B., D.B.)
| | - Dagmar Beier
- Department of Neurology, RWTH Aachen, Aachen, Germany (S.K., C.P.B., D.B.); Department of Neurology, University Hospital Odense and Clinical Institute, University of Southern Denmark, Odense, Denmark (C.P.B., D.B.)
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20
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Zannoni GF, Ciucci A, Marucci G, Travaglia D, Stigliano E, Foschini MP, Scambia G, Gallo D. Sexual dimorphism in medulloblastoma features. Histopathology 2015; 68:541-8. [DOI: 10.1111/his.12770] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/27/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Gian Franco Zannoni
- Department of Histopathology; Catholic University of the Sacred Heart; Rome Italy
| | - Alessandra Ciucci
- Department of Female, Maternal, Newborn, Child and Adolescent Health; Catholic University of the Sacred Heart; Rome Italy
| | - Gianluca Marucci
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM); Section of Pathology ‘M. Malpighi’; Bellaria Hospital; University of Bologna; Bologna Italy
| | - Daniele Travaglia
- Department of Female, Maternal, Newborn, Child and Adolescent Health; Catholic University of the Sacred Heart; Rome Italy
| | - Egidio Stigliano
- Department of Histopathology; Catholic University of the Sacred Heart; Rome Italy
| | - Maria Pia Foschini
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM); Section of Pathology ‘M. Malpighi’; Bellaria Hospital; University of Bologna; Bologna Italy
| | - Giovanni Scambia
- Department of Female, Maternal, Newborn, Child and Adolescent Health; Catholic University of the Sacred Heart; Rome Italy
| | - Daniela Gallo
- Department of Female, Maternal, Newborn, Child and Adolescent Health; Catholic University of the Sacred Heart; Rome Italy
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Zhang N, Ouyang T, Kang H, Long W, Thomas B, Zhu S. Adult medulloblastoma: clinical characters, prognostic factors, outcomes and patterns of relapse. J Neurooncol 2015; 124:255-64. [DOI: 10.1007/s11060-015-1833-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
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Abstract
Background:The purpose of this study was to determine incidence, survival rate, and prognostic factors as well as the frequency of Collins’ Law Violators (CLVs) in an unselected population of medulloblastoma patients. Collins’ Law dictates that ’cure’ of a child with a tumor occurs after a period that includes the child’s age at diagnosis plus 9 months.Methods:Using the Alberta Cancer Registry a population-based review identified 49 patients with medulloblastoma (19 adults, 30 children) diagnosed from 1975-96. Pathology was reviewed in all cases. All patients had surgical resection, followed by radiotherapy in 47 patients and chemotherapy in 17.Results:The overall 5-year survival was 50%. There was a trend for the extent of resection to be associated with a longer survival (Long rank test, p< 0.06) but this was not significant. Tumor recurrence occurred a median of 22.4 months (range, 6.4-192.3) after diagnosis and median survival after recurrence was 9.3 months (range, 0.4-64.9). The survival curve did not appear to plateau but was affected by tumor-related deaths in 3 (21.4%) of the 21 long-term survivors diagnosed in childhood. These three patients had recurrences a mean of 11.7 years after diagnosis and are designated as CLVs.Conclusions:The survival rate in an unselected population of patients with medulloblastoma is poor. Aggressive resection of the tumors prolongs survival. The Collins’ Law Violators were relatively common and we suggest this concept be abandoned in medulloblastoma.
