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Miyagishima KJ, Qiao F, Stasheff SF, Nadal-Nicolás FM. Visual Deficits and Diagnostic and Therapeutic Strategies for Neurofibromatosis Type 1: Bridging Science and Patient-Centered Care. Vision (Basel) 2024; 8:31. [PMID: 38804352 PMCID: PMC11130890 DOI: 10.3390/vision8020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024] Open
Abstract
Neurofibromatosis type 1 (NF1) is an inherited autosomal dominant disorder primarily affecting children and adolescents characterized by multisystemic clinical manifestations. Mutations in neurofibromin, the protein encoded by the Nf1 tumor suppressor gene, result in dysregulation of the RAS/MAPK pathway leading to uncontrolled cell growth and migration. Neurofibromin is highly expressed in several cell lineages including melanocytes, glial cells, neurons, and Schwann cells. Individuals with NF1 possess a genetic predisposition to central nervous system neoplasms, particularly gliomas affecting the visual pathway, known as optic pathway gliomas (OPGs). While OPGs are typically asymptomatic and benign, they can induce visual impairment in some patients. This review provides insight into the spectrum and visual outcomes of NF1, current diagnostic techniques and therapeutic interventions, and explores the influence of NF1-OPGS on visual abnormalities. We focus on recent advancements in preclinical animal models to elucidate the underlying mechanisms of NF1 pathology and therapies targeting NF1-OPGs. Overall, our review highlights the involvement of retinal ganglion cell dysfunction and degeneration in NF1 disease, and the need for further research to transform scientific laboratory discoveries to improved patient outcomes.
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Affiliation(s)
- Kiyoharu J. Miyagishima
- Retinal Neurophysiology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.J.M.); (F.Q.); (S.F.S.)
| | - Fengyu Qiao
- Retinal Neurophysiology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.J.M.); (F.Q.); (S.F.S.)
| | - Steven F. Stasheff
- Retinal Neurophysiology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.J.M.); (F.Q.); (S.F.S.)
- Center for Neuroscience and Behavioral Medicine, Gilbert Neurofibromatosis Institute, Children’s National Health System, Washington, DC 20010, USA
- Neurology Department, George Washington University School of Medicine, Washington, DC 20037, USA
| | - Francisco M. Nadal-Nicolás
- Retinal Neurophysiology Section, National Eye Institute, National Institutes of Health, Bethesda, MD 20892, USA; (K.J.M.); (F.Q.); (S.F.S.)
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2
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Kotch C, de Blank P, Gutmann DH, Fisher MJ. Low-grade glioma in children with neurofibromatosis type 1: surveillance, treatment indications, management, and future directions. Childs Nerv Syst 2024:10.1007/s00381-024-06430-8. [PMID: 38704493 DOI: 10.1007/s00381-024-06430-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/26/2024] [Indexed: 05/06/2024]
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant cancer predisposition syndrome characterized by the development of both central and peripheral nervous system tumors. Low-grade glioma (LGG) is the most prevalent central nervous system tumor occurring in children with NF1, arising most frequently within the optic pathway, followed by the brainstem. Historically, treatment of NF1-LGG has been limited to conventional cytotoxic chemotherapy and surgery. Despite treatment with chemotherapy, a subset of children with NF1-LGG fail initial therapy, have a continued decline in function, or recur. The recent development of several preclinical models has allowed for the identification of novel, molecularly targeted therapies. At present, exploration of these novel precision-based therapies is ongoing in the preclinical setting and through larger, collaborative clinical trials. Herein, we review the approach to surveillance and management of NF1-LGG in children and discuss upcoming novel therapies and treatment protocols.
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Affiliation(s)
- Chelsea Kotch
- Division of Oncology, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Peter de Blank
- Division of Oncology, University of Cincinnati Medical Center and Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David H Gutmann
- Division of Neurology, Washington University of St. Louis, St. Louis, MO, USA
| | - Michael J Fisher
- Division of Oncology, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
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3
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Irshad K, Huang YK, Rodriguez P, Lo J, Aghoghovwia BE, Pan Y, Chang KC. The Neuroimmune Regulation and Potential Therapeutic Strategies of Optic Pathway Glioma. Brain Sci 2023; 13:1424. [PMID: 37891793 PMCID: PMC10605541 DOI: 10.3390/brainsci13101424] [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: 09/08/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
Optic pathway glioma (OPG) is one of the causes of pediatric visual impairment. Unfortunately, there is as yet no cure for such a disease. Understanding the underlying mechanisms and the potential therapeutic strategies may help to delay the progression of OPG and rescue the visual morbidities. Here, we provide an overview of preclinical OPG studies and the regulatory pathways controlling OPG pathophysiology. We next discuss the role of microenvironmental cells (neurons, T cells, and tumor-associated microglia and macrophages) in OPG development. Last, we provide insight into potential therapeutic strategies for treating OPG and promoting axon regeneration.
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Affiliation(s)
- Khushboo Irshad
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.I.); (B.E.A.)
| | - Yu-Kai Huang
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan;
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Paul Rodriguez
- Department of Ophthalmology, Louis J. Fox Center for Vision Restoration, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
| | - Jung Lo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Benjamin E. Aghoghovwia
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.I.); (B.E.A.)
| | - Yuan Pan
- Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (K.I.); (B.E.A.)
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kun-Che Chang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Ophthalmology, Louis J. Fox Center for Vision Restoration, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA;
- Department of Neurobiology, Center of Neuroscience, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
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Rajagopal R, Khan M, Lethbridge R, Lee G, Lee S, Dyke J, Fabian V, McGrath A, Taylor M, Jacoby P, Endersby R, Nagabushan S, Gottardo NG. Long-term outcomes of symptomatic optic pathway glioma: 32-year experience at a single Western Australian tertiary pediatric oncology center. Front Oncol 2023; 13:1157909. [PMID: 37519788 PMCID: PMC10379632 DOI: 10.3389/fonc.2023.1157909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Optic pathway gliomas (OPGs) are associated with significant risk of visual and endocrine morbidity, but data on long-term outcomes in symptomatic patients is sparse. This study reviews the clinical course, disease progression, survival outcomes and long-term sequelae in pediatric patients with symptomatic OPGs in our institution over three decades. Methods Retrospective review of patients with symptomatic OPG treated in a single tertiary pediatric oncology center from 1984 to 2016. Results A total of 37 patients were diagnosed with symptomatic OPG. Decreased visual acuity was the commonest presenting symptom (75.7%). Surgical intervention was performed in 62.2%; 56.5% underwent biopsy, 26.1% surgical debulking and 17.4% had orbital decompression with cystic fenestration and cosmetic optic nerve excision at different treatment intervals. CSF diversion was performed in 47.8% patients. Histopathologic examination confirmed 86% to be pilocytic astrocytoma and 1 ganglioglioma. 46% received chemotherapy and 48% had radiotherapy, at different intervals. Median follow-up was 13.74 years. In NF1 patients, overall survival (OS) was 100% at 5 years and 55.6 ± 24.8% at 25 years while progression-free-survival (PFS) was 50 ± 15.8% at 5 and 20 years. In non-NF1 patients, OS was 96.2 ± 3.8% at 5 years and 87.4 ± 9% at 25-years. 5-year PFS was 53.8 ± 9.8% and 25-year PFS was 49.0 ± 10%. Cumulative PFS was 53 ± 8.3% at 5 years and 49.7 ± 8.4% at 20 years while cumulative OS was 97.2 ± 2.7% at 5 years and 77.5 ± 10.8% at 25 years. 59.5% patients developed post-operative endocrinopathy. Long-term vision was normal in 8.1%, improved in 13.5%, stabilized in 40.5% but worsened in 37.8% patients. Three patients treated with radiotherapy developed second brain tumors. Conclusion 25-year OS in this cohort was 77.5% but survivorship carried significant long-term morbidities including radiation-induced second malignant brain tumors.
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Affiliation(s)
- Revathi Rajagopal
- Department of Global Pediatric Medicine, St Jude Children’s Research Hospital, Memphis, TN, United States
| | - Mumtaz Khan
- Department of Anesthesia, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Robert Lethbridge
- School of Pediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - Gabriel Lee
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Sharon Lee
- Department of Neurosurgery, Perth Children’s Hospital, Perth, WA, Australia
| | - Jason Dyke
- Department of Neuropathology, Royal Perth Hospital, Perth, WA, Australia
| | - Vicki Fabian
- Department of Neuropathology, Royal Perth Hospital, Perth, WA, Australia
| | - Alycea McGrath
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Mandy Taylor
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Peter Jacoby
- Department of Biostatistics, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Raelene Endersby
- Brain Tumor Research Program, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sumanth Nagabushan
- Kids Cancer Centre, Sydney Children’s Hospital, Sydney, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW, Australia
| | - Nicholas G. Gottardo
- Brain Tumor Research Program, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Department of Pediatric and Adolescent Oncology and Hematology, Perth Children’s Hospital, Perth, WA, Australia
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5
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Bai L, Zhan Y, Zhou Y, Zhang Y, Shi L, Gupta S, Denburg A, Guan X. Evidence of clinical benefit of WHO essential anticancer medicines for children, 2011-2021. EClinicalMedicine 2023; 59:101966. [PMID: 37125406 PMCID: PMC10130597 DOI: 10.1016/j.eclinm.2023.101966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/02/2023] Open
Abstract
Background Access to essential cancer medicines is a key determinant of childhood cancer survival. WHO published the Model List of Essential Medicine for Children (EMLc) and updated it every two years since 2007 to promote better access to medicines for children. This study aimed to assess whether the inclusion of essential anticancer medicines for respective indications for children was based on evidence of significant clinical benefit between 2011 and 2021. Methods We identified all anticancer medicine indications added to the WHO EMLc Section 8 since 2011 and extracted evidence of benefit documented in the corresponding technical reports. Evidence in children was defined as evidence that included participants under 12, and graded into five levels, according to the Oxford Centre for Evidence-Based Medicine Levels of Evidence. We analyzed whether each anticancer medicine indication was listed with documented OS benefit or improvements in surrogate measures based on the highest level of documented evidence in children. Findings A total of 115 anticancer medicine indications were added to the EMLc from 2011 to 2021, of which 101 (87.8%) had some clinical evidence in children and 4 (3.5%) were added without any clinical evidence. Among the 101 medicine indications, none were added with level-1 evidence in children, and 43 (42.6%), 11 (10.9%), 41 (40.6%), and 6 (5.9%) were listed with level-2, level-3, level-4, and level-5 evidence in children, respectively. Only eight (7.9%) medicine indications were reported to have OS benefit, another 12 (11.9%) were reported to have improvements on surrogate measures, and 81 (80.2%) were listed in the EMLc without documented improvements in either OS or surrogate measures. Interpretation Most anticancer medicine indications of the WHO EMLc were added based on limited evidence of statistically significant clinical benefit in children. Our results suggest that WHO should refine requirements for clinical benefit criteria and permissible forms, quality, and reporting of evidence of essential anticancer medicines for children, specify whether anticancer medicine indications have required evidence of clinical benefit in children, and provide further details in its technical reports that summarise the available evidence. Funding Not applicable.
