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Święszkowska E, Broniszczak D, Kaliciński P, Szymczak M, Stefanowicz M, Grajkowska W, Dembowska-Bagińska B. Rhabdomyosarcoma of the Biliary Tract in Children: Analysis of Single Center Experience. Cancers (Basel) 2024; 16:3110. [PMID: 39272968 PMCID: PMC11394218 DOI: 10.3390/cancers16173110] [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: 07/30/2024] [Revised: 09/01/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
Rhabdomyosarcoma (RMS) of the biliary tract is a rare tumor in children, constituting 0.5-0.8% of all pediatric RMS. Still, it is the most common malignancy in this location in children. Due to its rarity and location, it may cause diagnostic and treatment difficulties. Above all, there are no therapeutic guidelines specific for this tumor location. The aim of the study was to present an analysis of our experience with the treatment of children with biliary tract rhabdomyosarcoma (RMS) and discuss clinical recommendations for this specific location published in the literature. A retrospective analysis of medical records of eight children with biliary tree RMS treated in one center between 1996-2022 was performed. Records of eight children, five boys and three girls aged 2 yrs 6 mo to 16 yrs 9 mo (median-6 yrs) were analyzed. All patients presented with jaundice as the first symptom. In two patients, initial diagnosis of a tumor was established. For the remaining six, the primary diagnoses were as follows: choledochal cyst-one, malformation of the biliary ducts-one, choledocholithiasis-one, cholangitis-three. In four patients, the extrahepatic bile ducts were involved; in four patients, both the intrahepatic and extrahepatic bile ducts were involved. Embryonal RMS was diagnosed in seven patients (three botryoides type). Alveolar RMS was found in one patient. Biopsy (three surgical, four during endoscopic retrograde cholangiopancreatography (ERCP)) was performed in seven patients. One child underwent primary partial tumor resection (R2). Seven patients received neoadjuvant chemotherapy, followed by delayed resection in five, including liver transplantation in one (five were R0). Two patients did not undergo surgery. Radiotherapy was administered in four patients (two in first-line treatment, two at relapse/progression). Six patients (75%) are alive with no evidence of disease, with follow-up ranging from 1.2 yrs to 27 yrs (median 11 yrs. and 4 mo.). Two patients died from disease, 2 y 9 mo and 3 y 7 mo from diagnosis. Children presenting with obstructive jaundice should be evaluated for biliary tract RMS. The treatment strategy should include biopsy and preoperative chemotherapy, followed by tumor resection and radiotherapy for residual disease and in case of relapse.
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Affiliation(s)
- Ewa Święszkowska
- Department of Oncology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Dorota Broniszczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Marek Szymczak
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Marek Stefanowicz
- Department of Pediatric Surgery and Organ Transplantation, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Wiesława Grajkowska
- Department of Pathology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Bożenna Dembowska-Bagińska
- Department of Oncology, The Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
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Mandeville HC, Bisogno G, Minard-Colin V, Alaggio R, Ben-Arush M, Chargari C, Coppadoro B, Craigie R, Devalck C, Ferman S, Ferrari A, Glosli H, Alvaro RH, Hol M, Mudry P, Orbach D, Albiac MR, Merks JHM, Jenney MEM. Localized incompletely resected standard risk rhabdomyosarcoma in children and adolescents: Results from the European Paediatric Soft Tissue Sarcoma Study Group RMS 2005 trial. Cancer 2024. [PMID: 39058728 DOI: 10.1002/cncr.35497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND The authors report the prospective evaluation of reduced dose alkylator chemotherapy combined with radiotherapy for European Pediatric Soft Tissue Sarcoma Study Group (EpSSG) standard risk nonalveolar rhabdomyosarcoma (NA-RMS). PATIENTS AND METHODS Localized node negative Intergroup Rhabdomyosarcoma Study (IRS) II/III NA-RMS at favorable sites (subgroup C), <25 years old, received five cycles of ifosfamide, vincristine, and dactinomycin (IVA) chemotherapy (30 g/m2 ifosfamide) and four cycles of vincristine and dactinomycin (if receiving radiotherapy), or nine cycles of IVA (54 g/m2 ifosfamide) ± radiotherapy. Delayed primary tumor excision was considered for IRS III tumors. The primary end points were event-free survival (EFS) and overall survival (OS). RESULTS From October 2005 to December 2016, 359 evaluable patients were recruited: orbit, 164 (45.7%); head and neck nonparameningeal, 77 (21.4%); and genitourinary non-bladder/prostate, 118 (32.9%). EFS and OS were 77.4% (95% confidence interval [CI], 72.5-81.6) and 93.5% (95% CI, 90.1-95.8), respectively. Lower dose alkylator chemotherapy and radiotherapy achieved 5-year OS of 93.7% but the difference with higher dose alkylator chemotherapy +/- radiotherapy was not significant (p = 0.8003). Adjuvant radiotherapy improved EFS with 5-year estimates of 84.7% versus 65.2% for nonirradiated (p < .0001), but not OS (p = .9298). Omitting radiotherapy for orbital tumors reduced OS (5-year was 87.1% vs. 97.3% for irradiated, p = .0257). Following R0 resection (n = 60), radiotherapy did not significantly improve EFS or OS. CONCLUSIONS Radiotherapy for local tumor control allows for reduction of cumulative dose of alkylators in EpSSG standard risk subgroup C RMS patients. The omission of radiotherapy did not affect OS in all patients except those with orbital RMS and was associated with inferior EFS.
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Affiliation(s)
- Henry C Mandeville
- The Royal Marsden Hospital and The Institute of Cancer Research, Surrey, UK
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, INSERM U1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesu Children's Hospital, IRCCS, Rome, Italy
| | - Myriam Ben-Arush
- Ruth Rappaport Children's Hospital, Rambam Medical Center, Joan and Sanford Weill Pediatric Hematology Oncology and Bone Marrow Transplantation Division, Haifa, Israel
| | - Cyrus Chargari
- Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Ross Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Christine Devalck
- Hôpital Universitaire des Enfants Reine Fabiola ULB, Brussels, Belgium
| | - Sima Ferman
- Pediatric Oncology Department, National Cancer Institute, Rio de Janeiro, Brazil
| | - Andrea Ferrari
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Heidi Glosli
- Centre for Rare Disorders, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Raquel Hladun Alvaro
- Department of Pediatric Oncology and Haematology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marinka Hol
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Peter Mudry
- Pediatric Oncology, Department University Hospital Brno and Faculty of Medicine Masaryk University, Brno, Czech Republic
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | - Monica Ramos Albiac
- Department of Radiotherapy, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Rodwin RL, Janardan SK, Hofstatter EW, Kadan-Lottick NS. A Case of Pheochromocytoma as a Subsequent Neoplasm in a Survivor of Childhood Embryonal Rhabdomyosarcoma. J Pediatr Hematol Oncol 2022; 44:e585-e588. [PMID: 35200227 PMCID: PMC8873988 DOI: 10.1097/mph.0000000000002270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
Childhood cancer survivors are at risk for subsequent neoplasms. We describe the clinical presentation and genetic testing of a 29-year-old woman diagnosed with a pheochromocytoma 22 years post-treatment for childhood embryonal rhabdomyosarcoma of the bladder. Genetic testing for cancer predisposition revealed a pathogenic variant in BRCA2 and a variant of uncertain significance in MSH2. Pathogenic variants associated with deafness were also identified in GJB2. This article reports a novel subsequent neoplasm following childhood embryonal rhabdomyosarcoma, and discusses the potential contribution of genetic cancer predisposition to this case as well as the clinical implications of genetic testing.