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23
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Gender effect in experimental models of human medulloblastoma: does the estrogen receptor β signaling play a role? PLoS One 2014; 9:e101623. [PMID: 25000562 PMCID: PMC4084991 DOI: 10.1371/journal.pone.0101623] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 05/24/2014] [Indexed: 01/28/2023] Open
Abstract
Background The male-to-female sex ratio for medulloblastoma (MB) is approximately 1.5∶1, female gender being also a favorable prognostic factor. This study aimed at evaluating the impact of gender on MB tumorigenesis. Methods In vitro activity of 17β-estradiol (E2), DPN [2,3-bis(4-hydroxyphenyl)-propionitrile, a selective estrogen receptor β (ERβ)-agonist], PPT [4,4′,4″-(4-Propyl-[1H]-pyrazole-1,3,5-triyl) trisphenol, a selective ERα-agonist] or DHT (5 alpha-dihydrotestosterone) was evaluated in three human MB cell lines. D283 Med cells were transplanted into athymic mice. Results A significant expression of ERβ, with little or no ERα, and low AR (androgen receptor) was found in MB cell lines. The compounds tested did not affect cell proliferation. In vivo, we observed a significantly lower growth of D283 Med in nude female mice compared to males. At microscopic examination, tumors from females showed a shift towards differentiation, as evaluated by lower nestin, and higher NSE (neuron-specific enolase) and GFAP (glial fibrillary acidic protein) expression compared to males. Tumors from females also showed lower Ki67 and p53 expression. The wild-type ERβ protein (ERβ1) was lost in male tumors, while it was a permanent feature in females, and a strong negative correlation was found between Ki67 and ERβ1 expression. Conversely, tumor levels of ERβ2 and ERβ5 did not significantly differ between genders. Increased levels of cyclin-dependent kinase inhibitor p21 were observed in females, suggesting that estrogen may decrease tumor growth through blocking cell cycle progression. An inhibition of the insulin-like growth factor I (IGF-I) signaling was also evident in females. Conclusion We provides mechanistic evidence supporting the idea that ERβ1 signaling may have pro-differentiation and tumor suppressive function in medulloblastomas.
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Management of recurrent medulloblastoma in adult patients: a systematic review and recommendations. J Neurooncol 2013; 115:1-8. [PMID: 23877361 DOI: 10.1007/s11060-013-1206-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/12/2013] [Indexed: 10/26/2022]
Abstract
Medulloblastoma accounts for almost one-third of pediatric central nervous system (CNS) cancers, but is very rare in the adult population. As a result, adult patients with medulloblastoma are often treated according to therapies developed for children with similarly staged disease at diagnosis, based on the assumption that adult and pediatric tumors have similar properties. The purpose of this review was to summarize the evidence and to make recommendations for the management of recurrent disease in adult patients with medulloblastoma. We conducted a systematic literature search to find publications addressing treatment of recurrent medulloblastoma in adults. Current treatment strategies for adult patients with relapsed medulloblastoma are based on the results of retrospective case series and published consensus recommendations, and include maximal safe re-resection where possible, combined with chemotherapy and/or re-irradiation. We describe the results of 13 publications involving 66 adult patients treated with high-dose chemotherapy (HDCT) plus stem cell transplantation for recurrent medulloblastoma. HDCT with stem cell transplantation may be a treatment option for a small proportion of adult patients who are unlikely to benefit from conventional chemotherapy and who are fit and have their disease recurrence contained within the CNS. Potential cases in which stem cell transplantation is being considered should be discussed at a multidisciplinary tumor board which includes involvement by hematologic oncologists and transplant specialists.
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Wu G, Pang H, Ghimire P, Liu G. (1)H magnetic resonance spectroscopy and diffusion weighted imaging findings of medulloblastoma in 3.0T MRI: A retrospective analysis of 17 cases. Neural Regen Res 2012; 7:2554-9. [PMID: 25337109 PMCID: PMC4200713 DOI: 10.3969/j.issn.1673-5374.2012.32.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 10/22/2012] [Indexed: 11/25/2022] Open
Abstract
1H magnetic resonance spectroscopy and diffusion weighted imaging features of the cerebellar vermis in 17 medulloblastoma patients were retrospectively analyzed, and 17 healthy volunteers were selected as controls. 1H magnetic resonance spectroscopy showed that in all 17 medulloblastoma patients, N-acetyl aspartate and creatine peaks were significantly decreased, the choline peak was significantly increased, and there was evidence of a myo-inositol peak. Further, 11 patients showed a low taurine peak at 3.4 ppm, five patients showed a lipid peak at 0.9–1.3 ppm, and three patients showed a negative lactic acid peak at 1.33 ppm. Compared with the control group, the ratios of N-acetyl aspartate/choline and N-acetyl aspartate/creatine were significantly decreased, and the ratio of choline/creatine was increased, in medulloblastoma patients. Diffusion weighted imaging displayed hyperintensity and decreased apparent diffusion coefficient in medulloblastoma patients. These findings indicate that 1H magnetic resonance spectroscopy and diffusion weighted imaging are useful for qualitative diagnosis of medulloblastoma.