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Affiliation(s)
- Lin Bai
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Yuqi Zhan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- Department of Pharmacy, Peking University People's Hospital, Beijing, 100044, China
| | - Yichen Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing, 100191, China
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Avram Denburg
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing, 100191, China
- Corresponding author. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China.
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6
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Bowman R, Walters B, Smith V, Prise KL, Handley SE, Green K, Mankad K, O'Hare P, Dahl C, Jorgensen M, Opocher E, Hargrave D, Thompson DA. Visual outcomes and predictors in optic pathway glioma: a single centre study. Eye (Lond) 2023; 37:1178-1183. [PMID: 35562551 PMCID: PMC10101957 DOI: 10.1038/s41433-022-02096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/31/2022] [Accepted: 05/06/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/AIMS Optic pathway gliomas (OPGs) may cause progressive visual loss despite chemotherapy. Newer, less toxic treatments might be given earlier, depending on visual prognosis. We aimed to investigate the prognostic value of visual evoked potentials (VEP) and optical coherence tomography (OCT). METHODS A retrospective study of OPG patients (treated 2003-2017) was conducted. Primary outcome was PEDIG category visual acuity in better and worse eyes (good < = 0.2, moderate 0.3-0.6 and poor > = 0.7 logMAR). Binary logistic regression analysis was used to identify predictors of these outcomes. RESULTS 60 patients (32 Neurofibromatosis type 1 [NF1] and 28 sporadic) had median presentation age 49 months (range 17-183) (NF1) and 27 months (range 4-92) (sporadic). Median follow up was 82 months (range 12-189 months). At follow up 24/32 (75%) of NF1 children and 14/28 (50%) of sporadic children had good better eye visual acuity and 11/32 (34%) of NF1 children and 15/28 (54%) of sporadics had poor worse eye acuity. Mean peripapillary retinal nerve fibre layer (RNFL) thickness predicted good better eye final acuity (OR 0.799, 95%CI 0.646-0.987, p = 0.038). Presenting with visual symptoms (OR 0.22 95% CI 0.001-0.508, p = 0.017) and poorer VEP scores (OR 2.35 95% CI 1.1-5.03, p = 0.027) predicted poor worse eye final acuity. 16 children had homonymous hemianopias at follow up, predicted by poor presenting binocular VEP score (OR 1.449 95%CI 1.052-1.995, p = 0.02). CONCLUSIONS We found that both RNFL thickness on OCT and VEP were useful in predicting future visual acuity and vision and potentially in planning treatment. We had a high prevalence of homonymous hemianopia.
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Affiliation(s)
- R Bowman
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England.
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England.
| | - B Walters
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - V Smith
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - K L Prise
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - S E Handley
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England
| | - K Green
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - K Mankad
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England
| | - P O'Hare
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - C Dahl
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - M Jorgensen
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - E Opocher
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
| | - D Hargrave
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England
| | - D A Thompson
- Great Ormond Street Hospital, Great Ormond Street NHS Foundation Trust, WC1N 3JH, London, England
- University College London, Great Ormond Street Institute of Child Health, WC1N 1EH, London, England
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7
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Bianchi F, Cocilovo FM, Ruggiero A, Tamburrini G. Optic Pathway Gliomas: The Trends of Basic Research to Reduce the Impact of the Disease on Visual Function. Adv Tech Stand Neurosurg 2023; 48:123-137. [PMID: 37770684 DOI: 10.1007/978-3-031-36785-4_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Pediatric optic pathway gliomas (OPG) are low-grade brain tumors characterized by slow progression and invalidating visual loss. Common therapeutic strategies include surgery, radiotherapy, chemotherapy, and combinations of these modalities, but despite the different treatment strategies, no actual treatment exists to prevent or revert visual impairment. Nowadays, several reports of the literature show promising results regarding NGF eye drop instillation and improvement of visual outcome. Such results seem to be related with the NGF-linked prevention in caspase activation, which reduces retinal ganglion cell loss.Reducing retinal ganglion cell loss results clinically in visual field improvement as well as visual electric potential and optical coherence tomography gain. Nonetheless, visual acuity fails to show significant changes.Visual impairment represents nowadays one of the major issues in dealing with OPGs. Secondary to the interesting results offered by NGF eye drop administration, further studies are warranted to better comprehend potential treatment strategies.
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Affiliation(s)
| | | | - Antonio Ruggiero
- Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Milan, Italy
| | - Gianpiero Tamburrini
- Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Milan, Italy
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8
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Use of Trametinib in Children and Young Adults With Progressive Low-Grade Glioma and Glioneuronal Tumors. J Pediatr Hematol Oncol 2022; 45:e464-e470. [PMID: 36730221 DOI: 10.1097/mph.0000000000002598] [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: 04/26/2022] [Accepted: 10/26/2022] [Indexed: 02/03/2023]
Abstract
Low-grade gliomas/glioneuronal tumors comprise one-third of all pediatric-type CNS tumors. These tumors are generally caused by activating mutations in the mitogen-activated protein kinase (MAPK) pathway. Targeted drugs, such as trametinib, have shown promise in other cancers and are being utilized in low-grade gliomas. A retrospective chart review was conducted to evaluate radiographic response, visual outcomes, tolerability, and durability of response in progressive circumscribed low-grade gliomas treated with trametinib. Eleven patients were treated with trametinib. The best radiographic response was 2/11 partial response, 3/11 minor response, 3/11 stable disease, and 3/13 progressive disease. In the patients with partial or minor response, the best response was seen after longer durations of therapy; 4 of 5 best responses occurred after at least 9 months of therapy with a median of 21 months. Patients with optic pathway tumors showed at least stable vision throughout treatment, with 3 having improved vision on treatment. Trametinib is effective and well-tolerated in patients with progressive low-grade glioma. Best responses were seen after a longer duration of therapy in those with a positive response. Patients with optic pathway lesions showed stable to improved vision while on treatment.
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9
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Management of Optic Pathway Glioma: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14194781. [PMID: 36230704 PMCID: PMC9563939 DOI: 10.3390/cancers14194781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: OPG accounts for 3−5% of childhood central nervous system (CNS) tumors and about 2% of pediatric glial lesions. Methods: Article selection was performed by searching PubMed, Web of Science, and Cochrane databases. Results: The pooled mortality rate was 0.12 (95%CI 0.09−0.14). Due to the unrepresentative data, improved and not changed outcomes were classified as favorable outcomes and worsened as unfavorable. Meta-analyses were performed to determine the rate of clinical and radiological favorable outcomes. In terms of visual assessment, the pooled rate of a favorable outcome in chemotherapy, radiotherapy, and surgery was 0.74, 0.81, and 0.65, respectively, and the overall pooled rate of the favorable outcome was 0.75 (95%CI 0.70−0.80). In terms of radiological assessment, the rate of a favorable outcome following chemotherapy, radiotherapy, and surgery was 0.71, 0.74, and 0.67, respectively, and the overall pooled rate of the favorable outcome is 0.71 (95%CI 0.65−0.77). The subgroup analysis revealed no significant difference in the rate of clinical and radiological favorable outcomes between the different treatment modalities (p > 0.05). Conclusion: Our analyses showed that each therapeutic modality represents viable treatment options to achieve remission for these patients.
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10
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Mohammad M, Alrawashdeh HM, Mehyar M, Amayiri N, Abu Laban D, Alnawaiseh I, Yousef Y. Visual Outcome for Children with Optic Pathway Gliomas Treated with Systemic Chemotherapy. Clin Ophthalmol 2022; 16:2933-2942. [PMID: 36071723 PMCID: PMC9444037 DOI: 10.2147/opth.s374959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients and Methods Results Conclusion
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Affiliation(s)
- Mona Mohammad
- Department of Surgery, Division of Ophthalmology, King Hussein Cancer Center (KHCC), Amman, Jordan
- Correspondence: Mona Mohammad; Yacoub Yousef, Department of Surgery, Division of Ophthalmology, King Hussein Cancer Center, P.O. Box 1269, Amman, 11941, Jordan, Tel +962 795372321; +962 79 100 3333, Fax +962 6 5345 567, Email ;
| | | | - Mustafa Mehyar
- Department of Surgery, Division of Ophthalmology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Nisreen Amayiri
- Department of Pediatric Oncology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Dima Abu Laban
- Department of Diagnostic Radiology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ibrahim Alnawaiseh
- Department of Surgery, Division of Ophthalmology, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Yacoub Yousef
- Department of Surgery, Division of Ophthalmology, King Hussein Cancer Center (KHCC), Amman, Jordan
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11
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A Single-Center Treatment Experience of Gamma Knife Radiosurgery for Optic Pathway Glioma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2043515. [PMID: 35983244 PMCID: PMC9381290 DOI: 10.1155/2022/2043515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022]
Abstract
Objectives To determine the independent prognostic factors that will influence the local tumor control/visual acuity (VA) preservation of optic pathway glioma (OPG) after Gamma Knife radiosurgery (GKS) and to optimize the treatment strategy. Methods A cohort of 52 consecutive OPG patients who underwent GKS in our center between August 1997 and September 2020 was studied retrospectively. Risk factors such as age at GKS, gender, tumor subtype, tumor site, tumor volume, intratumoral cyst formation, and marginal dose were selected for the univariate and multivariate analysis. COX proportional hazard models were built to determine the independent prognostic factors of local tumor control/VA preservation, and the Kaplan-Meier (K-M) curves were plotted to compare the survival rate among subgroups. Results 52 OPG patients were included in this study, with a median age of 13.8 years (2-53 years); female outnumbered male at a ratio of 30 : 22; 7 patients (13.5%) had a history of surgical resection; 14 patients (26.9%) were categorized as neurofibromatosis type I (NFI) associated OPG and the rest as sporadic OPG; there were 6 patients (11.5%) with tumors located at hypothalamus/optic chiasm and the rest located in the orbit; the mean tumor volume was 4.36 ml (0.25-11.4 ml); 49 patients (94.2%) presented with VA impairment before GKS; 28 patients (53.8%) underwent single fraction GKS, and the rest underwent fractionated GKS (2-4 fractions); the mean marginal dose (represented with biologically effective dose, BED) was 66.6 Gy (13.3-126.0 Gy); the median follow-up time was 39 months (6-147 months); 11 patients were observed with tumor relapse, 33 with stable disease, and 8 with tumor regression; tumor relapse time varied from 30 to 76 months (mean 54 months); the 1-, 3-, and 5-year progression-free survival (PFS) rates were 100%, 92%, and 78%, respectively; 30 patients were included in the visual analysis; 7 patients were observed with VA deterioration, 19 with stable VA, and 4 with VA improvement; the 1-,3-, and 5-year VA preservation rates were 92%, 84%, and 77%, respectively. COX proportional hazard risk models showed that intratumoral cyst formation and marginal dose were the only two independent prognostic factors of local tumor control/VA preservation; fractionated GKS provided a higher VA preservation rate than single fraction GKS. Four patients were observed with conjunctive edema/conjunctive hyperemia in 1-4 weeks after GKS. Conclusions GKS is a safe and effective treatment for OPG either as initial treatment or as salvage treatment after surgical resection, it provides good local tumor control and VA preservation, and fractionated GKS could be a preference for OPG patients with baseline VA ≥ 0.2.