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Affiliation(s)
- Rozalyn L. Rodwin
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT
| | - Sanyukta K. Janardan
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT
- Aflac Cancer and Blood Disorders Center, Emory University School of Medicine/Children’s Healthcare of Atlanta, Atlanta, GA
| | - Erin W. Hofstatter
- Section of Medical Oncology, Yale School of Medicine, New Haven, CT
- Yale Cancer Center, New Haven, CT
| | - Nina S. Kadan-Lottick
- Section of Pediatric Hematology/Oncology, Yale School of Medicine, New Haven, CT
- Yale Cancer Center, New Haven, CT
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Fuchs J, Murtha-Lemekhova A, Kessler M, Günther P, Fichtner A, Pfeiffenberger J, Probst P, Hoffmann K. Biliary Rhabdomyosarcoma in Pediatric Patients: A Systematic Review and Meta-Analysis of Individual Patient Data. Front Oncol 2021; 11:701400. [PMID: 34660271 PMCID: PMC8515851 DOI: 10.3389/fonc.2021.701400] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The biliary tree is a rare location of pediatric rhabdomyosarcoma. Due to the low incidence, there is a lack of evidence concerning therapeutic guidelines for this tumor location. In particular, the impact of surgery is discussed controversially. PURPOSE Objective is to generate evidence-based treatment guidelines for pediatric biliary rhabdomyosarcoma (BRMS). All available published data on therapeutic regimens and important prognostic factors are investigated with a focus on the role of surgery. METHODS A systematic literature search of MEDLINE, Web of Science, and CENTRAL was performed. Patient data were entered individually. Data was pooled and qualitative and quantitative analyses of demographic data, therapy, postoperative/interventional outcomes, relapse, and survival were conducted. In an individual patient data analysis, cox regression was applied to identify key factors predicting the outcome of patients with BRMS. RESULTS 65 studies met the inclusion criteria, providing data on 176 patients with BRMS. Individual patient data analysis showed a 5-year overall survival and progression-free survival of 51% and 50% for the total study population. For patients treated after 2000, 5-year OS and PFS was 65% and 59%, respectively. Absence of surgical tumor resection was an independent risk factor for death (Hazard ratio 8.9, 95%-CI 1.8-43.6, p = 0.007) and significantly associated with recurrent disease and disease-related death. CONCLUSION This analysis provides comprehensive information on the largest number of patients hitherto reported in the literature. BRMS is still associated with high morbidity and mortality. Surgical tumor resection is essential for appropriate oncological treatment of BRMS. International cooperation studies are needed to enhance evidence and improve the outcome of this orphan disease. PROTOCOL REGISTRATION PROSPERO (CRD42021228911) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228911.
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Affiliation(s)
- Juri Fuchs
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Anastasia Murtha-Lemekhova
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Kessler
- Department of General, Visceral and Transplantation Surgery, Division of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Günther
- Department of General, Visceral and Transplantation Surgery, Division of Pediatric Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Fichtner
- Department of Pediatrics I, Division of Pediatric Gastroenterology, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Jan Pfeiffenberger
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Study Center of the German Surgical Society (SDGC), University of Heidelberg, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
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Lautz TB, Chi YY, Li M, Wolden SL, Casey DL, Routh JC, Granberg CF, Binite O, Rudzinski ER, Hawkins DS, Venkatramani R, Rodeberg DA. Benefit of delayed primary excision in rhabdomyosarcoma: A report from the Children's Oncology Group. Cancer 2021; 127:275-283. [PMID: 33079399 PMCID: PMC7790947 DOI: 10.1002/cncr.33275] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Most children with intermediate-risk rhabdomyosarcoma (RMS) have gross disease (group III) at the initiation of chemotherapy. Delayed primary excision (DPE) after induction chemotherapy allows for a reduction in adjuvant radiation dose, but with the risk of potential surgical morbidity. The objectives of this study were to compare outcomes in children with group III RMS who did and did not undergo DPE and to assess surgical morbidity. METHODS The study included 369 patients who had clinical group III RMS at sites amenable to DPE from intermediate-risk Children's Oncology Group studies D9803 (encouraged DPE) and ARST0531 (discouraged DPE). RESULTS The primary tumor site was bladder/prostate (136 patients; 37%), extremity (97 patients; 26%), trunk (24 patients; 7%), retroperitoneum (91 patients; 25%), or intrathoracic/perineum/perianal (21 patients; 6%). In total, 112 patients (53.9%) underwent DPE in D9803, and 26 patients (16.2%) underwent DPE in ARST0531 (P < .001), with loss of vital organ or function in 30 of 138 patients (22%). DPE allowed for a reduced radiation dose in 110 of 135 patients (81%; 51% were reduced to 36 Gy, and 30% were reduced to 42 Gy). Patients who underwent DPE had improved unadjusted overall survival (P = .013). In adjusted regression analysis, the risk of death (hazard ratio, 0.71; 95% CI 0.43-1.16) was similar for patients who did and did not undergo DPE and was improved for the subset of patients who had tumors of the trunk and retroperitoneum (hazard ratio, 0.44; 95% CI, 0.20-0.97). CONCLUSIONS Children with group III RMS have equivalent or improved outcomes with DPE and can receive a decreased radiation dose for definitive local control. The choice of local control modality should weigh the potential morbidity of surgery versus that of higher dose irradiation.
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Affiliation(s)
- Timothy B. Lautz
- Department of Surgery, Ann & Robert H Lurie Children’s Hospital of Chicago; Northwestern University, Chicago, IL USA
| | - Yueh-Yun Chi
- Department of Pediatrics and Preventive Medicine, University of Southern California, Los Angeles, CA USA
| | - Minjie Li
- Department of Biostatistics, University of Florida, Gainesville, FL USA
| | - Suzanne L. Wolden
- Division of Radiation Oncology, Memorial Sloan Kettering Cancer Center; New York, NY USA
| | - Dana L. Casey
- Division of Radiation Oncology, University of North Carolina, Chapel Hill, NC USA
| | - Jonathan C. Routh
- Division of Urologic Surgery, Duke University School of Medicine, Durham, NC USA
| | | | - Odion Binite
- Department of Orthopedic Surgery, Moffitt Cancer Center, Tampa, FL USA
| | - Erin R. Rudzinski
- Department of Pathology, Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - Douglas S. Hawkins
- Division of Hematology/Oncology, Seattle Children’s Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA USA
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - David A. Rodeberg
- Division of Pediatric Surgery, Department of Surgery, East Carolina University
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Pushpam D, Garg V, Ganguly S, Biswas B. Management of Refractory Pediatric Sarcoma: Current Challenges and Future Prospects. Onco Targets Ther 2020; 13:5093-5112. [PMID: 32606731 PMCID: PMC7293381 DOI: 10.2147/ott.s193363] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
Paediatric sarcomas are a heterogeneous group of disorders constituting bone sarcoma and various soft tissue sarcomas. Almost one-third of these presents with metastasis at baseline and another one-third recur after initial curative treatment. There is a huge unmet need in this cohort in terms of curative options and/or prolongation of survival. In this review, we have discussed the current treatment options, challenges and future strategies of managing relapsed/refractory paediatric sarcomas. Upfront risk-adapted treatment with multidisciplinary management remains the main strategy to prevent future recurrence or relapse of the disease. In the case of limited local and/or systemic relapse or late relapse, initial multimodality management can be administered. In treatment-refractory cases or where cure is not feasible, the treatment options are limited to novel therapeutics, immunotherapeutic approach, targeted therapies, and metronomic therapies. A better understanding of disease biology, mechanism of treatment refractoriness, identifications of driver mutation, the discovery of novel targeted therapies, cellular vaccine and adapted therapies should be explored in relapsed/refractory cases. Close national and international collaboration for translation research is needed to fulfil the unmet need.
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Affiliation(s)
| | - Vikas Garg
- Department of Medical Oncology, AIIMS, New Delhi, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Bivas Biswas
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
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Park KR, Yun HM, Hong JT. G721-0282 inhibits cell growth and induces apoptosis in human osteosarcoma through down-regulation of the STAT3 pathway. Int J Biol Sci 2020; 16:330-341. [PMID: 31929760 PMCID: PMC6949149 DOI: 10.7150/ijbs.37781] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/23/2019] [Indexed: 12/11/2022] Open
Abstract
Osteosarcoma (OS) is considered the most common type of primary malignant bone tumor, which has an urgent need for more effective treatment. Recently, chitinase 3 like 1 (Chi3L1) expression has been found in a variety of cancer cells. However it is not known whether Chi3L1 regulates the STAT3 pathway in OS cells. Herein, we examined the effects of the G721-0282, a ligand of Chi3L1, in vitro and in vivo against OS cells. G721-0282 inhibited the proliferation of OS cells and induced apoptosis. This apoptosis was accompanied by upregulation of apoptotic proteins (PARP and procaspase-3), but downregulation of anti-apoptotic proteins (Survivin and Bcl-2). G721-0282 induced the inactivation of mitogen-activated protein kinases (MAPKs) with a decrease in the phosphorylation of Src and STAT3 in OS cells. Importantly, overexpression of Chi3L1 potentiated the effects of G721-0282, while knockdown of Chi3L1 attenuated the effects of G721-0282. Docking model study also showed that G721-0282 interacted with Chi3L1. In addition, G721-0282 inhibited cell migration, invasion, and colony formation. Furthermore, the anti-tumor effects of G721-0282 were observed in an xenograft in vivo model in association with the reduced expression of Chi3L1, PCNA, Cyclin D1, p-STAT3, as well as the increased expression of Chi3L1 was correlated with the p-STAT3 level in human bone tumor tissues. Taken together, a Chi3L1 ligand, G721-0282 may be an attractive therapeutic strategy for OS, especially in vitro and in vivo anti-proliferative effects against OS cells through the inhibition of the STAT3 pathway, and suggest the potentially therapeutic application of G721-0282 in the treatment of OS.