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Affiliation(s)
- Guangyao Wu
- MR Room, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Haopeng Pang
- MR Room, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Prasanna Ghimire
- MR Room, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Guobing Liu
- MR Room, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
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Balducci M, Chiesa S, Chieffo D, Manfrida S, Dinapoli N, Fiorentino A, Miccichè F, Frascino V, Anile C, Valentini V, De Bari B. The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature. J Neurooncol 2011; 106:315-23. [PMID: 21805324 DOI: 10.1007/s11060-011-0665-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 07/06/2011] [Indexed: 01/22/2023]
Abstract
Medulloblastoma (MB) occurs infrequently in adult patients and standard treatment is still controversial. We report our long-term, single-institution experience of adult MB and a review of the literature. We analysed adult patients with histologically proved MB treated by postoperative radiotherapy. Primary endpoints were local control (LC), disease-free survival (DFS), and overall survival (OS). Acute toxicity was reported according to CTC-NCI score vers. 3.0 and specific neuropsychological assessment analysis was performed to define late brain toxicity. From 1990-2008, 13 patients were treated by craniospinal (CSI, 12/13) or cranial irradiation (1/13, because of bad clinical conditions). Median follow up was 101 months (64-218). Complete radiological response was observed in 12/13 patients and a partial response in 1/13. Ten-year LC, OS, and DFS were 91, 76, and 84%, respectively. Two patients died because of local and spinal progression after 13 and 62 months. Acute G3 haematological toxicity (RTOG score) was observed for one patient only. The neuropsychological analysis did not reveal late toxicity related to brain radiotherapy. This experience confirms the efficacy and safety of radiotherapy in adult MB patients, resulting in very interesting 10-year LC and OS.
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Affiliation(s)
- M Balducci
- Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168 Rome, Italy
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Faccion RS, Ferreira RM, Grabois MF, Fonseca TC, de Oliveira JA, Maia RC. Lack of Prognostic Significance of Survivin in Pediatric Medulloblastoma. Pathol Oncol Res 2011; 17:899-908. [DOI: 10.1007/s12253-011-9401-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 04/06/2011] [Indexed: 11/29/2022]
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Mancuso M, Leonardi S, Ceccarelli M, Pasquali E, De Stefano I, Prisco MG, Rebessi S, Tanori M, Scambia G, Di Majo V, Pazzaglia S, Saran A, Gallo D. Protective role of 17 β-estradiol on medulloblastoma development in Patched 1 heterozygous mice. Int J Cancer 2011; 127:2749-57. [PMID: 21351254 DOI: 10.1002/ijc.25293] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Medulloblastoma (MB) is the most common pediatric tumor of the CNS, representing ∼20% of all childhood CNS tumors. Although in recent years many molecular mechanisms that control MB development have been clarified, the effects of biological factors such as sex on this tumor remain to be explained. Epidemiological data, in fact, indicate a significant difference in the incidence of MB between the 2 sexes, with considerably higher susceptibility of males than females. Besides this different susceptibility, female sex is also a significant favorable prognostic factor in MB, with girls having a much better outcome. Despite these literature data, there has been little investigation into estrogen influence on MB development. In our study, we evaluated how hormone deficiency resulting from ovariectomy and hormone replacement influences the development of early and advanced MB stages in Patched1 heterozygous mice, a well-characterized mouse model of radiation-induced MB. Susceptibility to MB development was significantly increased in ovariectomized Ptch1(+/-) females and restored to levels observed in control mice after estrogen replacement. We next investigated the molecular mechanisms by which estrogen might influence tumor progression and show that ERβ, but not ERα, is involved in modulation of MB development by estrogens. Finally, our study shows that a functional interaction between estrogen- and IGF-I-mediated pathways may be responsible for the effects observed.