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12
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Park M. Recent Update in Pharmacological Agents for Optic Pathway Glioma. Brain Tumor Res Treat 2022; 10:101-107. [PMID: 35545829 PMCID: PMC9098979 DOI: 10.14791/btrt.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Optic pathway gliomas (OPGs) are insidious, debilitating low-grade tumors. They can affect the optic nerve, optic chiasm, and optic tracts and can be sporadic or associated with neurofibromatosis type 1 (NF1). The location of OPGs within the optic pathway typically precludes complete resection or optimal radiation dose. Treatment is unnecessary for sporadic and NF1-related OPGs that do not cause visual impairments. Chemotherapy is the mainstay of treatment for patients with progressive disease. However, outcomes following standard treatments have been mixed, and standardized outcome measurements are lacking. In recent years, newer molecularly targeted therapies such as anti-vascular endothelial growth factor (VEGF) monoclonal antibody, mitogen-activated protein kinase (MAPK) inhibitor, and mammalian target of rapamycin (mTOR) inhibitor, represent a promising treatment modality.
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Affiliation(s)
- Meerim Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang, Korea.
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13
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Samples DC, Mulcahy Levy JM, Hankinson TC. Neurosurgery for Optic Pathway Glioma: Optimizing Multidisciplinary Management. Front Surg 2022; 9:884250. [PMID: 35599811 PMCID: PMC9114802 DOI: 10.3389/fsurg.2022.884250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Optic pathway glioma (OPG) comprises 10% of pediatric brain tumors and 40% of all pediatric low-grade gliomas (pLGGs). While generally considered benign pathologically, many require interventions with chemotherapy, radiation, or targeted therapies. Management has historically foregone tissue diagnosis given the classical clinical/radiographic presentation of these tumors, inability to safely remove the lesions surgically, and efficacy and safety of available chemotherapy options. Furthermore, when considering such aspects as their delicate location, the role of surgery continues to be heavily debated. More recently, however, a greater understanding of the genetic drivers of OPGs has made operative tissue sampling a critical step in management planning, specifically for patients without Neurofibromatosis, Type I (NF1). Given the need for long-term, complex management of pediatric OPGs, it is crucial that a multidisciplinary approach is employed, and the rapidly expanding role of molecular characterization be incorporated into their management.
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Affiliation(s)
- Derek C. Samples
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, CO, United States
- Correspondence: Derek C. Samples
| | - Jean M. Mulcahy Levy
- Department of Pediatrics (Center for Cancer and Blood Disorders), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States
| | - Todd C. Hankinson
- Department of Neurosurgery, Children’s Hospital Colorado, Aurora, CO, United States
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, United States
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14
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Visual Outcomes After Treatment for Sporadic Optic Pathway Gliomas in Pediatric Patients: A Systematic Review. World Neurosurg 2022; 164:436-449.e2. [DOI: 10.1016/j.wneu.2022.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/18/2022]
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15
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José P, Couceiro R, Passos J, Jorge Teixeira F. Visual Outcomes of Optic Pathway Glioma Treated With Chemotherapy in Neurofibromatosis Type 1. J Pediatr Ophthalmol Strabismus 2022; 59:128-135. [PMID: 34592874 DOI: 10.3928/01913913-20210720-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the visual outcomes following chemotherapy for optic pathway glioma in children with neurofibromatosis type 1. METHODS This was a retrospective cohort study of 58 children with optic pathway glioma between 2003 and 2019. Best corrected visual acuity (BCVA) at diagnosis and at the last follow-up visit were analyzed. Correlation tests were performed to determine whether the final BCVA was predicted by the initial BCVA, initial Dodge stage, or retinal nerve fiber layer (RNFL) thickness stability. The first-line chemotherapy regimen included vincristine plus carboplatin (2003 to 2016) and vinblastine (since 2017). RESULTS Twenty-four children (41%) received chemotherapy. The median age at diagnosis was 3 years, and 61% of the children were female. From the first visit to the last follow-up visit, there was a statistically significant difference in mean BCVA in eyes in the no treatment group (P = .034) but not in eyes in the chemotherapy group (P = .824). A moderate and weak positive correlation was found (r = 0.58 and r = 0.29, respectively). At the last follow-up visit, BCVA remained stable in 73% and improved in 27% of eyes in the no treatment group, and BCVA worsened in 25%, remained stable in 62%, and improved in 13% of eyes in the chemotherapy group. At the last follow-up visit, BCVA and Dodge stage had a weak negative correlation (r = -0.06 and r = -0.17, respectively). A negative moderate correlation was identified between RNFL thickness and BCVA at the last follow-up visit (r = -0.48 in the no treatment group and r = -0.46 in the chemotherapy group). CONCLUSIONS Children treated with chemotherapy had worse BCVA, although the treatment arrested the decline or improved BCVA in 75% of the patients with no major side effects. [J Pediatr Ophthalmol Strabismus. 2022;59(2):128-135.].
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16
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Lin X, Huang R, Su J, Li H, Liu Z, Zhang P, Tian X. Optic nerve gliomas in adults: a SEER-based study. ALL LIFE 2022. [DOI: 10.1080/26895293.2022.2046180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Xiaoning Lin
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Rong Huang
- Department of Child Health, Women and Children's Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Jinyun Su
- Department of Anesthesiology, Nan'an City Hospital, Quanzhou, People’s Republic of China
| | - Heng Li
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Zhong Liu
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Pengfei Zhang
- Department of Infectious Diseases, The first affiliated Hospital of Anhui Medical University, Hefei, People’s Republic of China
| | - Xinhua Tian
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
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17
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Liu H, Chen Y, Qin X, Jin Z, Jiang Y, Wang Y. Epidemiology and Survival of Patients With Optic Pathway Gliomas: A Population-Based Analysis. Front Oncol 2022; 12:789856. [PMID: 35223473 PMCID: PMC8874351 DOI: 10.3389/fonc.2022.789856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background We aimed to analyze the epidemiology and outcomes of pediatric patients and adult patients with optic pathway gliomas in the United States using a population-based method. Methods Data for patients with optic pathway gliomas diagnosed between 2000 and 2018 were extracted from the SEER database. We divided the patients into a pediatric group and an adult group. Descriptive analyses were conducted to analyze demographic and clinical characteristics and treatment. We used the chi-square test to evaluate differences between pediatric and adult patients with optic pathway gliomas. The possible prognostic indicators were analyzed by Kaplan–Meier curves and Cox proportional hazards models. Results Optic pathway gliomas represented 86.6% of all lesions originating from the optic pathway. In total, 1257 cases of optic pathway gliomas were included in our study. Pediatric patients accounted for 83.7% in this cohort, and most of the patients were diagnosed at 1-4 years old. Chemotherapy was chosen most often for pediatric patients, but radiation therapy was chosen most often for adult patients. Pilocytic astrocytoma accounted for 59.1% of pediatric patients and 37.5% of adult patients. The overall survival (OS) rates were 94.8% 5 years after diagnosis and 93.0% 10 years after diagnosis. Survival analysis showed that surgery, radiation and chemotherapy did not help patients obtain a better prognosis. Overall, pediatric patients had a better prognosis. Conclusion Optic pathway gliomas are relatively rare lesions with good prognosis. They mostly affect children, and pilocytic astrocytoma is the most common histological diagnosis. Highly individualized treatment is essential for such patients.
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Bennebroek CAM, Wijninga LE, Limpens J, Schouten-van Meeteren AYN, Saeed P. Impact of systemic anticancer therapy in pediatric optic pathway glioma on visual function: A systematic review. PLoS One 2021; 16:e0258548. [PMID: 34673789 PMCID: PMC8530362 DOI: 10.1371/journal.pone.0258548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/29/2021] [Indexed: 01/11/2023] Open
Abstract
Pediatric optic pathway glioma (OPG) can seriously decrease visual function in the case of progression. Systemic anticancer therapy (SAT) is considered the treatment of first choice for unresectable OPG. New SAT modalities for the treatment of progressive OPG have been introduced in the last decade, including VEGF and MAPK pathway inhibition. This systematic review evaluated the effect of SAT on change in visual acuity and visual field in OPG. A systematic review was performed on SAT for OPG (January 1990 to August 2020). MEDLINE and EMBASE (Ovid) were searched for studies reporting on change in visual acuity and visual field after treatment with SAT for OPG. Overall, 11 series, including 358 patients, fulfilled the eligibility criteria. After follow-up of median 3.7 years (range: cessation of SAT- 8.2 years), improvement in binocular VA was found in 0-45% of studies, stability in 18-77% and a decrease in 0-82%. Two studies reported on change in visual field (improvement in 19% and 71% of patients), although either the change was not defined or the testing strategy was lacking. Considerable heterogeneity was present among the included studies, such as variety in the combinations of SAT administered, status of neurofibromatosis type 1, definition regarding change in visual acuity, 1- or 2-eye analysis, diversity in anatomic location, and extent of follow-up, all of which made meta-analysis inappropriate. This systematic review suggests that the impact of SAT in OPG on visual function is still unclear. The wide ranges reported on the efficacy of SAT and the observed heterogeneity highlight the need for prospective studies with uniform definitions of outcome parameters.