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Affiliation(s)
- Kyung-Ran Park
- College of Pharmacy and Medical Research Center, Chungbuk National University, Chungbuk 194-31, Republic of Korea
| | - Hyung-Mun Yun
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Jin Tae Hong
- College of Pharmacy and Medical Research Center, Chungbuk National University, Chungbuk 194-31, Republic of Korea
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8
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Zhang B, Li YL, Zhao JL, Zhen O, Yu C, Yang BH, Yu XR. Hypoxia-inducible factor-1 promotes cancer progression through activating AKT/Cyclin D1 signaling pathway in osteosarcoma. Biomed Pharmacother 2018; 105:1-9. [PMID: 29807229 DOI: 10.1016/j.biopha.2018.03.165] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Osteosarcoma is an aggressive malignant neoplasm, which commonly afflicts patients of 20-30 years of age, and its morbidity has increased markedly in recent years. Certain genes and signal pathways have been identified to exert key roles in osteosarcoma progression. Here, we set out to characterize in more detail of the role of HIF-1/AKT/Cyclin D1 pathway in the progression of osteosarcoma. METHODS Immunohistochemistry, western blot and qPCR were used to test the protein or mRNA levels of HIF-1 in osteosarcoma tissues or adjacent nontumor tissues. MTT, clone formation, wound healing, Transwell, in vivo tumorigenesis, flow cytometry and western blot analysis were used to determine cell proliferation, clone formation ability, migration, invasion, tumorigenesis, and cell apoptosis in MG63 and U2OS cells, respectively. Immunoprecipitation and immunofluorescence assays were performed to investigate the protein-protein interaction between HIF-1α and proteins related to signal pathways. RESULTS HIF-1 was overexpressed in osteosarcoma tissues and cell lines, which promoted cell proliferation, clone formation, migration, invasion and inhibited cell apoptosis. Results also demonstrated that HIF-1 combined with AKT, and there might be a positive loop between the two proteins of HIF-1 and AKT, then the protein-protein interaction up-regulated the expression of Cyclin D1 in protein level, but not mRNA level, made Cyclin D1 protein more stable, triggered cell proliferation, clone formation, tumorigenesis, but inhibited cell apoptosis. CONCLUSIONS The present study showed that HIF-1 modulated Cyclin D1 expression might through shaping a positive loop with AKT proteins. Additionally, HIF-1α promoted the tumor cells growth, migration and invasion in osteosarcoma through the activation of the AKT/Cyclin D1 signal cascade. We proposed that HIF-1 could be served as a marker for distinguishing osteosarcoma and an effective therapeutic target for osteosarcoma.
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Affiliation(s)
- Bo Zhang
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China; 3201 Hosptial Affiliated to Xi'an Jiaotong University, Hanzhong, Shaanxi, 723000,China
| | - Ya-Li Li
- 3201 Hosptial Affiliated to Xi'an Jiaotong University, Hanzhong, Shaanxi, 723000,China
| | - Jin-Long Zhao
- 3201 Hosptial Affiliated to Xi'an Jiaotong University, Hanzhong, Shaanxi, 723000,China
| | - Ouyang Zhen
- 3201 Hosptial Affiliated to Xi'an Jiaotong University, Hanzhong, Shaanxi, 723000,China
| | - Chao Yu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Bin-Hui Yang
- 3201 Hosptial Affiliated to Xi'an Jiaotong University, Hanzhong, Shaanxi, 723000,China
| | - Xiao-Rui Yu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China; Key laboratory of Environment and Genes Related to Disease(Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi 710061, China.
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9
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Ou JY, Spraker-Perlman H, Dietz AC, Smits-Seemann RR, Kaul S, Kirchhoff AC. Conditional survival of pediatric, adolescent, and young adult soft tissue sarcoma and bone tumor patients. Cancer Epidemiol 2017; 50:150-157. [PMID: 28992567 PMCID: PMC6719689 DOI: 10.1016/j.canep.2017.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Survival estimates for soft tissue sarcomas (STS) and malignant bone tumors (BT) diagnosed in pediatric, adolescent, and young adult patients are not easily available. We present survival estimates based on a patient having survived a defined period of time (conditional survival). Conditional survival estimates for the short-term were calculated for patients from diagnosis to the first five years after diagnosis and for patients surviving in the long-term (up to 20 years after diagnosis). METHODS We identified 703 patients who were diagnosed with a STS or BT at age ≤25 years from January 1, 1986 to December 31, 2012 at a large pediatric oncology center in Salt Lake City, Utah, United States. We obtained cancer type, age at diagnosis, primary site, and demographic data from medical records, and vital status through the National Death Index. Cancer stage was available for a subset of the cohort through the Utah Cancer Registry. Cox proportional hazards models, adjusted for age and sex, calculated survival estimates for all analyses. RESULTS Short-term survival improves over time for both sarcomas. Short-term survival for STS from diagnosis (Year 0) did not differ by sex, but short-term survival starting from 1-year post diagnosis was significantly worse for male patients (Survival probability 1-year post-diagnosis [SP1]:77% [95% CI:71-83]) than female patients (SP1:86% [81-92]). Survival for patients who were diagnosed at age ≤10 years (Survival probability at diagnosis [SP0]:85% [79-91]) compared to diagnosis at ages 16-25 years (SP0:67% [59-75]) was significantly better at all time-points from diagnosis to 5-years post-diagnosis. Survival for axial sites (SP0:69% [63-75]) compared to extremities (SP0:84% [79-90]) was significantly worse from diagnosis to 1-year post-diagnosis. Survival for axial BT (SP0: 64% [54-74] was significantly worse than BT in the extremities (SP0:73% [68-79]) from diagnosis to 3-years post diagnosis. Relapsed patients of both sarcoma types had significantly worse short-term survival than non-relapsed patients. Long-term survival for STS in this cohort is 65% at diagnosis, and improves to 86% 5-years post-diagnosis. BT survival improves from 51% at diagnosis to 78% at 5-years post-diagnosis. CONCLUSION Conditional survival for short- and long-term STS and BT improve as time from diagnosis increases. Short-term survival was significantly affected by patients' sex, age at diagnosis, cancer site, and relapse status.
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Affiliation(s)
- Judy Y Ou
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, United States; Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT 84113, United States.
| | - Holly Spraker-Perlman
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT 84113, United States
| | - Andrew C Dietz
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA 90027, United States
| | - Rochelle R Smits-Seemann
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, United States; Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT 84113, United States; Institutional Research and Reporting, Salt Lake Community College, Salt Lake City, UT 84123, United States
| | - Sapna Kaul
- Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, 77555, United States
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, United States; Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Utah School of Medicine, Salt Lake City, UT 84113, United States
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10
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Chang J, Li Y, Wang X, Hu S, Wang H, Shi Q, Wang Y, Yang Y. Polyphyllin I suppresses human osteosarcoma growth by inactivation of Wnt/β-catenin pathway in vitro and in vivo. Sci Rep 2017; 7:7605. [PMID: 28790389 PMCID: PMC5548759 DOI: 10.1038/s41598-017-07194-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 06/27/2017] [Indexed: 12/26/2022] Open
Abstract
Osteosarcoma is the most common primary bone cancer in children and adolescents. In spite of aggressive treatment, osteosarcoma has a high mortality rate with minimal improvements in survival over past few decades. Polyphyllin I (PPI), a component in the traditional Chinese medicinal herb Paris polyphylla Smith, has been shown to have anti-tumor properties. However, its mechanism as an anti-osteosarcoma agent has not been well elucidated. In this study, we found that PPI suppressed osteosarcoma cell viability, arrested cell cycle in G2/M phase, induced apoptosis and inhibited invasion and migration of osteosarcoma cells. Moreover, PPI significantly suppressed intratibial primary tumor growth in xenograft orthotopic mouse model without any obvious side effects. These therapeutic efficacies were associated with inactivation of Wnt/β-catenin pathway, as PPI treatment decreased the amount of p-GSK-3β, leading to down-regulated levels of active β-catenin. PPI induced inhibition of osteosarcoma cell viability was abolished upon addition of GSK-3β specific inhibitor, CHIR99021, while PPI induced inhibition of osteosarcoma cell viability and migration were potentiated by β-catenin silencing. These findings suggested that, in vitro and in vivo, PPI treatment inhibited osteosarcoma, at least in part, via the inactivation of Wnt/β-catenin pathway. Thus, PPI could serve a novel therapeutic option for osteosarcoma patients.