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Affiliation(s)
- Mariateresa Mancuso
- Section of Toxicology and Biomedical Sciences, Research Center Casaccia, ENEA, Rome, Italy.
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Phi JH, Lee J, Wang KC, Cho BK, Kim IO, Park CK, Kim CY, Ahn HS, Kim IH, Kim SK. Cerebrospinal fluid M staging for medulloblastoma: reappraisal of Chang's M staging based on the CSF flow. Neuro Oncol 2010; 13:334-44. [PMID: 21134897 DOI: 10.1093/neuonc/noq171] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Tumor seeding is a strong negative prognostic factor for patients with medulloblastoma. Because Chang's M staging is based primarily on CT and myelographic findings and might be contradictory to the direction of normal cerebrospinal fluid (CSF) flow, seeding patterns and appropriate staging of medulloblastoma need to be revisited in patients diagnosed in the MRI era. We retrospectively reviewed the clinical and radiological data of 86 patients with a diagnosis of medulloblastoma who were treated in the MRI era. The presence of seeding in each subarachnoid space compartment and the patterns of seeding were analyzed in correlation with patient survival data. Thirty-four patients had gross seeding on perioperative MRI. Thirty-two patients had seeding in the spinal compartment. Sixteen and 12 patients had seeding in the infratentorial and supratentorial compartments, respectively. There was an apparent hierarchy of seeding (ie, from seeding in the spinal compartment up to the supratentorial compartment). Patients with seeding in the spinal compartment had longer progression-free survival (P = .038) and a tendency toward better overall survival (P = .053) compared with patients with seeding in intracranial compartments. We modified Chang's M staging based on the CSF flow and termed this approach "CSF M staging." CSF M staging for medulloblastoma, in which intracranial seeding occupies a higher rank than spinal seeding, was a better predictor of patient prognosis. This modified staging method may be applied to metastatic staging of brain tumors located in the fourth ventricle.
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Affiliation(s)
- Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehangno, Jongno-gu, 110-744 Seoul, South Korea
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Elamin MH, Shinwari Z, Hendrayani SF, Al-Hindi H, Al-Shail E, Khafaga Y, Al-Kofide A, Aboussekhra A. Curcumin inhibits the Sonic Hedgehog signaling pathway and triggers apoptosis in medulloblastoma cells. Mol Carcinog 2010; 49:302-14. [PMID: 20025076 DOI: 10.1002/mc.20604] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Medulloblastoma is an aggressive primary brain tumor that arises in the cerebellum of children and young adults. The Sonic Hedgehog (Shh) signaling pathway that plays important roles in the pathology of this aggressive disease is a promising therapeutic target. In the present report we have shown that curcumin has cytotoxic effects on medulloblastoma cells. Curcumin suppressed also cell proliferation and triggered cell-cycle arrest at G(2)/M phase. Moreover, curcumin inhibited the Shh-Gli1 signaling pathway by downregulating the Shh protein and its most important downstream targets GLI1 and PTCH1. Furthermore, curcumin reduced the levels of beta-catenin, the activate/phosphorylated form of Akt and NF-kappaB, which led to downregulating the three common key effectors, namely C-myc, N-myc, and Cyclin D1. Consequently, apoptosis was triggered by curcumin through the mitochondrial pathway via downregulation of Bcl-2, a downstream anti-apoptotic effector of the Shh signaling. Importantly, the resistant cells that exhibited no decrease in the levels of Shh and Bcl-2, were sensitized to curcumin by the addition of the Shh antagonist, cyclopamine. Furthermore, we have shown that curcumin enhances the killing efficiency of nontoxic doses of cisplatin and gamma-rays. In addition, we present clear evidence that piperine, an enhancer of curcumin bioavailability in humans, potentiates the apoptotic effect of curcumin against medulloblastoma cells. This effect was mediated through strong downregulation of Bcl-2. These results indicate that curcumin, a natural nontoxic compound, represents great promise as Shh-targeted therapy for medulloblastomas.