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Affiliation(s)
- Carlien A. M. Bennebroek
- Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laura. E. Wijninga
- Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Peerooz Saeed
- Department of Ophthalmology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Sharafeddine H, Hamideh D, Morsi RZ, Najjar MW. Surgical techniques in the management of supratentorial pediatric brain tumors: 10 years' experience at a tertiary care center in the Middle East. Surg Neurol Int 2021; 12:269. [PMID: 34221600 PMCID: PMC8247713 DOI: 10.25259/sni_205_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/25/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The goal of this retrospective study is to present the first epidemiological data on pediatric supratentorial central nervous system (CNS) tumors in Lebanon and to review the various surgical management strategies used. Methods: We conducted a retrospective case series of all pediatric patients who presented with a supratentorial CNS tumor and underwent surgery at our institution between 2006 and 2016. We collected and analyzed demographic characteristics, tumor location, clinical manifestations, histopathology, and surgical management strategies and outcome, and discussed them after dividing the tumors as per location and in view of published literature. Results: Ninety-nine children were studied with a male-to-female ratio of 2.3:1 and a mean age of 8.5 years. The most common location was convexity (44%) and included low-grade and high-grade glial tumors, along with other miscellaneous lesions. The next location was sellar/diencephalic (34%), including craniopharyngiomas, hypothalamic/optic pathway/thalamic gliomas, hamartomas, and pituitary/Rathke’s cyst, where there was notable use of endoscopic techniques (21%). Tumors in the pineal region (13%) were tectal gliomas, germ cell tumors, and pineoblastomas and were mostly treated endoscopically. The last group was lateral intraventricular tumors (8%) and was mostly choroid plexus lesions and ependymomas. Overall, the surgical objective was achieved in 95% with mild/moderate complications in 17%. Conclusion: A variety of pathologies may affect the pediatric population in the supratentorial region. Different surgical strategies, including microsurgical and endoscopic techniques, may be employed to remove, debulk, or biopsy these tumors depending on their location, suspected diagnosis, prognosis, and the need for treatment of possible associated hydrocephalus.
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Affiliation(s)
- Hiba Sharafeddine
- Department of Surgery-Neurosurgery, American University of Beirut, United States
| | - Dima Hamideh
- Department of Pediatrics, Children Cancer Institute, American University of Beirut, Beirut, Lebanon, United States
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Marwan W Najjar
- Department of Surgery-Neurosurgery, American University of Beirut, United States
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20
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Azizi AA, Walker DA, Liu JF, Sehested A, Jaspan T, Pemp B, Simmons I, Ferner R, Grill J, Hargrave D, Driever PH, Evans DG, Opocher E. NF1 optic pathway glioma: analyzing risk factors for visual outcome and indications to treat. Neuro Oncol 2021; 23:100-111. [PMID: 32628746 PMCID: PMC7850076 DOI: 10.1093/neuonc/noaa153] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of the project was to identify risk factors associated with visual progression and treatment indications in pediatric patients with neurofibromatosis type 1 associated optic pathway glioma (NF1-OPG). METHODS A multidisciplinary expert group consisting of ophthalmologists, pediatric neuro-oncologists, neurofibromatosis specialists, and neuro-radiologists involved in therapy trials assembled a cohort of children with NF1-OPG from 6 European countries with complete clinical, imaging, and visual outcome datasets. Using methods developed during a consensus workshop, visual and imaging data were reviewed by the expert team and analyzed to identify associations between factors at diagnosis with visual and imaging outcomes. RESULTS Eighty-three patients (37 males, 46 females, mean age 5.1 ± 2.6 y; 1-13.1 y) registered in the European treatment trial SIOP LGG-2004 (recruited 2004-2012) were included. They were either observed or treated (at diagnosis/after follow-up).In multivariable analysis, factors present at diagnosis associated with adverse visual outcomes included: multiple visual signs and symptoms (adjusted odds ratio [adjOR]: 8.33; 95% CI: 1.9-36.45), abnormal visual behavior (adjOR: 4.15; 95% CI: 1.20-14.34), new onset of visual symptoms (adjOR: 4.04; 95% CI: 1.26-12.95), and optic atrophy (adjOR: 3.73; 95% CI: 1.13-12.53). Squint, posterior visual pathway tumor involvement, and bilateral pathway tumor involvement showed borderline significance. Treatment appeared to reduce tumor size but improved vision in only 10/45 treated patients. Children with visual deterioration after primary observation are more likely to improve with treatment than children treated at diagnosis. CONCLUSIONS The analysis identified the importance of symptomatology, optic atrophy, and history of vision loss as predictive factors for poor visual outcomes in children with NF1-OPG.
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Affiliation(s)
- Amedeo A Azizi
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria
| | - David A Walker
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Jo-Fen Liu
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Astrid Sehested
- Department of Pediatrics, Copenhagen University Hospital, Copenhagen, Denmark
| | - Timothy Jaspan
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Ian Simmons
- Department of Ophthalmology and Paediatric Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rosalie Ferner
- Department of Neurology Guy's and St. Thomas' NHS Foundation Trust and IoPPN, King's College London, London, UK
| | | | - Darren Hargrave
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Charity University Medicine Berlin, Berlin, Germany.,corporate member of Free University Berlin, Humboldt University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - D Gareth Evans
- Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Enrico Opocher
- Department of Pediatrics, University of Padua, Padua, Italy
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Ullrich NJ, Prabhu SP, Packer RJ, Goldman S, Robison NJ, Allen JC, Viskochil DH, Gutmann DH, Perentesis JP, Korf BR, Fisher MJ, Kieran MW. Visual outcomes following everolimus targeted therapy for neurofibromatosis type 1-associated optic pathway gliomas in children. Pediatr Blood Cancer 2021; 68:e28833. [PMID: 33336845 DOI: 10.1002/pbc.28833] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/07/2022]
Abstract
Data for visual acuity (VA) after treatment of neurofibromatosis type 1-associated optic pathway gliomas (NF1-OPGs) are limited. We retrospectively collected VA, converted to logMAR, before and after targeted therapy with everolimus for NF1-OPG, and compared to radiologic outcomes (14/18 with NF1-OPG, 25 eyes [three without quantifiable vision]). Upon completion of treatment, VA was stable in 19 eyes, improved in four eyes, and worsened in two eyes; visual and radiologic outcomes were discordant. In summary, the majority of children with NF1-OPG exhibited stabilization of their VA after everolimus treatment. A larger, prospective study will help delineate visual outcomes after targeted therapy.
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Affiliation(s)
- Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts
| | - Sanjay P Prabhu
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Roger J Packer
- Center for Neuroscience and Behavioral Medicine, Children's National Hospital, Washington, District of Columbia
| | | | - Nathan J Robison
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeffrey C Allen
- Departments of Pediatrics and Neurology, NYU Langone Medical Center, New York, New York
| | | | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - John P Perentesis
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bruce R Korf
- Department of Medical Genetics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michael J Fisher
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark W Kieran
- Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, Massachusetts
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22
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Abstract
Objectives To describe the diagnostic and management features of optic nerve gliomas. Design Literature review. Results Optic nerve gliomas are generally benign in the pediatric age group although they are usually malignant and aggressive in adults. As such, the mechanisms by which these lesions are diagnosed, the systemic implications, the goals of intervention, and the nature of therapeutic management all differ between these tumors. Conclusions This article addresses these lesions and discusses the diagnostic and therapeutic paradigms by which they may be approached.
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Affiliation(s)
- Edward J Wladis
- Department of Ophthalmology, Lions Eye Institute, Albany Medical College, Slingerlands, New York, United States
| | - Matthew A Adamo
- Department of Neurosurgery, Albany Medical College, Slingerlands, New York, United States
| | - Lauren Weintraub
- Division of Hematology/Oncology, Department of Pediatrics, Albany Medical College, Slingerlands, New York, United States
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Fangusaro J, Onar-Thomas A, Poussaint TY, Wu S, Ligon AH, Lindeman N, Campagne O, Banerjee A, Gururangan S, Kilburn L, Goldman S, Qaddoumi I, Baxter P, Vezina G, Bregman C, Patay Z, Jones JY, Stewart CF, Fisher MJ, Doyle LA, Smith M, Dunkel IJ, Fouladi M. A Phase 2 Trial of Selumetinib in Children with Recurrent Optic Pathway and Hypothalamic Low-Grade Glioma without NF1: A Pediatric Brain Tumor Consortium Study. Neuro Oncol 2021; 23:1777-1788. [PMID: 33631016 DOI: 10.1093/neuonc/noab047] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pediatric low-grade gliomas (pLGGs) are the most common childhood brain tumor. Progression-free survival (PFS) is much lower than overall survival, emphasizing the need for alternative treatments. Sporadic (without neurofibromatosis type-1) optic pathway and hypothalamic glioma (OPHGs) are often multiply recurrent and cause significant visual deficits. Recently, there has been a prioritization of functional outcomes. METHODS We present results from children with recurrent/progressive OPHGs treated on a PBTC phase 2 trial evaluating efficacy of selumetinib, (AZD6244, ARRY-142886) a MEK-1/2 inhibitor. Stratum 4 of PBTC-029 included patients with sporadic recurrent/progressive OPHGs treated with selumetinib at the recommended phase 2 dose (25mg/m 2 /dose BID) for a maximum of 26 courses. RESULTS Twenty-five eligible and evaluable patients were enrolled with a median of 4 (1-11) previous therapies. Six of 25 (24%) had partial response, 14/25 (56%) had stable disease and 5 (20%) had progressive disease while on treatment. The median treatment courses were 26 (2-26); 14/25 patients completed all 26 courses. Two-year PFS was 78 ± 8.5%. Nineteen of 25 patients were evaluable for visual acuity which improved in 4/19 patients (21%), was stable in 13/19 (68%) and worsened in 2/19 (11%). Five of 19 patients (26%) had improved visual fields and 14/19 (74%) were stable. The most common toxicities were grade 1/2 CPK elevation, anemia, diarrhea, headache, nausea/emesis, fatigue, AST and ALT increase, hypoalbuminemia and rash. CONCLUSIONS Selumetinib was tolerable and led to responses and prolonged disease stability in children with recurrent/progressive OPHGs based upon radiographic response, PFS and visual outcomes.