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Affiliation(s)
- Junli Chang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Key laboratory of theory and therapy of muscles and bones, Ministry of Education, Shanghai, 200032, China
| | - Yimian Li
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Key laboratory of theory and therapy of muscles and bones, Ministry of Education, Shanghai, 200032, China
| | - Xianyang Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Key laboratory of theory and therapy of muscles and bones, Ministry of Education, Shanghai, 200032, China
| | - Shaopu Hu
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Key laboratory of theory and therapy of muscles and bones, Ministry of Education, Shanghai, 200032, China
| | - Hongshen Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Key laboratory of theory and therapy of muscles and bones, Ministry of Education, Shanghai, 200032, China
| | - Qi Shi
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.,Key laboratory of theory and therapy of muscles and bones, Ministry of Education, Shanghai, 200032, China
| | - Yongjun Wang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China. .,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China. .,Key laboratory of theory and therapy of muscles and bones, Ministry of Education, Shanghai, 200032, China. .,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Yanping Yang
- Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China. .,Spine Institute, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China. .,Key laboratory of theory and therapy of muscles and bones, Ministry of Education, Shanghai, 200032, China.
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11
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Abstract
Pediatric sarcomas are a heterogeneous group of tumors accounting for approximately 10% of childhood solid tumors. Treatment is focused on multimodality therapy, which has improved the prognosis over the past two decades. Current regimens focus on decreasing treatment for low-risk patients to decrease the long-term side effects while maximizing therapy for patients with metastatic disease to improve survival. Pediatric sarcomas can be divided into soft tissue sarcomas and osseous tumors. Soft tissue sarcomas are further delineated into rhabdomyosarcomas, which affect young children and nonrhabdomyosarcomas, which are most common in adolescents. The most common bone sarcomas are osteosarcomas and Ewing's sarcoma.
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12
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Park KR, Yun HM, Quang TH, Oh H, Lee DS, Auh QS, Kim EC. 4-Methoxydalbergione suppresses growth and induces apoptosis in human osteosarcoma cells in vitro and in vivo xenograft model through down-regulation of the JAK2/STAT3 pathway. Oncotarget 2016; 7:6960-71. [PMID: 26755649 PMCID: PMC4872761 DOI: 10.18632/oncotarget.6873] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 01/03/2016] [Indexed: 12/18/2022] Open
Abstract
Although the heartwood of Dalbergia odorifera T. Chen (Leguminosae) is an important source of traditional Korean and Chinese medicines, the effects of novel compound methoxydalbergione (4-MD) isolated from Dalbergia odorifera was not reported. Herein, we investigated the effects of the 4-MD in vitro and in vivo against osteosarcoma cells and its molecular mechanisms. 4-MD inhibited the proliferation of osteosarcoma cells and induced apoptosis as evidenced by Annexin V + and TUNEL + cells. This apoptosis was accompanied by upregulation of apoptotic proteins (procaspase-3 and PARP), but downregulation of anti-apoptotic proteins (Bcl-2, Bcl-xL, and Survivin). 4-MD inhibited phosphorylation of JAK2 and STAT3 with the inactivation of mitogen-activated protein kinases (MAPKs) and CREB, and the upregulation of PTEN in osteosarcoma cells. Importantly, 4-MD reduced colony formation in soft agar and inhibited tumor growth in mice xenograft model in association with the reduced expression of PCNA, Ki67, p-STAT3, and Survivin. Taken together, the present study for the first time demonstrates that 4-MD exerts in vitro and in vivo anti-proliferative effects against osteosarcoma cells through the inhibition of the JAK2/STAT3 pathway, and suggest the potential for therapeutic application of 4-MD in the treatment of osteosarcoma.
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Affiliation(s)
- Kyung-Ran Park
- Department of Oral and Maxillofacial Regeneration, Kyung Hee University, Seoul, Republic of Korea
| | - Hyung-Mun Yun
- Department of Oral and Maxillofacial Pathology, School of Dentistry and Research Center for Tooth and Periodontal Regeneration (MRC), Kyung Hee University, Seoul, Republic of Korea
| | - Tran-Hong Quang
- Institute of Pharmaceutical Research and Development, College of Pharmacy, Wonkwang University, Iksan, Korea
| | - Hyuncheol Oh
- Institute of Pharmaceutical Research and Development, College of Pharmacy, Wonkwang University, Iksan, Korea
| | - Dong-Sung Lee
- Department of Biomedical Chemistry, College of Health and Biomedical Science, Konkuk University, Chung-Ju, Korea
| | - Q-Schick Auh
- Department of Oral Medicine, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Eun-Cheol Kim
- Department of Oral and Maxillofacial Pathology, School of Dentistry and Research Center for Tooth and Periodontal Regeneration (MRC), Kyung Hee University, Seoul, Republic of Korea
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13
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Vallabhaneni KC, Hassler MY, Abraham A, Whitt J, Mo YY, Atfi A, Pochampally R. Mesenchymal Stem/Stromal Cells under Stress Increase Osteosarcoma Migration and Apoptosis Resistance via Extracellular Vesicle Mediated Communication. PLoS One 2016; 11:e0166027. [PMID: 27812189 PMCID: PMC5094708 DOI: 10.1371/journal.pone.0166027] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 10/21/2016] [Indexed: 12/11/2022] Open
Abstract
Studies have shown that mesenchymal stem/stromal cells (MSCs) from bone marrow are involved in the growth and metastasis of solid tumors but the mechanism remains unclear in osteosarcoma (OS). Previous studies have raised the possibility that OS cells may receive support from associated MSCs in the nutrient deprived core of the tumors through the release of supportive macromolecules and growth factors either in vesicular or non-vesicular forms. In the present study, we used stressed mesenchymal stem cells (SD-MSCs), control MSCs and OS cells to examine the hypothesis that tumor-associated MSCs in nutrient deprived core provide pro-proliferative, anti-apoptotic, and metastatic support to nearby tumor cells. Assays to study of the effects of SD-MSC conditioned media revealed that OS cells maintained proliferation when compared to OS cells grown under serum-starved conditions alone. Furthermore, OS cells in MSCs and SD-MSC conditioned media were significantly resistant to apoptosis and an increased wound healing rate was observed in cells exposed to either conditioned media or EVs from MSCs and SD-MSCs. RT-PCR assays of OS cells incubated with extracellular vesicles (EVs) from SD-MSCs revealed microRNAs that could potentially target metabolism and metastasis associated genes as predicted by in silico algorithms, including monocarboxylate transporters, bone morphogenic receptor type 2, fibroblast growth factor 7, matrix metalloproteinase-1, and focal adhesion kinase-1. Changes in the expression levels of focal adhesion kinase, STK11 were confirmed by quantitative PCR assays. Together, these data indicate a tumor supportive role of MSCs in osteosarcoma growth that is strongly associated with the miRNA content of the EVs released from MSCs under conditions that mimic the nutrient deprived core of solid tumors.
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Affiliation(s)
- Krishna C. Vallabhaneni
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, United States of America
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Meeves-Yoni Hassler
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Anu Abraham
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Jason Whitt
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Yin-Yuan Mo
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, United States of America
- Department of Pharmacology-Toxicology, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Azeddine Atfi
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, United States of America
- Department of Biochemistry, University of Mississippi Medical Center, Jackson, MS, United States of America
| | - Radhika Pochampally
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, United States of America
- Department of Biochemistry, University of Mississippi Medical Center, Jackson, MS, United States of America
- * E-mail:
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14
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Teepen JC, de Vroom SL, van Leeuwen FE, Tissing WJ, Kremer LC, Ronckers CM. Risk of subsequent gastrointestinal cancer among childhood cancer survivors: A systematic review. Cancer Treat Rev 2015; 43:92-103. [PMID: 26827697 DOI: 10.1016/j.ctrv.2015.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 12/07/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Childhood cancer survivors (CCS) are at increased risk of developing subsequent malignant neoplasms, including gastrointestinal (GI) cancer. We performed a systematic review to summarize all available literature on the risk of, risk factors for, and outcome after subsequent GI cancer among CCS. METHODS A systematic search of the literature databases Medline/PubMed (1945-2014) and Embase (1947-2014) was performed to identify studies that consisted of ⩾1000 CCS and assessed incidence of or mortality from subsequent GI cancer as an outcome. RESULTS A total of 45 studies were included. Studies that reported risk measures for subsequent GI cancer compared to the general population showed a 3.2 to 9.7-fold elevated risk in cohort studies including all childhood cancer types. Abdominal radiotherapy was associated with an increased risk of subsequent GI cancer in all four studies that assessed this risk. Survivors who had received procarbazine and platinum agents were also suggested to be at increased risk. CONCLUSION Abdominal radiotherapy is a risk factor for developing a subsequent GI cancer. Few studies examined detailed treatment-related risk factors and most studies had small number of GI cancer cases. Therefore, no conclusions could be drawn on the effect of time since childhood cancer on GI cancer risk and on outcome after a subsequent GI cancer. Additional research is necessary to further explore risk factors for and outcome after a subsequent GI cancer, and to systematically evaluate the harms and benefits of GI screening among high-risk survivors in order to give sound screening recommendations.