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Affiliation(s)
- Maha H Elamin
- Department of Biological and Medical Research, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Cognitive and Academic Outcome After Benign or Malignant Cerebellar Tumor in Children. Cogn Behav Neurol 2009; 22:270-8. [DOI: 10.1097/wnn.0b013e3181bf2d4c] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Microvessel density and vascular endothelial growth factor expression as predictors of childrens’ survival from cerebellar medulloblastoma. J Clin Neurosci 2009; 16:1199-202. [DOI: 10.1016/j.jocn.2008.10.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 09/23/2008] [Accepted: 10/31/2008] [Indexed: 11/19/2022]
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Padovani L, André N, Carrie C, Muracciole X. [Childhood and adult medulloblastoma: what difference?]. Cancer Radiother 2009; 13:530-5. [PMID: 19713143 DOI: 10.1016/j.canrad.2009.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Accepted: 06/05/2009] [Indexed: 11/17/2022]
Abstract
Medulloblastoma is the most frequent childhood brain tumor (30%) but account only for less than 1% of adult brain tumor. The overall survival increased significantly during the last two decades with 80% of long survivors at five years whatever the stage. Most children who survive have significant neurocognitive sequelae. All children are included in national and international prospective studies which propose risk-adapted radiation therapy and chemotherapy after surgery. Quality control of radiotherapy leads to reduce significantly the risk of recurrence and has an impact on survival. Risks of late toxicity should be taken into account at the time of the treatment. Due to the rarety in adult population, no prospective studies and few data about late effects are available. Adult medulloblastoma is a therapeutic challenge and their therapeutic strategies are similar to pediatric protocols. In order to improve the understanding of adult disease and to homogenize the treatment, National Cancer Institute (INCa) stimulated the creation of web conference to discuss each case prospectively and to propose a protocol of treatment. A better comprehension of biological processes and abnormal cellular signalling pathways involved in medulloblastoma pathogenesis had led toward a new prognostic classification to adapt the therapeutic strategy and gives hope of new therapeutic tools.
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Affiliation(s)
- L Padovani
- Département de Radiothérapie, CHU de la Timone-Enfant, 13385 Marseille cedex 5, France.
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Meurer RT, Martins DT, Hilbig A, Ribeiro MDC, Roehe AV, Barbosa-Coutinho LM, Fernandes MDC. Immunohistochemical expression of markers Ki-67, neun, synaptophysin, p53 and HER2 in medulloblastoma and its correlation with clinicopathological parameters. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:385-90. [PMID: 18641877 DOI: 10.1590/s0004-282x2008000300020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Accepted: 04/29/2008] [Indexed: 01/15/2023]
Abstract
Medulloblastoma (MB) is the most common malignant brain tumor in childhood. The alterations found include: presence of oncoproteins p53 and HER2, elevated mitotic index, and presence of neuronal differentiation. The aim of this study was to determine the immunohistochemical expression of markers Ki-67, NeuN, synaptophysin, HER2 and p53 in 40 MB samples and their correlation with clinicopathologic parameters and survival. In 29 patients (72.5%), >20% of cells were positive for Ki-67. Males showed greater ki-67 expression (p=0.02) and smaller survival rates (p=0.002). NeuN and synaptophysin were negative in 16 (40%) and 8 (20%) cases, respectively. P53 was positive in 18 (45%) cases, with 11 (61%) weakly positive and 7 (39%) strongly positive. HER2 was positive in 23 (57.5%) of the samples and did not show statistical association with survival (p=0.07).