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Affiliation(s)
- Jason Fangusaro
- Department of Hematology, Oncology, and Stem Cell Transplantation. Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Arzu Onar-Thomas
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | | | - Shengjie Wu
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Azra H Ligon
- Department of Pathology. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Neal Lindeman
- Department of Pathology. Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivia Campagne
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Anu Banerjee
- Center for Cancer and Blood Disorders. University of California, San Francisco, CA
| | | | - Lindsay Kilburn
- Division of Oncology (LBK) and Department of Radiology (GV). Children's National Hospital, Washington DC
| | - Stewart Goldman
- Department of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplantation (SG) and Department of Medical Imaging (CB). Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Ibrahim Qaddoumi
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Patricia Baxter
- Department of Hematology and Oncology. Texas Children's Hospital, Houston, TX, USA
| | - Gilbert Vezina
- Division of Oncology (LBK) and Department of Radiology (GV). Children's National Hospital, Washington DC
| | - Corey Bregman
- Department of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplantation (SG) and Department of Medical Imaging (CB). Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Zoltan Patay
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Jeremy Y Jones
- Department of Radiology (JYJ) and Department of Hematology and Oncology (MF). Nationwide Children's Hospital, Columbus, OH
| | - Clinton F Stewart
- Department of Biostatistics (AOT and SW), Department of Oncology (IQ), Department of Diagnostic Imaging (ZP) and Department of Pharmaceutical Sciences (OC and CFS). St. Jude Children's Research Center, Memphis, TN, USA
| | - Michael J Fisher
- Division of Oncology. The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laurence Austin Doyle
- Investigational Drug Branch (LAD) and Clinical Investigation Branch (MS). National Cancer Institute and Cancer Therapy Evaluation Program, Rockville, MD
| | - Malcolm Smith
- Investigational Drug Branch (LAD) and Clinical Investigation Branch (MS). National Cancer Institute and Cancer Therapy Evaluation Program, Rockville, MD
| | - Ira J Dunkel
- Department of Pediatrics. Memorial Sloan Kettering Cancer Center, NY
| | - Maryam Fouladi
- Department of Radiology (JYJ) and Department of Hematology and Oncology (MF). Nationwide Children's Hospital, Columbus, OH
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24
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Attina G, Maurizi P, Triarico S, Capozza MA, Romano A, Mastrangelo S, Ruggiero A. Management of Children with Optic Gliomas and Neurofibromatosis Type 1. BIOMEDICAL AND PHARMACOLOGY JOURNAL 2020; 13:1601-1606. [DOI: 10.13005/bpj/2035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Optic pathway gliomas (OPG) are a common cancer in children with neurofibromatosis type 1. OPGs can cause clinical symptoms such as reduction of visual acuity, alterations of the visual field, pallor of the optical papilla, strabismus, endocrinological alterations up to diencephalic syndrome.The current guidelines provide for wait and see as the main approach if the tumor is not causing visual deterioration and adopting treatment only in the event of significant impairment of the visual function. Therefore, it is essential to early detect the visual deterioration changes as well as the identification of children eligible for treatment.
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Affiliation(s)
- Giorgio Attina
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Palma Maurizi
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Silvia Triarico
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Michele Antonio Capozza
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Alberto Romano
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Stefano Mastrangelo
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A.Gemelli IRCCS, Universita’ Cattolica Sacro Cuore, Rome, Italy
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25
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Heidary G, Fisher MJ, Liu GT, Ferner RE, Gutmann DH, Listernick RH, Kapur K, Loguidice M, Ardern-Holmes SL, Avery RA, Hammond C, Hoffman RO, Hummel TR, Kuo A, Reginald A, Ullrich NJ. Visual field outcomes in children treated for neurofibromatosis type 1-associated optic pathway gliomas: a multicenter retrospective study. J AAPOS 2020; 24:349.e1-349.e5. [PMID: 33221469 DOI: 10.1016/j.jaapos.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Optic pathway gliomas associated with neurofibromatosis type 1 (NF1-OPGs) may adversely affect visual acuity, but data regarding visual field (VF) outcomes after treatment in children are limited. The purpose of this study was to investigate the effects of NF1-OPGs on VF function in a large cohort of children after treatment with chemotherapy. METHODS We performed a retrospective, international, multicenter study of VF outcomes in patients treated with chemotherapy for NF1-OPGs. RESULTS A total of 25 participants underwent VF testing using formal perimetric techniques. At the end of treatment, 19 participants (76%) had persistent VF deficits. Formal VF testing was available for 16 participants (64%) at initiation and completion of treatment. Of the 16 children who underwent VF testing at initiation and completion of treatment, 7 (44%) showed stability of VF changes, 3 (19%) showed improvement of VF function, and 6 (38%) had worsening of VFs. Improvement or worsening of VF outcome did not always correlate with visual acuity outcome. Posterior tumor location involving the optic tracts and radiations was associated with more frequent and more profound VF defects. CONCLUSIONS In our study cohort, children undergoing initial chemotherapy for NF1-OPGs had a high prevalence of VF loss, which could be independent of visual acuity loss. A larger, prospective study is necessary to fully determine the prevalence of VF loss and the effects of chemotherapy on VF outcomes in children with NF1-OPGs.
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Affiliation(s)
- Gena Heidary
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Michael J Fisher
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grant T Liu
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - David H Gutmann
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Robert H Listernick
- Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kush Kapur
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Loguidice
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Robert A Avery
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Children's National Medical Center, Washington, District of Columbia
| | | | | | - Trent R Hummel
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Annie Kuo
- Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Arun Reginald
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicole J Ullrich
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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26
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Stella I, Helleringer M, Joud A, Chastagner P, Thomas R, Klein O. Optic pathway tumor in children: Toward a new classification for neurosurgical use. Neurochirurgie 2020; 67:336-345. [PMID: 33232713 DOI: 10.1016/j.neuchi.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/26/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECT Optic pathway tumors (OPT) represent a challenge for pediatric neurosurgeons. Role of surgery is debated due to the high risk of iatrogenic damage, and in lasts decades it lost its importance in favor of chemotherapy. However, in some cases surgery is necessary to make biomolecular and histological diagnosis, to manage intracranial hypertension (IH) and to cooperate with medical therapies in controlling tumor relapse. With the aim to standardize selection of surgical OPT cases, we propose a simple, practical and reproducible classification. METHODS We retrospectively analyzed data of 38 patients with OPT treated at our institution (1990-2018). After careful analysis of MRI images, we describe a new classification system. Group 1: lesion limited to one or both optic nerve(s). Group 2: chiasmatic lesions extending minimally to hypothalamus. Group 3: hypothalamo-chiasmatic exophitic lesions invading the third ventricle; they can be further divided on the base of concomitant hydrocephalus. Group 4: hypothalamo-chiasmatic lesions extending widely in lateral direction, toward the temporal or the frontal lobes. Patients' data and adopted treatment are reported and analyzed, also depending on this classification. RESULTS Twenty children were operated on for treatment of OPT during the study period. Permanent clinical impairment was noted in 5 (25%) of operated patients, while visual improvement was noted in 1 patient. OS rate was 100% at 5 years, with a median follow up of 9 years (ranging from 2 to 23). Prevalence of intracranial hypertension and proportion of first-line surgical treatment decision were significantly higher in groups 3-4 compared to groups 1-2 (P<0.001 for both tests). CONCLUSION Surgery can offer a valuable therapeutic complement for OPT without major risk of iatrogenic damage. Surgery is indispensable in cases presenting with IH, as in groups 3 and 4 lesions. Eligibility of patients to surgery can be based on this new classification system.
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Affiliation(s)
- I Stella
- Pediatric Neurosurgical Unit, Nancy Regional University Hospital, University of Lorraine, France.
| | - M Helleringer
- Pediatric Neurosurgical Unit, Nancy Regional University Hospital, University of Lorraine, France
| | - A Joud
- Pediatric Neurosurgical Unit, Nancy Regional University Hospital, University of Lorraine, France
| | - P Chastagner
- Pediatric Onco-hematology Department, Nancy Regional University Hospital, University of Lorraine, France
| | - R Thomas
- Methodologic, data-management and statistics Unit, Nancy Regional University Hospital, University of Lorraine, France
| | - O Klein
- Pediatric Neurosurgical Unit, Nancy Regional University Hospital, University of Lorraine, France
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27
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Shofty B, Ben Sira L, Constantini S. Neurofibromatosis 1-associated optic pathway gliomas. Childs Nerv Syst 2020; 36:2351-2361. [PMID: 32524182 DOI: 10.1007/s00381-020-04697-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Optic Pathway Gliomas (OPG) are the most common brain tumor in Neurofibromatosis 1 patients (NF1). They are found along the optic pathway and may involve the optic nerves, chiasm, retro-chiasmatic structures, and the optic radiations. NF1 associate OPG (NF1-OPG) have variable presentation, disease course and response to treatment. The optimal management is patient-specific and should be tailored by a multidisciplinary team. Age, sex, histology, and molecular markers may be important factors in the individualized decision-making process. Chemotherapy is the first-line treatment in cases of progressive tumors, and visual preservation is the main goal of treatment. PURPOSE In this paper we will review the disease, practical management, and recent advances of NF1-OPG.
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Affiliation(s)
- Ben Shofty
- Department of Neurosurgery, Tel-Aviv Medical Center, The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv University, Tel Aviv, Israel
| | - Liat Ben Sira
- Pediatric Radiology, Tel-Aviv Medical Center, The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Constantini
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, The Gilbert Israeli International Neurofibromatosis Center (GIINFC), Tel Aviv University, 6th Weizmann St., 64239, Tel-Aviv, Israel.