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Affiliation(s)
- Jop C Teepen
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Suzanne L de Vroom
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Flora E van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, P.O. Box 90203, 1066 CX Amsterdam, The Netherlands
| | - Wim J Tissing
- Department of Pediatric Oncology and Hematology, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Leontien C Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Cécile M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
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15
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Farnia B, Majumder MA, Paulino AC. Ethical analysis as a tool for addressing treatment controversies: radiotherapy timing in children with orbital rhabdomyosarcoma as a case example. J Am Coll Radiol 2014; 12:484-90. [PMID: 25544244 DOI: 10.1016/j.jacr.2014.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/16/2014] [Accepted: 10/20/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The treatment of orbital rhabdomyosarcoma is a topic of debate between North American and European clinicians, with the utility of radiation therapy as part of initial management in question. Despite differences in philosophy, the dominant North American approach of upfront radiation and the dominant European approach of radiation only in the event of recurrence yield a similar rate of overall survival. We sought to identify the ethical arguments for each approach. METHODS Established moral principles and appeals in contemporary medical ethics were utilized to identify the ethical arguments supporting each treatment approach. The potential for technologic advances to alter the analysis was considered. RESULTS Emphasizing the principle of beneficence, the North American approach seeks to reduce recurrence rates. In contrast, the European approach seeks to avoid radiation-induced sequelae, emphasizing the principle of nonmaleficence. Both approaches are based on well-established ethical principles, evidence, and clinical experience. Thus, both approaches currently appear to have legitimacy and should be included in the informed consent process. However, if treatment-related toxicity is reduced through improvements in radiation delivery, the North American approach could emerge as ethically superior. CONCLUSIONS Ethical analysis can aid in addressing challenges that arise when professional practices and perspectives differ in the management of cancer patients.
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Affiliation(s)
- Benjamin Farnia
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary A Majumder
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Arnold C Paulino
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
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16
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Rodeberg DA, Wharam MD, Lyden ER, Stoner JA, Brown K, Wolden SL, Paidas CN, Donaldson SS, Hawkins DS, Spunt SL, Arndt CA. Delayed primary excision with subsequent modification of radiotherapy dose for intermediate-risk rhabdomyosarcoma: a report from the Children's Oncology Group Soft Tissue Sarcoma Committee. Int J Cancer 2014; 137:204-11. [PMID: 25418440 DOI: 10.1002/ijc.29351] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 10/09/2014] [Indexed: 12/19/2022]
Abstract
The majority of intermediate-risk rhabdomyosarcoma (RMS) patients have gross residual disease (Group III) after their first operative procedure. It is currently not known if local control rates can be maintained when, following induction chemotherapy, the radiation therapy (RT) dose is decreased after a delayed primary excision (DPE). To answer this question we evaluated patients enrolled on COG D9803 (1999-2005) who had Group III tumors of the bladder dome, extremity or trunk (thorax, abdomen and pelvis) were candidates for DPE at Week 12 if the primary tumor appeared resectable. RT dose was then adjusted by the completeness of DPE: no evidence of disease 36 Gy, microscopic residual 41.4 Gy and gross residual disease (GRD) 50.4 Gy. A total of 161 Group III patients were evaluated (24 bladder dome, 63 extremity and 74 trunk). Seventy-three patients (45%) underwent DPE which achieved removal of all gross disease in 61 (84%) who were then eligible for reduced RT dose (43/73 received 36 Gy, 19/73 received 41.4 Gy). The local 5-year failure rate (0% for bladder dome, 7% for extremity and 20% for trunk) was similar to IRS-IV, which did not encourage DPE and did not allow for DPE adapted RT dose reduction. In conclusion, DPE was performed in 45% of Group III RMS patients with tumors at select anatomic sites (bladder dome, extremity and trunk) and 84% of those who had DPE were eligible for RT dose reduction. Local control outcomes were similar to historic results with RT alone.
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17
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Walterhouse DO, Pappo AS, Meza JL, Breneman JC, Hayes-Jordan AA, Parham DM, Cripe TP, Anderson JR, Meyer WH, Hawkins DS. Shorter-duration therapy using vincristine, dactinomycin, and lower-dose cyclophosphamide with or without radiotherapy for patients with newly diagnosed low-risk rhabdomyosarcoma: a report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group. J Clin Oncol 2014; 32:3547-52. [PMID: 25267746 DOI: 10.1200/jco.2014.55.6787] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Intergroup Rhabdomyosarcoma Study Group (IRSG) studies III and IV showed improved failure-free survival (FFS) rates with vincristine, dactinomycin, and cyclophosphamide (VAC; total cumulative cyclophosphamide dose, 26.4 g/m(2)) compared with vincristine and dactinomycin (VA) for patients with subset-one low-risk embryonal rhabdomyosarcoma (ERMS; stage 1/2 group I/II ERMS or stage 1 group III orbit ERMS). The objective of Children's Oncology Group ARST0331 was to reduce the length of therapy without compromising FFS for this subset of low-risk patients by using VA in combination with lower-dose cyclophosphamide (total cumulative dose, 4.8 g/m(2)) plus radiotherapy (RT). PATIENTS AND METHODS This noninferiority prospective clinical trial enrolled newly diagnosed patients with subset-one clinical features. Therapy included four cycles of VAC followed by four cycles of VA over 22 weeks. Patients with microscopic or gross residual disease at study entry received RT. RESULTS With a median follow-up of 4.3 years, we observed 35 failures among 271 eligible patients versus 48.4 expected failures, calculated using a fixed outcome based on the FFS expected for similar patients treated on the IRSG D9602 protocol. The estimated 3-year FFS rate was 89% (95% CI, 85% to 92%), and the overall survival rate was 98% (95% CI, 95% to 99%). Patients with paratesticular tumors had the most favorable outcome. Three-year cumulative incidence rates for any local, regional, or distant failures were 7.6%, 1.5%, and 3.4%, respectively. CONCLUSION Shorter-duration therapy that included lower-dose cyclophosphamide and RT did not compromise FFS for patients with subset-one low-risk ERMS.
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Affiliation(s)
- David O Walterhouse
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA.
| | - Alberto S Pappo
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Jane L Meza
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - John C Breneman
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Andrea A Hayes-Jordan
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - David M Parham
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Timothy P Cripe
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - James R Anderson
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - William H Meyer
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Douglas S Hawkins
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Alberto S. Pappo, Saint Jude Children's Research Hospital, Memphis, TN; Jane L. Meza, James R. Anderson, University of Nebraska Medical Center College of Public Health, Omaha, NE; John C. Breneman, Children's Hospital Medical Center, Cincinnati; Timothy P. Cripe, Nationwide Children's Hospital, Columbus, OH; Andrea Hayes-Jordan, MD Anderson Cancer Center, Houston, TX; David M. Parham, William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK; Douglas S. Hawkins, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
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18
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Liang W, Gao B, Xu G, Weng D, Xie M, Qian Y. Possible contribution of aminopeptidase N (APN/CD13) to migration and invasion of human osteosarcoma cell lines. Int J Oncol 2014; 45:2475-85. [PMID: 25340499 DOI: 10.3892/ijo.2014.2664] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 09/02/2014] [Indexed: 11/06/2022] Open
Abstract
Osteosarcoma is the most common primary malignancy of the bone. Aminopeptidase N (APN/CD13), a Zn+2-dependent ectopeptidase localized on the cell surface, is widely considered to influence the invasion mechanism. This study explores the potential involvement of APN in migration and invasion of human osteosarcoma cells in vitro using inhi-bitors and activators of APN. Cells treated with APN inhibitor bestatin displayed decreased migration and invasion in a Boyden chamber Transwell assay. Western blotting revealed reduced levels of mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K) pathway proteins, reduced phosphorylation of p38, ERK1/2 and JNK and decreased levels of NF-κB. Bestatin treatment also lowered APN, matrix metalloproteinase (MMP)-2 and -9 enzymatic activity and their mRNA expression. Reduced MMP-2 and -9 protein levels were also observed. By comparison, cells treated with cytokine interleukin-6 (IL-6), a stimulator of APN, displayed increased migration and invasion. Western blotting revealed increased levels of MAPK and PI3K pathway proteins, phosphorylated p38, ERK1/2 and JNK, and NF-κB. IL-6 treatment also increased APN and MMP-2 and -9 enzymatic activity. An increase of APN, MMP-2 and -9 mRNA levels, and MMP-2 and -9 protein levels was also observed. Together these experiments reveal potential enzymatic and signalling roles for APN in osteosarcoma and establish a starting point for an in-depth analysis of the role of APN in regulating invasiveness. A deeper knowledge about the regulatory mechanisms of APN may contribute to the development of anti-metastatic therapies.