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Affiliation(s)
- Rosalva Thereza Meurer
- Postgraduate Program in Pathology, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre, RS, Brazil.
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Ang C, Hauerstock D, Guiot MC, Kasymjanova G, Roberge D, Kavan P, Muanza T. Characteristics and outcomes of medulloblastoma in adults. Pediatr Blood Cancer 2008; 51:603-7. [PMID: 18649371 DOI: 10.1002/pbc.21588] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adult medulloblastoma is a rare disease for which there is no internationally accepted standard of care. Treatment regimens have typically been modeled after pediatric protocols. We sought to review the presentation, management, and outcome of patients with adult medulloblastoma treated at the McGill University teaching hospitals over the past 18 years. METHODS Medical records were reviewed to gather demographic and clinical data including presenting symptoms, tumor characteristics, management, survival, and treatment toxicity. RESULTS Twenty-five patients were identified. Eleven patients were female and 14 were male. The median age at diagnosis was 30 (range 17-48). Our 5- and 10-year overall survival (OS) rates were 78% and 30%, respectively. Median OS was 108 months and median progression-free survival time was 63 months. Age, sex, risk, stage, extent of resection, chemotherapy and time between surgery and adjuvant therapy did not significantly influence survival outcomes. The most frequently reported adverse events included sensory neuropathy, nausea, vomiting, febrile neutropenia, and radiation dermatitis. CONCLUSION Adult medulloblastoma has distinct characteristics from the pediatric population including presentation in the lateral cerebellar hemispheres. Late relapses, especially in the posterior fossa, are a significant problem. Further follow-up will be required to ascertain the effect of adjuvant chemotherapy on survival.
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Affiliation(s)
- Celina Ang
- Department of Internal Medicine, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
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Chen SH, Liu LY, Jaing TH, Tseng CK, Lin KL, Lui TN. Multivariate survival analysis of children with medulloblastoma--a single-center experience. Pediatr Hematol Oncol 2008; 25:647-54. [PMID: 18850477 DOI: 10.1080/08880010802243979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The authors sought to evaluate the treatment outcome of children with medulloblastoma at a single institution. Forty-two children were analyzed. Eighty-six percent of the children who received chemotherapy were treated with cisplatin-based chemotherapy. No factors were found to affect outcome significantly. Compared with children treated before 1994 at the same institution, the median survival time was significantly longer (40 vs. 25 months, p = .0003). The authors conclude that some improvement of treatment outcome for children with medulloblastoma seemed to be achieved.
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Affiliation(s)
- Shih-Hsiang Chen
- Division of Hematology and Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Sauvageot CM, Kesari S, Stiles CD. Molecular pathogenesis of adult brain tumors and the role of stem cells. Neurol Clin 2008; 25:891-924, vii. [PMID: 17964020 DOI: 10.1016/j.ncl.2007.07.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Primary brain tumors consist of neoplasms with varied molecular defects, morphologic phenotypes, and clinical outcomes. The genetic and signaling abnormalities involved in tumor initiation and progression of the most prevalent adult primary brain tumors, including gliomas, meningiomas, and medulloblastomas, are described in this article. The current understanding of the cell-of-origin of these neoplasms is reviewed, which suggests that the malignant phenotype is propelled by cells with stem-like qualities. A comprehensive understanding of the molecular basis of transformation and the cell-of-origin of these neoplasms will enable the formulation of more targeted treatment alternatives that could improve survival and quality of life.