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28
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Liao C, Zhang H, Liu Z, Han Z, Li C, Gong J, Liu W, Ma Z, Tian Y. The Visual Acuity Outcome and Relevant Factors Affecting Visual Improvement in Pediatric Sporadic Chiasmatic-Hypothalamic Glioma Patients Who Received Surgery. Front Neurol 2020; 11:766. [PMID: 32973646 PMCID: PMC7466562 DOI: 10.3389/fneur.2020.00766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background: The role and effectiveness of primary surgical treatment for sporadic chiasmatic–hypothalamic glioma (CHG) are not clear. The present study was to describe sporadic CHG visual acuity (VA) outcomes after surgery and to analyze the relevant factors affecting VA improvement. Methods: Forty-five pediatric sporadic CHG patients who met the inclusion criteria were included in a retrospective study. All patients received primary intratumor partial resection. Disease characteristics, treatment strategies, complications, and VA outcome were analyzed. Univariate and multivariate analyses were performed to identify relevant factors of VA improvement. Receiver operating characteristic (ROC) analysis was performed to evaluate the predictive accuracy of measurement indexes. Results: There were 77 eyes of 45 children suffering from various levels of VA impairment before surgical treatment, and only 13 eyes had normal vision. Patients with resection extents >70, 50–70, and <50% accounted for 26.67, 24.44, and 48.89%, respectively. The percentages of VA maintained and deteriorated in normal vision eyes were 61.54 and 38.46%. The percentages of VA improved, maintained, and deteriorated in visually impaired eyes after surgery were 29.87, 45.45, and 24.68%, respectively. There was a positive correlation between the IVA level and VA improvement. There was no significant difference in VA improvement between the different resection extents. Blindness occurred in ~4.4%. Approximately 11.1% of the children had complications that affected quality of life, which correlated with resection extent. IVA and tumor size were correlated with VA improvement. The AUC for IVA + tumor size predicting VA improvement was 0.831. The cutoff points for IVA level and tumor volume were 4.5 and 43.50 cm3, respectively. Conclusions: IVA and tumor size were correlated with VA improvement after primary intratumor partial resection. Children with IVA ≥ level 5 were more likely to achieve visual improvement after decompression surgery, but decompression had limited effectiveness on vision improvement in patients with tumor volumes ≥ 43.50 cm3. Performing resections < 50% was safe and did not reduce the effect of decompression to improve VA.
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Affiliation(s)
- Chihyi Liao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brain Tumor, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Heng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brain Tumor, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhiming Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brain Tumor, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhe Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brain Tumor, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Chunde Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brain Tumor, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Jian Gong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brain Tumor, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Wei Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brain Tumor, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhenyu Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brain Tumor, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
| | - Yongji Tian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Brain Tumor, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China
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29
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Abstract
Phakomatoses present with characteristic findings on the skin, central or peripheral nervous system, and tumors. Neurofibromatosis type 1 is the most common syndrome and is characterized by Café-au-lait macules, intertriginous freckling, Lisch nodules, and tumors including neurofibromas, malignant peripheral nerve sheath tumors, and gliomas. Tuberous Sclerosis Complex is characterized by benign hamartomas presenting with hypomelanotic macules, shagreen patches, angiofibromas, confetti lesions and tumors including cortical tubers, subependymal nodules, subependymal giant cell astrocytomas and tumors of the kidney, lung, and heart. Managing these disorders requires disease specific supportive care, tumor monitoring, surveillance for selected cancers, and treatment of comorbid conditions.
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Affiliation(s)
- Benjamin Becker
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Roy E Strowd
- Department of Neurology, Wake Forest Baptist Health, 1 Medical Center Boulevard, Winston Salem, NC 27157, USA; Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest Baptist Health, Winston Salem, NC 27157, USA; Translational Science Institute, Wake Forest Baptist Health, Winston Salem, NC 27157, USA
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30
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Wu WS, Liu JJ, Sun YL, DU SX, Li CD, Li M, Ren SQ, Zhang J, Gong XJ, Sun LM. [Effect of bevacizumab in treatment of children with optic pathway glioma]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:1193-1197. [PMID: 31874658 PMCID: PMC7389006 DOI: 10.7499/j.issn.1008-8830.2019.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the effect of bevacizumab in the treatment of children with optic pathway glioma (OPG). METHODS A retrospective analysis was performed for the clinical data of 30 children with OPG who underwent chemotherapy. According to whether bevacizumab was used, they were divided into conventional chemotherapy (carboplatin, vincristine and etoposide) group with 12 children and combined chemotherapy (bevacizumab, carboplatin, vincristine and etoposide) group with 18 children. The children were followed up to 6 months after chemotherapy, and the two groups were compared in terms of visual acuity and tumor size before and after chemotherapy and adverse reactions during chemotherapy. RESULTS The combined chemotherapy group had a significantly higher proportion of children achieving tumor regression than the conventional chemotherapy group (P<0.05), while there were no significant differences between the two groups in the proportion of children with improved visual acuity or adverse reactions (P>0.05). No chemotherapy-related death was observed in either group. CONCLUSIONS Bevacizumab combined with conventional chemotherapy can effectively reduce tumor size. Compared with conventional chemotherapy, such combination does not increase adverse reactions and can thus become a new direction for the treatment of OPG in children.
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Affiliation(s)
- Wan-Shui Wu
- Department of Pediatrics, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China.
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31
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Optic Pathway Glioma in Type 1 Neurofibromatosis: Review of Its Pathogenesis, Diagnostic Assessment, and Treatment Recommendations. Cancers (Basel) 2019; 11:cancers11111790. [PMID: 31739524 PMCID: PMC6896195 DOI: 10.3390/cancers11111790] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022] Open
Abstract
Type 1 neurofibromatosis (NF1) is a dominantly inherited condition predisposing to tumor development. Optic pathway glioma (OPG) is the most frequent central nervous system tumor in children with NF1, affecting approximately 15-20% of patients. The lack of well-established prognostic markers and the wide clinical variability with respect to tumor progression and visual outcome make the clinical management of these tumors challenging, with significant differences among distinct centers. We reviewed published articles on OPG diagnostic protocol, follow-up and treatment in NF1. Cohorts of NF1 children with OPG reported in the literature and patients prospectively collected in our center were analyzed with regard to clinical data, tumor anatomical site, diagnostic workflow, treatment and outcome. In addition, we discussed the recent findings on the pathophysiology of OPG development in NF1. This review provides a comprehensive overview about the clinical management of NF1-associated OPG, focusing on the most recent advances from preclinical studies with genetically engineered models and the ongoing clinical trials.
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32
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Nuijts MA, Degeling MH, Stegeman I, Schouten-van Meeteren AYN, Imhof SM. Visual impairment in children with a brain tumor: a prospective nationwide multicenter study using standard visual testing and optical coherence tomography (CCISS study). BMC Ophthalmol 2019; 19:220. [PMID: 31706271 PMCID: PMC6842490 DOI: 10.1186/s12886-019-1225-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/23/2019] [Indexed: 01/11/2023] Open
Abstract
Background Children with a brain tumor have a high risk of impaired vision. Up to now, visual acuity measurement, visual field testing and orthoptic testing are the most informative diagnostic investigations for the assessment of visual function. Evaluating vision in children can be challenging given the challenges in cooperation, concentration and age-dependent shifts in visual tests. Since visual loss due to a brain tumor can be progressive and irreversible, we must aim to detect visual impairment as early as possible. Several studies have shown that optical coherence tomography facilitates discovery of nerve fiber damage caused by optic nerve glioma. Consequently, early detection of potential ocular damage will effect treatment decisions and will provide timely referral to visual rehabilitation centers. Methods/design The CCISS study is a prospective, observational, multicenter cohort study in The Netherlands. Patients aged 0–18 years with a newly diagnosed brain tumor are invited for inclusion in this study. Follow-up visits are planned at 6, 12, 18 and 24 months. Primary endpoints are visual acuity, visual field and optical coherence tomography parameters (retinal nerve fiber layer thickness and ganglion cell layer – inner plexiform layer thickness). Secondary endpoints include the course of visual function (measured by visual acuity, visual field and optical coherence tomography at different follow-up visits), course of the disease and types of treatment. Discussion The CCISS study will heighten the awareness of visual impairment in different types of brain tumors in children. This study will show whether optical coherence tomography leads to earlier detection of visual impairment compared to standard ophthalmological testing (i.e. visual acuity, visual field testing) in children with a brain tumor. Furthermore, the systematic approach of ophthalmological follow-up in this study will give us insight in the longitudinal relation between the course of visual function, course of the disease and types of treatment in children with a brain tumor. Trial registration The CCISS study is prospectively registered in the Netherlands Trial Register (NTR) since April 2019. Identifier: NL7697.
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Affiliation(s)
- M A Nuijts
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Room E 03.136, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands.
| | - M H Degeling
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Stegeman
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - S M Imhof
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
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33
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Abstract
PURPOSE OF REVIEW Optic pathway gliomas are low-grade neoplasms that affect the precortical visual pathway of children and adolescents. They can affect the optic nerve, optic chiasm, optic tracts and radiations and can either be sporadic or associated with neurofibromatosis type one. Gliomas isolated to the optic nerve (ONG) represent a subgroup of optic pathway gliomas, and their treatment remains controversial. New developments in ONG treatment have emerged in recent years, and it is necessary for clinicians to have a current understanding of available therapies. RECENT FINDINGS The current review of the literature covers the background of and recent developments in ONG treatment, with a focus on standard chemotherapy, new molecularly targeted therapies, radiation therapy and surgical resection and debulking. SUMMARY Although standard chemotherapy remains the mainstay of ONG treatment, newer molecularly targeted therapies such as mitogen-activated protein kinase kinase inhibitors and bevacizumab represent a promising new treatment modality, and clinical studies are ongoing.
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34
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Cooney T, Yeo KK, Kline C, Prados M, Haas-Kogan D, Chi S, Mueller S. Neuro-Oncology Practice Clinical Debate: targeted therapy vs conventional chemotherapy in pediatric low-grade glioma. Neurooncol Pract 2019; 7:4-10. [PMID: 32257279 DOI: 10.1093/nop/npz033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The treatment of children with low-grade glioma has evolved over the last several decades, beginning initially with focal radiotherapy, which has now been largely replaced by systemic treatment with conventional chemotherapy agents or more recently molecularly targeted therapeutics. A consensus standard of care is not well defined, leaving clinicians and parents to choose from an increasing number of options, often without complete information concerning the associated risks and benefits. Issues critical to this topic include timing of interventions (when to treat), preservation of neurological function (goals of treatment), choice of initial therapy strategy (conventional cytotoxic chemotherapy vs molecularly targeted therapy), duration of treatment (how long, and what clinical or imaging endpoints to consider), and perhaps most important, risk reduction relative to anticipated benefit. The groups from the University of California, San Francisco and Dana Farber Cancer Institute, moderated by Michael Prados, herein debate the merits of cytotoxic chemotherapy and targeted therapeutics as initial treatment strategies in pediatric low-grade glioma, a topic discussed daily in Tumor Boards across the United States and abroad. Prospective, randomized, phase 3 trials comparing the 2 strategies, conducted within homogenous disease settings, with consistently evaluated functional and imaging endpoints, are not available to guide the risks/benefit discussion. As is often the case in rare biologically diverse diseases, in a vulnerable population, therapy decisions are frequently based on incomplete data, physician experience, bias to some degree, and patient/family preference.