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Affiliation(s)
- Wenqing Liang
- Department of Orthopedics, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Bo Gao
- Department of Orthopedics, The 306th Hospital of PLA, Beijing 100101, P.R. China
| | - Guojian Xu
- Department of Orthopedics, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Dong Weng
- Department of Orthopedics, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Minghua Xie
- Department of Orthopedics, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
| | - Yu Qian
- Department of Orthopedics, Shaoxing People's Hospital, Shaoxing, Zhejiang 312000, P.R. China
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Contaldo C, Myers TJ, Zucchini C, Manara MC, Chiodoni C, Colombo MP, Nicoletti G, Lollini PL, Li T, Longobardi L, Scotlandi K, Spagnoli A. Expression levels of insulin receptor substrate-1 modulate the osteoblastic differentiation of mesenchymal stem cells and osteosarcoma cells. Growth Factors 2014; 32:41-52. [PMID: 24438070 DOI: 10.3109/08977194.2013.870168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The insulin-like growth factor-1 system, including its critical mediator insulin receptor substrate-1 (IRS-1), is involved in regulating osteosarcoma (OS) cell proliferation or differentiation. The aim of this study is to define the role of IRS-1 in OS cells by assessing the contribution of IRS-1 in the differentiation of human and murine OS cell lines and mouse mesenchymal stem cells (MSCs) and found that the basal level of IRS-1 is important for the initiation of differentiation. Both down-regulation and over-expression of IRS-1 inhibited osteoblastic differentiation. In vivo studies showed that OS cells over-expressing IRS-1 have increased metastatic potential and tumor growth. The proteasome inhibitor MG-132 led to an increase in IRS-1 protein level that inhibited osteoblastic differentiation, suggesting a role for proteasomal regulation in maintaining the appropriate expression level of IRS-1. Thus, precise regulation of IRS-1 expression level is critical for determining the differentiating capacity of MSCs and OS cells, and that derangement of IRS-1 levels can be a critical step in OS transformation.
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Affiliation(s)
- Clara Contaldo
- Laboratory of Experimental Oncology, CRS Development of Molecular Therapies, Orthopaedic Rizzoli Institute , Bologna , Italy
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20
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Malogolowkin M, Spreafico F, Dome JS, van Tinteren H, Pritchard-Jones K, van den Heuvel-Eibrink MM, Bergeron C, de Kraker J, Graf N. Incidence and outcomes of patients with late recurrence of Wilms' tumor. Pediatr Blood Cancer 2013; 60:1612-5. [PMID: 23737480 DOI: 10.1002/pbc.24604] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 04/26/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Most relapses from Wilms' tumor occur within 2 years from diagnosis. This study aims to describe the incidence and outcome of patients who experienced a late recurrence (LR) more than 5 years after diagnosis across several clinical trials, and to develop evidence-based recommendations for follow-up surveillance. METHODS Available records on children with Wilms' tumor enrolled onto 10 national or international cooperative clinical trials were reviewed to identify patients who experienced a LR. RESULTS Seventy of 13,330 (0.5%) patients with Wilms' tumor experienced a LR. No gender bias was observed. Median time elapsing between initial Wilms' tumor diagnosis and first recurrence was 13.2 years (range: 5.1-17.3 years). Initial tumor stage was: stage I (15); stage II (19); stage III (14); stage IV (8); bilateral disease stage V (14). The most frequent sites of relapse were--abdomen: 21, lungs: 20, and contralateral kidney: 15. Thirty-five children died of disease progression. Recurrence in the contralateral kidney was associated with a better outcome (13/15 patients alive), while initial tumor stage did not seem to influence the post-recurrence outcome. Therapies administered at recurrence varied between centers, preventing any conclusion about the best salvage treatment. CONCLUSIONS LR of Wilms' tumor is rare and associated with similar outcome to those experiencing earlier recurrence. The low rate of LR does not justify prolonged monitoring. Further study of the biology of these tumors may give us some insights in regards to mechanisms on tumor cell dormancy or cancer stem cell maintenance.
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Affiliation(s)
- M Malogolowkin
- Division of Hematology-Oncology-Bone Marrow Transplant, Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA.
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21
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Zhu L, McManus MM, Hughes DPM. Understanding the Biology of Bone Sarcoma from Early Initiating Events through Late Events in Metastasis and Disease Progression. Front Oncol 2013; 3:230. [PMID: 24062983 PMCID: PMC3775316 DOI: 10.3389/fonc.2013.00230] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/21/2013] [Indexed: 12/27/2022] Open
Abstract
The two most common primary bone malignancies, osteosarcoma (OS), and Ewing sarcoma (ES), are both aggressive, highly metastatic cancers that most often strike teens, though both can be found in younger children and adults. Despite distinct origins and pathogenesis, both diseases share several mechanisms of progression and metastasis, including neovascularization, invasion, anoikis resistance, chemoresistance, and evasion of the immune response. Some of these processes are well-studies in more common carcinoma models, and the observation from adult diseases may be readily applied to pediatric bone sarcomas. Neovascularization, which includes angiogenesis and vasculogenesis, is a clear example of a process that is likely to be similar between carcinomas and sarcomas, since the responding cells are the same in each case. Chemoresistance mechanisms also may be similar between other cancers and the bone sarcomas. Since OS and ES are mesenchymal in origin, the process of epithelial-to-mesenchymal transition is largely absent in bone sarcomas, necessitating different approaches to study progression and metastasis in these diseases. One process that is less well-studied in bone sarcomas is dormancy, which allows micrometastatic disease to remain viable but not growing in distant sites – typically the lungs – for months or years before renewing growth to become overt metastatic disease. By understanding the basic biology of these processes, novel therapeutic strategies may be developed that could improve survival in children with OS or ES.
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Affiliation(s)
- Limin Zhu
- Department of Pediatrics - Research, UT MD Anderson Cancer Center , Houston, TX , USA
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22
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Abstract
The most common childhood genitourinary cancers are Wilms tumour, rhabdomyosarcoma and germ cell tumour (GCT). Long-term survival rates for patients with these tumours are generally excellent, ranging from 80% to 100%. However, the high cure rates have highlighted the need to minimize the long-term complications of treatments (referred to as 'late effects'), which can be caused by the three treatment modalities used to treat genitourinary tumours: surgery, chemotherapy and radiation therapy. Serious late effects, such as death, second cancers and tumour recurrence, are uncommon but do occur occasionally. Chronic health conditions--such as cardiac, pulmonary and fertility disorders--are more prevalent. Given the high prevalence of late effects, survivors of childhood genitourinary malignancies require regular surveillance and health promotion delivered by health-care providers with specialist knowledge of the long-term complications of treatment.
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Affiliation(s)
- Karim T Sadak
- Division of Oncology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA
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Bisogno G, Pastore G, Perilongo G, Sotti G, Cecchetto G, Dallorso S, Carli M. Long-term results in childhood rhabdomyosarcoma: a report from the Italian Cooperative Study RMS 79. Pediatr Blood Cancer 2012; 58:872-6. [PMID: 22028198 DOI: 10.1002/pbc.23292] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 06/30/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND The results obtained by protocols for children with rhabdomyosarcoma (RMS) have improved in recent decades. Survival curves usually reach a plateau 3 years after the diagnosis, suggesting that long-term survival can be expected, but late events are known to occur. We analyzed the long-term results of the RMS 79 protocol to investigate the type and impact of such events. PROCEDURE From 1979 to 1987, 163 children with RMS diagnosed at 21 Italian institutions were registered. Each institution was contacted every year to record patients' status after the end of treatment. When patients were lost to follow-up, their status was checked by inquiring at the Registry Offices of the towns of residence and the cause of death or occurrence of second cancers was investigated by contacting the patients or their family by phone. RESULTS Overall, 16 patients had late events, that is, 7 tumor recurrences, 6 second tumors, and 3 deaths due to treatment-related complications. The overall survival rates dropped from 62.6 at 3 years to 52.8 at 20 years. By multivariate analysis, the characteristics influencing long-term survival were histology, tumor site and size, and IRS group. Factors predictive of any kind of late event were tumor site and IRS group. CONCLUSIONS Major late events can significantly affect the long-term survival of children with RMS. Modern protocols should provide for a much longer follow-up than is usually considered to confirm the results achieved and enable possible correlations between primary treatment and late events to be investigated.
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Affiliation(s)
- Gianni Bisogno
- Department of Pediatrics, University Hospital of Padova, Padova, Italy.