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Affiliation(s)
- Claire M Sauvageot
- Department of Cancer Biology, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115-6084, USA
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Brandes AA, Franceschi E, Tosoni A, Blatt V, Ermani M. Long-term results of a prospective study on the treatment of medulloblastoma in adults. Cancer 2007; 110:2035-41. [PMID: 17823910 DOI: 10.1002/cncr.23003] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Because medulloblastoma (MB) is rare in adults, the few studies on this condition have been retrospective, and the follow-up has tended to be short. Furthermore, the different therapeutic strategies used in these patients has made it difficult to assess survival rates and prognostic factors. METHODS In 1989, a prospective Phase II trial was initiated to evaluate the efficacy of treatment for adults with MB. Patients were staged completely with a neuroradiologic examination of the brain and neuroaxis and by cerebrospinal fluid cytology, according to Chang's staging system. Low-risk patients received radiotherapy alone, whereas high-risk patients received 2 cycles of upfront chemotherapy followed by radiotherapy and adjuvant chemotherapy. The current article reports on the long-term results from that trial. RESULTS After a median follow up of 7.6 years, among a total of 36 adults with MB, the overall progression-free survival (PFS) and overall survival (OS) rates at 5 years were 72% and 75%, respectively. In low-risk patients, the 5-year PFS rate was 80%, and the 5-year OS rate was 80%; in high-risk patients, the 5-year PFS rate was 69%, and the 5-year OS rate was 73%. CONCLUSIONS In adult patients with MB, long-term follow-up was essential for evaluating the real impact of treatments. Low-risk and high-risk patients did not differ significantly in terms of PFS or OS.
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Affiliation(s)
- Alba A Brandes
- Department of Medical Oncology, Azienda Unità Sanitaria Locale (USL) Bellaria-Maggiore Hospital, Bologna, Italy.
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Rodriguez FJ, Eberhart C, O'Neill BP, Slezak J, Burger PC, Goldthwaite P, Wu W, Giannini C. Histopathologic grading of adult medulloblastomas. Cancer 2007; 109:2557-65. [PMID: 17487854 DOI: 10.1002/cncr.22717] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Histopathologic evaluation of the degree and extent of anaplasia is a useful prognostic parameter in pediatric medulloblastomas. Whether the same applies to adult medulloblastomas is not known. METHODS The study included 74 adult patients with histologically confirmed medulloblastomas and retrospectively reassessed 67 cases with available slides for the presence of nodularity, collagen deposition (desmoplasia without nodules), and degree and extent of anaplasia. RESULTS Patients included 43 men and 31 women with the following age distribution: 18-40 years (84%); 41-50 years (9%); and 51-70 years (7%). At last follow-up, 56 patients were alive with a mean follow-up of 6.3 years (range, 0.1-20.8 years). A variety of treatments were employed during the study period, including postoperative radiation (85%) and chemotherapy (27%). Precise treatment modalities were unknown in 12% of patients. Anaplasia was absent (34%), mild (34%), moderate (27%), or severe (5%). Severe anaplasia was diffuse in 2 cases and focal in 1, although in the latter cases severe anaplasia was diffusely present at the time of disease recurrence. Male sex was associated with decreased 10-year recurrence-free survival (40% vs 66%; P = .021) and overall survival (38% vs 68%; P = .005). Severe anaplasia at first resection was found to be an independent predictor of decreased recurrence-free survival (P = .005) and overall survival (P = .015). CONCLUSIONS The incidence of severe anaplasia in adult medulloblastomas is lower than in the pediatric population. Male sex and the presence of severe anaplasia at the time of first resection are predictors of decreased recurrence-free and overall survival. However, the significance of severe anaplasia should be regarded with caution based on the small number of tumors with this feature in the current study.