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Affiliation(s)
- Tabitha Cooney
- Department of Pediatrics, University of California, San Francisco
| | - Kee Kiat Yeo
- Dana Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, MA.,Harvard Medical School, Boston MA
| | - Cassie Kline
- Department of Pediatrics, University of California, San Francisco.,Department of Neurology, University of California, San Francisco
| | - Michael Prados
- Department of Neurology, University of California, San Francisco.,Department of Neurosurgery, University of California, San Francisco
| | - Daphne Haas-Kogan
- Boston Children's Hospital, MA.,Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA.,Harvard Medical School, Boston MA
| | - Susan Chi
- Dana Farber Cancer Institute, Boston, MA.,Boston Children's Hospital, MA.,Harvard Medical School, Boston MA
| | - Sabine Mueller
- Department of Pediatrics, University of California, San Francisco.,Department of Neurology, University of California, San Francisco.,Department of Neurosurgery, University of California, San Francisco.,Children's Hospital University of Zürich, Oncology, Switzerland
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35
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Calixto NC, Simão GN, Dos Santos AC, de Oliveira RS, Junior LGD, Valera ET, Cintra MB, Mello AS. Monitoring optic chiasmatic-hypothalamic glioma volumetric changes by MRI in children under clinical surveillance or chemotherapy. Childs Nerv Syst 2019; 35:63-72. [PMID: 30078056 DOI: 10.1007/s00381-018-3904-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Optic pathway gliomas represent 5% of pediatric brain tumors and are typically low-grade lesions. Because of their unpredictable clinical course, adequate treatment approaches have been controversial, involving surveillance, surgery, chemotherapy, and radiotherapy. In this study, we use volumetric imaging to compare evolution of optic chiasmatic-hypothalamic gliomas (OCHG) treated with and without chemotherapy, analyzing tumor volume variation during the overall period. METHODS A total of 45 brain MRI were retrospectively analyzed for 14 patients with OCHG. Volumetric assessment of the lesions was performed by a neuroradiologist, using software DISPLAY. OCHG patients were allocated into two groups: group 1 (n = 8) who underwent chemotherapy and group 2 (n = 6) who did not receive chemotherapy. Outcome analysis was performed comparing tumor volume evolution of these two groups. RESULTS The results showed a reduction of 4.4% of the volume of the lesions for group 1 after the end of chemotherapy, with an increase of 5.3% in volume in the late follow-up examination. For group 2, we found a slight reduction (5%) of the overall volume of the lesions, both with no statistical significance (p > 0.05). CONCLUSIONS From the limited series analyzed in this study, no significant differences were observed in relation to the volume change of lesions treated or not treated with chemotherapy. Larger prospective clinical trials are needed to better evaluate the effect of chemotherapy and radiological response of OCHG.
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Affiliation(s)
- Nathalia Cunha Calixto
- Division of Radiology, Department of Clinics, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil.
| | - Gustavo Novelino Simão
- Division of Radiology, Department of Clinics, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Antonio Carlos Dos Santos
- Division of Radiology, Department of Clinics, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Ricardo Santos de Oliveira
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Luiz Guilherme Darrigo Junior
- Division of Pediatric Neuroncology, Department of Pediatrics, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Elvis Terci Valera
- Division of Pediatric Neuroncology, Department of Pediatrics, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Murilo Bicudo Cintra
- Division of Radiology, Department of Clinics, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Alessandro Spano Mello
- Division of Radiology, Department of Clinics, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
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Siwá A, Autrata R, Vejmělková K, Pavelka Z, Zitterbart K. NEUROFIBROMATOSIS TYPE 1 AND OPTIC PATHWAY GLIOMA. ACTA ACUST UNITED AC 2019; 75:200-208. [PMID: 32397722 DOI: 10.31348/2019/4/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Evaluate the effectiveness of treatment of patients with optic pathway glioma. MATERIALS AND METHODS Comparison of literature research on neurofibromatosis and optic pathway glioma with a cohort of pediatric patients treated at the Childrens Ophthalmology Clinic of the University Hospital in Brno from January 2013 until June 2018. DISCUSSION The main challenge of this and other retrospective studies is variable intervals between ophthalmologic examinations. In some pediatric patients it is also difficult to objectively assess visual functions. The main risk factors are age at the time of treatment and tumor localization. Tumor progression itself does not always correlate with worse visual acuity outcomes, and it remains to be evaluated whether some patients would be better off without treatment. As of now, there are no clinical biomarkers able to predict impending visual acuity loss. CONCLUSION The cohort outcome agrees with literature. Chemotherapy remains a treatment of choice and its most likely outcome is visual acuity stabilization. In order to properly evaluate the treatments effectiveness, better collaboration between medical specialists and regular standardized ophthalmology examinations are required.
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Park ES, Park JB, Ra YS. Pediatric Glioma at the Optic Pathway and Thalamus. J Korean Neurosurg Soc 2018; 61:352-362. [PMID: 29742884 PMCID: PMC5957311 DOI: 10.3340/jkns.2018.0040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/15/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022] Open
Abstract
Gliomas are the most common pediatric tumors of the central nervous system. In this review, we discuss the clinical features, treatment paradigms, and evolving concepts related to two types of pediatric gliomas affecting two main locations: the optic pathway and thalamus. In particular, we discuss recently revised pathologic classification, which adopting molecular parameter. We believe that our review contribute to the readers' better understanding of pediatric glioma because pediatric glioma differs in many ways from adult glioma according to the newest advances in molecular characterization of this tumor. A better understanding of current and evolving issues in pediatric glioma is needed to ensure effective management decision.
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Affiliation(s)
- Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young-Shin Ra
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Freret ME, Gutmann DH. Insights into optic pathway glioma vision loss from mouse models of neurofibromatosis type 1. J Neurosci Res 2018; 97:45-56. [PMID: 29704429 DOI: 10.1002/jnr.24250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 04/09/2018] [Indexed: 12/12/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a common cancer predisposition syndrome caused by mutations in the NF1 gene. The NF1-encoded protein (neurofibromin) is an inhibitor of the oncoprotein RAS and controls cell growth and survival. Individuals with NF1 are prone to developing low-grade tumors of the optic nerves, chiasm, tracts, and radiations, termed optic pathway gliomas (OPGs), which can cause vision loss. A paucity of surgical tumor specimens and of patient-derived xenografts for investigative studies has limited our understanding of human NF1-associated OPG (NF1-OPG). However, mice genetically engineered to harbor Nf1 gene mutations develop optic gliomas that share many features of their human counterparts. These genetically engineered mouse (GEM) strains have provided important insights into the cellular and molecular determinants that underlie mouse Nf1 optic glioma development, maintenance, and associated vision loss, with relevance by extension to human NF1-OPG disease. Herein, we review our current understanding of NF1-OPG pathobiology and describe the mechanisms responsible for tumor initiation, growth, and associated vision loss in Nf1 GEM models. We also discuss how Nf1 GEM and other preclinical models can be deployed to identify and evaluate molecularly targeted therapies for OPG, particularly as they pertain to future strategies aimed at preventing or improving tumor-associated vision loss in children with NF1.
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Affiliation(s)
- Morgan E Freret
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
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Marked functional recovery and imaging response of refractory optic pathway glioma to BRAFV600E inhibitor therapy: a report of two cases. Childs Nerv Syst 2018; 34:605-610. [PMID: 29392423 PMCID: PMC5857244 DOI: 10.1007/s00381-018-3739-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite appropriate therapeutic interventions, progressive optic pathway glioma (OPG) in children may result in loss of vision and other neurologic morbidities. Molecularly targeted therapy against the MAP kinase pathway holds promise in improving outcomes while resulting in lower treatment-related toxicities. We report two children with refractory OPG who had a substantial and early reversal of their neurologic deficits and an impressive imaging response of their tumor to BRAFV600E inhibition therapy. METHODS Two children with OPG (BRAFV600E-mutated pilocytic astrocytoma) who did not respond to at least one frontline therapy were treated with the oral BRAFV600E inhibitor vemurafenib. RESULTS Both children had substantial visual compromise before start of therapy, with one child additionally having motor deficits. Both had an early improvement in their vision, and the second child showed a demonstrable improvement in motor weakness. This was accompanied by a decrease in tumor size, which was sustained at 6 months from therapy. Neither child had significant toxicities except for mild skin sensitivity to vemurafenib. CONCLUSIONS BRAFV600E inhibitor therapy can potentially reverse visual and neurologic decline associated with progressive OPG. The clinico-radiologic response appears to be prompt and marked. Ongoing clinical trials using BRAFV600E inhibitors can help confirm these early promising findings.
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Falzon K, Drimtzias E, Picton S, Simmons I. Visual outcomes after chemotherapy for optic pathway glioma in children with and without neurofibromatosis type 1: results of the International Society of Paediatric Oncology (SIOP) Low-Grade Glioma 2004 trial UK cohort. Br J Ophthalmol 2018; 102:1367-1371. [DOI: 10.1136/bjophthalmol-2017-311305] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/24/2017] [Accepted: 12/29/2017] [Indexed: 02/04/2023]
Abstract
AimsTo report visual acuity (VA) outcomes following chemotherapy for optic pathway glioma (OPG) in children with or without neurofibromatosis type-1 (NF1) and to analyse associated risk factors.MethodsA prospective, multicentre, cohort study involving 155 children treated between September 2004 and December 2012. Initial and final VA was used for per-eye and per-subject analysis. Correlation tests were performed to determine whether initial VA predicted final VA. Logistic regression was used to determine whether age and tumour location were associated risk factors.Results90 children had complete ophthalmological data. At initiation of chemotherapy, 26% and 49% of eyes with NF1-OPG and sporadic OPG, respectively, had VA of ≥0.7 log of the minimum angle of resolution (logMAR). At final visit, per eye, 49% had ≤0.2, 23% had 0.30–0.60 and 28% had VA≥0.70 logMAR in the NF1-OPG group. In the sporadic OPG group, per eye, 32% had ≤0.2, 11% had VA 0.30–0.60 and 57% had ≥0.70 logMAR. Children with sporadic OPG, per eye, were significantly less likely to have VA outcomes ≤0.60 logMAR compared with children with NF1-OPG (OR=0.30; 95% CI 0.16 to 0.56; P<0.0001). Per subject, VA improved in 24%, remained stable in 35% and worsened in 41% of children with NF1-OPG and improved in 18%, remained stable in 43% and worsened in 39% of children with sporadic OPG.ConclusionsChildren with and without NF1 demonstrated the same rate of VA improvement, stabilisation or worsening; however, children with sporadic OPG had a poorer VA outcome. Better initial VA, older age, absence of postchiasm tumour and presence of NF1 were associated with improved or stable VA outcomes.