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Anovulatory bleeding in a 12-year-old as presenting sign for rare undifferentiated sarcoma. J Pediatr Adolesc Gynecol 2011; 24:e97-e100. [PMID: 21620741 DOI: 10.1016/j.jpag.2011.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Revised: 03/08/2011] [Accepted: 03/10/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Abnormal uterine bleeding is a common phenomenon in perimenarchal females. Though most cases of abnormal bleeding are due to anovulatory bleeding or bleeding disorders, rare cases are attributable to underlying malignancy. CASE Here we report a 12-year-old female patient who presented with abnormal uterine bleeding three months after menarche. She was ultimately diagnosed with a pelvic sarcoma of unknown primary origin. She was subsequently treated with chemotherapy, whole pelvic radiation, and hysterectomy with bilateral salpingo-oophorectomy. SUMMARY Abnormal uterine bleeding unresponsive to conventional temporizing measures should be thoroughly evaluated. Management of pelvic malignancies in the pediatric population requires cooperation amongst specialists from an array of disciplines.
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Sugawara W, Arai Y, Kasai F, Fujiwara Y, Haruta M, Hosaka R, Nishida K, Kurosumi M, Kobayashi Y, Akagi K, Kaneko Y. Association of germline or somatic TP53 missense mutation with oncogene amplification in tumors developed in patients with Li-Fraumeni or Li-Fraumeni-like syndrome. Genes Chromosomes Cancer 2011; 50:535-45. [DOI: 10.1002/gcc.20878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 03/18/2011] [Indexed: 11/11/2022] Open
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Wasilewski-Masker K, Liu Q, Yasui Y, Leisenring W, Meacham LR, Hammond S, Meadows AT, Robison LL, Mertens AC. Late recurrence in pediatric cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 2009; 101:1709-20. [PMID: 19966206 DOI: 10.1093/jnci/djp417] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An increasing percentage of childhood cancer patients are surviving their disease, but there is limited research on late recurrence. We sought to estimate late recurrence rates for the most common pediatric cancers and to determine risk factors for late recurrence. METHODS The incidence of late recurrences, or first recurrences that occurred more than 5 years after diagnosis, was analyzed for the most common pediatric cancers using data from the Childhood Cancer Survivor Study, a retrospective cohort of 5-year survivors of childhood and adolescent cancers who were diagnosed between 1970 and 1986. A total of 12,795 survivors with no history of recurrence within 5 years after their original cancer diagnosis were included in the analysis, with a total of 217,127 person-years of follow-up. Cumulative incidence of late recurrence at 5, 10, 15, and 20 years after diagnosis was calculated using death as a competing risk. Adjusted relative rates of late recurrence were obtained using multivariable Poisson regression. All statistical tests were two-sided. RESULTS Overall, 5-year survivors of pediatric cancers experienced a cumulative incidence of recurrent disease of 4.4%, 5.6%, and 6.2% at 10, 15, and 20 years, respectively. Cumulative incidence varied by diagnosis: Survivors of Ewing sarcoma and astrocytoma had the highest 20-year cumulative incidences at 13.0% (95% confidence interval [CI] = 9.4 to 16.5) and 14.4% (95% CI = 12.3 to 16.6), respectively. In multivariable analysis, the greatest risk factors for late recurrence included diagnosis, combination treatment with chemotherapy and radiation, earlier treatment era, and fewer years since diagnosis (P < .001 for all). CONCLUSION Late recurrence is a risk for some pediatric cancers. By understanding diagnosis-specific risks, patients, families, and their medical providers can be better informed of the probability of cure.
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Affiliation(s)
- Karen Wasilewski-Masker
- Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta at Scottish Rite, 5455 Meridian Mark Rd, Ste 400, Atlanta, GA 30342, USA.
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Late relapse of botryoid embryonal rhabdomyosarcoma of the vagina in prepubertal age. J Pediatr Hematol Oncol 2009; 31:380-1. [PMID: 19415026 DOI: 10.1097/mph.0b013e31819ed289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vasquez R, Collini P, Meazza C, Favini F, Casanova M, Ferrari A. Late relapse of embryonal rhabdomyosarcoma, botryoid variant, of the vagina. Pediatr Blood Cancer 2008; 51:140-1. [PMID: 18253956 DOI: 10.1002/pbc.21482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report on two very similar cases of vaginal embryonal RMS, botryoid variant, that relapsed 9 and 10 years after initial diagnosis, a few months after the menarche in both cases. A possible causal association with estrogen hormones is hypothesized, particularly for the second case described, in which estrogen receptors were negative in the primary tumor specimen and positive in the relapsing tumor specimen.
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Affiliation(s)
- Roberto Vasquez
- Department of Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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30
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Abstract
Rhabdomyosarcoma is the most common sarcoma of childhood. Fortunately, the goal of cure is realistic for the majority of patients with localized tumors. However, management of these patients remains challenging. The fact that the tumor arises in a wide variety of primary sites, some of which are associated with specific patterns of local invasion, regional lymph node spread, and therapeutic response, requires physicians to be familiar with site-specific staging and treatment details. In addition, rhabdomyosarcoma requires multimodality therapy that can be associated with significant acute toxicities and long-term effects, particularly when administered to young children. These factors sometimes present a dilemma as to the best approach to optimize the chance of cure, minimize toxicity, and respect quality of life. The purpose of this review is to discuss 'optimal' management of this complicated tumor. Since the tumor is relatively rare, requires highly specialized care, and important management questions remain to be answered, optimal management of rhabdomyosarcoma includes enrollment in clinical trials whenever possible. Appropriate management begins with establishing the correct pathologic diagnosis, histologic subtype, primary site, extent of disease (International Society of Pediatric Oncology [SIOP]-TNM-Union Internationale Contre le Cancer stage or Intergroup Rhabdomyosarcoma Study Group [IRSG] stage), and extent of resection (IRSG group). Cooperative groups throughout North America and Europe have defined risk-adapted treatment based on these factors; this treatment requires a coordinated management plan that includes surgery, chemotherapy, and usually radiotherapy. The surgical approach for rhabdomyosarcoma is to excise the primary tumor whenever possible without causing major functional or cosmetic deficits. Wide excision is difficult in some primary sites and can be complicated by the fact that the tumor grows in a locally infiltrative manner so that complete resection is often neither possible nor medically indicated. Incompletely resected tumors are generally treated with radiotherapy. The cooperative groups reduce the dose of radiation based on the response of the tumor to chemotherapy and delayed primary resection to differing degrees. Response-adjusted radiation administration may reduce the long-term effects of radiotherapy, such as bone growth arrest, muscle atrophy, bladder dysfunction, and induction of second malignant neoplasms; however, it may also be associated with an increased risk of tumor recurrence. All patients with rhabdomyosarcoma require chemotherapy. A backbone of vincristine and dactinomycin with either cyclophosphamide (VAC) or ifosfamide (IVA) has been established. Risk-adapted treatment involves reducing or eliminating the alklyating agent for patients with the most favorable disease characteristics. Clinical trials are ongoing to improve outcomes for higher risk patients; newer agents, such as topotecan or irinotecan, in combination with VAC or use of agents in novel ways are being investigated. Acute and long-term toxicities associated with these chemotherapy regimens include myelosuppression, febrile neutropenia, hepatopathy, infertility, and second malignant neoplasms. A 5-year survival rate >70% has been achieved in recent trials for patients with localized rhabdomyosarcoma. However, the outcome for patients who present with metastatic disease remains poor. In the future, risk-adapted classification of rhabdomyosarcoma will likely be based on biologic features, such as the presence of chromosomal translocations or specific gene expression profiles. It is hoped that newer therapies directed at specific molecular genetic defects will benefit all patients with rhabdomyosarcoma.
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Affiliation(s)
- David Walterhouse
- Division of Hematology/Oncology, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60614, USA.