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Affiliation(s)
- Fausto J Rodriguez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
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40
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Franceschi E, Tosoni A, Paioli A, Cavallo G, Spagnolli F, Brandes AA. Challenges and progress in the treatment of adult medulloblastomas. Future Oncol 2007; 3:115-7. [PMID: 17381408 DOI: 10.2217/14796694.3.2.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Nicolis SK. Cancer stem cells and "stemness" genes in neuro-oncology. Neurobiol Dis 2006; 25:217-29. [PMID: 17141509 DOI: 10.1016/j.nbd.2006.08.022] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 08/27/2006] [Indexed: 11/29/2022] Open
Abstract
The main properties of stem cells include long-term self-renewal and the capacity to give rise to one or more types of differentiated progeny. Recently, much evidence was provided that leukemia and tumor maintenance and growth are sustained by a small proportion of cells exhibiting stem cell properties. In neural tumors, stem cells have been detected in glioblastoma, medulloblastoma and ependymoma. These observations imply that normal stem cells could be the origin of cancer stem cells; alternatively, a more differentiated progeny may revert to a "stem-like" status, and give rise to cancer stem cells. In adult brain residual stem cells are located in the hippocampus, the subventricular zone and possibly the cerebellum. However, evidence for the ability of more differentiated progeny (astroglia, oligodendroglia) to convert into "stem cells" in vitro has also been provided, thus greatly expanding the potential target of oncogenic mutations. In the framework of the cancer stem cell hypothesis, genes originally identified as important for normal neural stem cells may be essential to support cancer stem cells as well. Stem cell genes act in several ways: they stimulate stem cell self-replication, inhibit differentiation, control excessive replication that might lead to "exhaustion" of the stem cell pool. Mutations in man and mouse, in spontaneous or experimental brain tumors, often target stem cell genes or genes lying in their functional pathway, the main examples being the Sonic hedgehog and the Wnt pathways. Interestingly, several stem cell genes are often overexpressed in brain tumors, even if they are not mutated. This suggests that these genes may be important for the generation of cancer stem cells from more differentiated precursors, or for cancer stem cell maintenance. Cancer stem cells partially differentiate in vivo, and in vitro they also give rise to seemingly normal differentiated progeny, like normal stem cells: thus, their main defect, leading to cancer, may lie in the unbalance between self-replication and terminal differentiation of this minority cell population. Knowledge of extrinsic diffusible factors affecting the activity of stem cell genes may help identifying tools for inducing cancer stem cell differentiation, which might be of use in therapy.
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Affiliation(s)
- Silvia K Nicolis
- Department of Biotechnology and Biosciences, University of Milano Bicocca, piazza della Scienza 2, 20126 Milano, Italy.
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Yoon IS, Seo JY, Shin CH, Kim IH, Shin HY, Yang SW, Ahn HS. Endocrine dysfunction and growth in children with medulloblastoma. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.3.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- In Suk Yoon
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Young Seo
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Young Shin
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Seop Ahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Giordana MT, D'Agostino C, Pollo B, Silvani A, Ferracini R, Paiolo A, Ghiglione P, Chiò A. Anaplasia Is Rare and Does Not Influence Prognosis in Adult Medulloblastoma. J Neuropathol Exp Neurol 2005; 64:869-74. [PMID: 16215458 DOI: 10.1097/01.jnen.0000182980.64236.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Histopathologic grading based on increasing anaplasia predicts clinical behavior of pediatric medulloblastomas. The present study was aimed at grading 86 medulloblastomas of adult patients (aged 18 and older) by anaplasia and analyzing the predictive power. Nodularity, desmoplasia, nuclear size, nuclear pleomorphism, necrosis, and endothelial proliferations have been evaluated. Morphometric analysis of nuclear size was performed using the Eclipse Net program. Patients treated with standard postoperative radiotherapy (35 Gy to craniospinal axis and 50 Gy to posterior fossa) were considered for correlation with survival. Pathologic data and total survival were compared by Kaplan-Meier and logrank analysis. No correlation was found between total survival duration and individual pathologic features. Cooccurrence of nuclear pleomorphism, large nuclear diameter, microvascular proliferations, and necroses did not predict outcome. Severe nuclear pleomorphism was found in 4 of 86 cases; the only large-cell medulloblastoma was from an 18-year-old patient. Histopathologic factors have no clinical use for stratification of patients in risk groups. The histologic spectrum of medulloblastoma in adults is different from that in children.
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