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Dantonello TM, Int-Veen C, Winkler P, Leuschner I, Schuck A, Schmidt BF, Lochbuehler H, Kirsch S, Hallmen E, Veit-Friedrich I, Bielack SS, Niggli F, Kazanowska B, Ladenstein R, Wiebe T, Klingebiel T, Treuner J, Koscielniak E. Initial Patient Characteristics Can Predict Pattern and Risk of Relapse in Localized Rhabdomyosarcoma. J Clin Oncol 2008; 26:406-13. [DOI: 10.1200/jco.2007.12.2382] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Evaluation of primary tumor-, treatment-, and patient-related factors predicting relapse pattern, risk, and survival after relapse with the aim to design a risk-adapted, tumor-directed surveillance program for patients with localized rhabdomyosarcoma (RMS). Patients and Methods One thousand one hundred sixty-four patients with nonmetastatic RMS achieved complete remission at the end of multimodal therapy in the consecutive trials of the Cooperative Weichteilsarkom Studiengruppe (CWS)-81, CWS-86, CWS-91, and CWS-96 between 1980 and 2002 (median follow-up, 5 years). Three hundred thirty-seven of these individuals developed either locoregional, metastatic, or combined relapses. Predictive factors for relapse, its pattern, and postrelapse survival were analyzed. Results Age, histology, tumor size, tumor site, postsurgical stage, and omission of radiotherapy were identified as factors associated with an increased relapse risk in multivariate analyses. Relapse rates did not differ among the CWS trials. Median time to relapse was 1.43 years from first diagnosis (range, 0.13 to 13.5 years). There were 217 locoregional, 72 metastatic, and 48 combined recurrences. Only two patients developed metastases more than 4 years after diagnosis, and both had combined recurrences. Five-year postrelapse survival was 24%. Patient subsets with consistent relapse pattern, risk, and postrelapse survival rates were identified on the basis of histologic subtype and tumor size. Conclusion Initial patient and tumor characteristics predict pattern and risk of relapse and also correlate with postrelapse survival probabilities. In localized RMS, tumor-directed follow-up should focus on the primary site. Screening for metastatic relapse may not be necessary more than 4 years after diagnosis. The identification of subgroups with distinctive pattern and risk of relapse may be used to develop risk-adapted, tumor-directed guidance for detection of recurrent disease in localized RMS.
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Affiliation(s)
- Tobias M. Dantonello
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Christoph Int-Veen
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Peter Winkler
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Ivo Leuschner
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Andreas Schuck
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Bernhard F. Schmidt
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Helmut Lochbuehler
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Sylvia Kirsch
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Erika Hallmen
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Iris Veit-Friedrich
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Stefan S. Bielack
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Felix Niggli
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Bernarda Kazanowska
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Ruth Ladenstein
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Thomas Wiebe
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Thomas Klingebiel
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Joern Treuner
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
| | - Ewa Koscielniak
- From the Olgahospital, Pediatrics 5 (Oncology, Hematology, Immunology), Department of Pediatric Oncology, and Department of Pediatric Surgery; Katharinenhospital, Department of Radiotherapy, Klinikum Stuttgart, Stuttgart; Institute of Pediatric Pathology, University of Kiel, Kiel; Department of Radiotherapy, University of Muenster; Department of Pediatric Hematology and Oncology, University Children's Hospital, Muenster; Department of Pediatric Oncology, University of Frankfurt (Main), Frankfurt
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Sbeity S, Abella A, Arcand P, Quintal MC, Saliba I. Temporal bone rhabdomyosarcoma in children. Int J Pediatr Otorhinolaryngol 2007; 71:807-14. [PMID: 17346806 DOI: 10.1016/j.ijporl.2007.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 02/01/2007] [Accepted: 02/01/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Rhabdomyosarcoma is the most frequent soft tissue sarcoma in the pediatric age group. The authors present their series of rhabdomyosarcoma of the temporal bone in children at Saint Justine Hospital. The twofold objective of this study is to illustrate the clinical presentation, management, and prognosis of this malignant striated muscle tumor, and to compare these results with previously reported series. METHODS A retrospective study was conducted of patients diagnosed and treated for rhabdomyosarcoma of the head and neck at Saint Justine Hospital, a tertiary pediatric center, between 1970 and 2005. Only cases of temporal bone rhabdomyosarcoma were included in the study. A thorough review of medical and surgical charts was performed to obtain demographic, clinical, paraclinical, and therapeutic data, which were subsequently analyzed and compared to published results. A MEDLINE search yielded 34 studies dealing with temporal bone rhabdomyosarcoma since the year 1966. RESULTS Thirty-nine patients with rhabdomyosarcoma of the head and neck region were identified, among which only six children had temporal bone rhabdomyosarcoma. The mean age at the time of diagnosis was 4.15 years. Chronic otitis media was the most common clinical presentation. Five children had the embryonal subtype and one had the botryoid subtype on histology. All patients except two received combined chemotherapy and radiotherapy as treatment. Five-year survival rate was 66%. Our results match those reported in the literature 41-81%. CONCLUSION Rhabdomyosarcoma of the temporal bone is an aggressive tumor that clinically simulates chronic otitis media. A high index of suspicion should be raised in the context of otitis media that is unresponsive to ordinary medical treatment. A biopsy is hence recommended in the presence of polyps in the external auditory canal that are resistant to medical treatment. Early diagnosis and the adoption of multimodal therapy offer the best outcome.
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Affiliation(s)
- S Sbeity
- ENT, Hôpital Sainte-Justine, 3175, Côte Sainte-Catherine, Service ORL, Montréal, Que. H3T 1C5, Canada.
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33
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Abstract
Whether in its preventive role of CNS prophylaxis for high-risk ALL, its central role in brain tumors, its adjunct role combined with chemotherapy for disease such as Hodgkin's lymphoma, Ewing's sarcoma, and rhabdomyosarcoma, or its palliative role for metastatic disease, radiation remains an important therapy for pediatric cancers.
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Affiliation(s)
- Iris C Gibbs
- Department of Radiation Oncology, Stanford Cancer Center, School of Medicine, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305-5847, USA.
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34
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Abstract
Rhabdomyosarcoma is a typical tumor of childhood and adolescence. Over the years there has been a gradual but important improvement in survival for patients with this tumor, despite its high grade of malignancy. These results are due to multidisciplinary treatment approaches including surgery, radiotherapy and especially chemotherapy. Rhabdomyosarcoma is a highly chemosensitive neoplasm, and the role of this therapeutic approach has also been clearly demonstrated in the adjuvant setting. This review covers current concepts on chemotherapy for rhabdomyosarcoma, with an overview of the results of the main clinical trials conducted over recent years and considerations of possible strategies for the near future. Recommendations for adult patients with rhabdomyosarcoma are also discussed, suggesting that these patients should be treated according to pediatric guidelines.
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Affiliation(s)
- Andrea Ferrari
- Istituto Nazionale Tumori, Via G.Venezian, 1-20133 Milan, Italy.
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35
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Punyko JA, Mertens AC, Baker KS, Ness KK, Robison LL, Gurney JG. Long-term survival probabilities for childhood rhabdomyosarcoma. A population-based evaluation. Cancer 2005; 103:1475-83. [PMID: 15712283 DOI: 10.1002/cncr.20929] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evidence from clinical trials has documented improvements in event-free survival from childhood rhabdomyosarcoma (RMS) since the 1970s; however, the survival experience of children enrolled on cancer clinical trials may not reflect the full range of patients treated in community settings. The current study evaluated 5-year survival and 10-year conditional survival for RMS from U.S. population-based cancer registry data. METHODS Public-use data from the Surveillance, Epidemiology, and End Results (SEER) program were used in life table and Cox regression analyses to evaluate RMS survival by patient age at diagnosis, gender, tumor histology, tumor site and stage, and major treatment eras among 848 children who were age < 20 years at the time of diagnosis, were a resident of 1 of 9 geographic reporting regions, and were diagnosed between 1973 and 2000. RESULTS The 5-year survival probabilities were found to be highest for younger-age children (ages 1-4 years: 77%), patients with localized disease (83%), those whose tumors had an embryonal histology (67%), and patients with orbital (86%) and genitourinary (80%) tumor sites. Poor prognosis was associated with diagnosis during infancy (47%) and adolescence (48%); metastatic disease at the time of presentation (31%); alveolar histology (49%); and tumors of the extremities (50%), retroperitoneum (52%), and trunk (52%). Conditional 10-year survival probabilities among those who survived > or = 5 years were 85% or higher. The probability of survival by stage at the time of diagnosis increased with each successive treatment era, suggesting a stage shift phenomenon over time. CONCLUSIONS Large variations in 5-year survival were evident depending on patient age and tumor characteristics. However, children who survived the first 5 years after diagnosis were found to have an excellent long-term prognosis. The patterns in RMS survival noted from the current population-based evaluation did not appear to differ substantially from those previously reported by major clinical trials.
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Affiliation(s)
- Judith A Punyko
- Department of Pediatrics and the University of Minnesota Cancer Center, University of Minnesota, Minneapolis, Minnesota 55455, USA
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36
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Abstract
Survival of children and young people with rhabdomyosarcoma has improved substantially during the past 30 years. The improvement can be attributed to the introduction of coordinated multimodality therapy through the efforts of collaborative clinical-trial groups in the USA and Europe. As survival has improved, important late sequelae of treatment have been characterised, and many relate to the local therapy used. Efforts have since been made by some groups to explore ways in which local treatment, particularly radiotherapy, can be omitted for some patients in an attempt to reduce the risk of late sequelae without compromising prospects for cure. An important issue is the overall cost of cure in relation to the treatment received and the need for better selection of patients most likely to benefit from this approach to therapy.
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