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Shofty B, Ben-Sira L, Kesler A, Jallo G, Groves ML, Iyer RR, Lassaletta A, Tabori U, Bouffet E, Thomale UW, Hernáiz Driever P, Constantini S. Isolated optic nerve gliomas: a multicenter historical cohort study. J Neurosurg Pediatr 2017; 20:549-555. [PMID: 28984541 DOI: 10.3171/2017.6.peds17107] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Isolated optic nerve gliomas (IONGs) constitute a rare subgroup of optic pathway gliomas (OPGs). Due to the rarity of this condition and the difficulty in differentiating IONGs from other types of OPGs in most clinical series, little is known about these tumors. Currently, due to lack of evidence, they are managed the same as any other OPG. METHODS The authors conducted a multicenter retrospective cohort study aimed at determining the natural history of IONGs. Included were patients with clear-cut glioma of the optic nerve without posterior (chiasmatic/hypothalamic) involvement. At least 1 year of follow-up, 2 MRI studies, and 2 neuro-ophthalmological examinations were required for inclusion. RESULTS Thirty-six patients with 39 tumors were included in this study. Age at diagnosis ranged between 6 months and 16 years (average 6 years). The mean follow-up time was 5.6 years. Twenty-five patients had neurofibromatosis Type 1. During the follow-up period, 59% of the tumors progressed, 23% remained stable, and 18% (all with neurofibromatosis Type 1) displayed some degree of spontaneous regression. Fifty-one percent of the patients presented with visual decline, of whom 90% experienced further deterioration. Nine patients were treated with chemotherapy, 5 of whom improved visually. Ten patients underwent operation, and no local or distal recurrence was noted. CONCLUSIONS Isolated optic nerve gliomas are highly dynamic tumors. Radiological progression and visual deterioration occur in greater percentages than in the general population of patients with OPGs. Response to chemotherapy may be better in this group, and its use should be considered early in the course of the disease.
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Affiliation(s)
- Ben Shofty
- 1The Gilbert Israeli Neurofibromatosis Center, Dana Children's Hospital.,2Division of Neurosurgery
| | - Liat Ben-Sira
- 1The Gilbert Israeli Neurofibromatosis Center, Dana Children's Hospital.,3Pediatric Radiology
| | - Anat Kesler
- 1The Gilbert Israeli Neurofibromatosis Center, Dana Children's Hospital.,4Division of Ophthalmology; and
| | - George Jallo
- 5Department of Neurosurgery, Johns Hopkins School of Medicine and Hospital, Baltimore, Maryland
| | - Mari L Groves
- 5Department of Neurosurgery, Johns Hopkins School of Medicine and Hospital, Baltimore, Maryland
| | - Rajiv R Iyer
- 5Department of Neurosurgery, Johns Hopkins School of Medicine and Hospital, Baltimore, Maryland
| | - Alvaro Lassaletta
- 6Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Uri Tabori
- 6Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Eric Bouffet
- 6Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada; and
| | - Ulrich-Wilhelm Thomale
- 7Pediatric Neurosurgery, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany
| | - Pablo Hernáiz Driever
- 7Pediatric Neurosurgery, Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany
| | - Shlomi Constantini
- 1The Gilbert Israeli Neurofibromatosis Center, Dana Children's Hospital.,8Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center and Tel Aviv University, Tel Aviv, Israel
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Kinori M, Hodgson N, Zeid JL. Ophthalmic manifestations in neurofibromatosis type 1. Surv Ophthalmol 2017; 63:518-533. [PMID: 29080631 DOI: 10.1016/j.survophthal.2017.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a relatively common multisystemic inherited disease and has been extensively studied by multiple disciplines. Although genetic testing and confirmation are available, NF1 remains a clinical diagnosis. Many manifestations of NF1 involve the eye and orbit, and the ophthalmologist, therefore, plays a significant role in the diagnosis and treatment of NF1 patients. Improvements in diagnostic and imaging instruments have provided new insight to study the ophthalmic manifestations of the disease. We provide a comprehensive and up-to-date overview of the ocular and orbital manifestations of NF1.
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Affiliation(s)
- Michael Kinori
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nickisa Hodgson
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, USA
| | - Janice Lasky Zeid
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
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Lassaletta A, Scheinemann K, Zelcer SM, Hukin J, Wilson BA, Jabado N, Carret AS, Lafay-Cousin L, Larouche V, Hawkins CE, Pond GR, Poskitt K, Keene D, Johnston DL, Eisenstat DD, Krishnatry R, Mistry M, Arnoldo A, Ramaswamy V, Huang A, Bartels U, Tabori U, Bouffet E. Phase II Weekly Vinblastine for Chemotherapy-Naïve Children With Progressive Low-Grade Glioma: A Canadian Pediatric Brain Tumor Consortium Study. J Clin Oncol 2017; 34:3537-3543. [PMID: 27573663 DOI: 10.1200/jco.2016.68.1585] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Vinblastine monotherapy has shown promising activity and a low-toxicity profile in patients with pediatric low-grade glioma (PLGG) who experienced treatment failure after initial treatment with chemotherapy and/or radiation. The aim of this study was to assess the activity of vinblastine in therapy-naïve children. Patients and Methods Patients < 18 years old with unresectable and/or progressive therapy-naïve PLGG were eligible. Vinblastine was administered once per week at a dose of 6 mg/m2 intravenously over a period of 70 weeks. Vision, quality of life, neurofibromatosis type 1 (NF1) status, and BRAF mutation/fusion status were also determined and correlated with outcome. Results Fifty-four patients were enrolled onto the study, with a median age of 8 years (range, 0.7 to 17.2 years). Most patients had chiasmatic/hypothalamic tumors (55.5%), and 13 patients (24.1%) had NF1. The most common histology was pilocytic astrocytoma (46.3%). Seventeen patients were diagnosed using radiologic criteria alone. Best response to chemotherapy was centrally reviewed with a response rate (complete, partial, or minor response) of 25.9%. Disease stabilization (complete, partial, or minor response or stable disease) was achieved in 47 patients (87.0%). Visual improvement was observed in 20% of patients with optic pathway glioma. Five-year overall survival and progression-free survival (PFS) rates were 94.4% (95% CI, 88.5% to 100%) and 53.2% (95% CI, 41.3% to 68.5%), respectively, for the entire cohort. Patients with NF1 had a significantly better PFS (85.1%; 95% CI, 68.0% to 100%) when compared with patients without NF1 (42.0%; 95% CI, 29.1% to 60.7%; P = .012). Age< 3 years or > 10 years was not associated with poor outcome. Treatment was well tolerated, and quality of life was not affected during treatment. In this trial, there was no correlation between BRAF alterations and outcome. Conclusion Vinblastine administered once per week is well tolerated in children with treatment naïve PLGG. Overall survival and PFS are comparable to current therapies, with a favorable toxicity profile and a maintained quality of life.
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Affiliation(s)
- Alvaro Lassaletta
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Katrin Scheinemann
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Shayna M Zelcer
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Juliette Hukin
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Beverley A Wilson
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Nada Jabado
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Anne Sophie Carret
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Lucie Lafay-Cousin
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Valerie Larouche
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Cynthia E Hawkins
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Gregory Russell Pond
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ken Poskitt
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel Keene
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Donna L Johnston
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - David D Eisenstat
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Rahul Krishnatry
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Matthew Mistry
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Anthony Arnoldo
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Vijay Ramaswamy
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Annie Huang
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Ute Bartels
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Uri Tabori
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Bouffet
- Alvaro Lassaletta, Cynthia E. Hawkins, Rahul Krishnatry, Matthew Mistry, Anthony Arnoldo, Vijay Ramaswamy, Annie Huang, Ute Bartels, Uri Tabori, and Eric Bouffet, The Hospital for Sick Children, Toronto; Katrin Scheinemann, McMaster Children's Hospital; Shayna M. Zelcer, Children's Hospital of Western Ontario, London; Gregory Russell Pond, Ontario Clinical Oncology Group, McMaster University, Hamilton; Daniel Keene and Donna L. Johnston, Children's Hospital of Eastern Ontario, Ottawa, Ontario; Juliette Hukin and Ken Poskitt, British Columbia Children's Hospital, Vancouver, British Columbia; Beverley A. Wilson, University of Alberta Hospital; Lucie Lafay-Cousin, Alberta Children's Hospital, Calgary; David D. Eisenstat, Stollery Children's Hospital, Edmonton; Alberta; Nada Jabado, McGill University; Anne Sophie Carret, Hospital Sainte Justine, Montreal; Valerie Larouche, Centre Hospitalier Universitaire de Québec, Québec, Québec; and David D. Eisenstat, Cancer Care Manitoba, Winnipeg, Manitoba, Canada
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Mora J, Perez-Jaume S, Cruz O. Treatment of childhood astrocytomas with irinotecan and cisplatin. Clin Transl Oncol 2017; 20:500-507. [DOI: 10.1007/s12094-017-1741-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
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Gnekow AK, Walker DA, Kandels D, Picton S, Giorgio Perilongo, Grill J, Stokland T, Sandstrom PE, Warmuth-Metz M, Pietsch T, Giangaspero F, Schmidt R, Faldum A, Kilmartin D, De Paoli A, De Salvo GL. A European randomised controlled trial of the addition of etoposide to standard vincristine and carboplatin induction as part of an 18-month treatment programme for childhood (≤16 years) low grade glioma - A final report. Eur J Cancer 2017; 81:206-225. [PMID: 28649001 PMCID: PMC5517338 DOI: 10.1016/j.ejca.2017.04.019] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of chemotherapy to manage newly diagnosed low grade glioma (LGG) was first introduced in the 1980s. One randomised trial has studied two- versus four-drug regimens with a duration of 12 months of treatment after resection. METHODS Within the European comprehensive treatment strategy for childhood LGG, the International Society of Paediatric Oncology-Low Grade Glioma (SIOP LGG) Committee launched a randomised trial involving 118 institutions and 11 countries to investigate the addition of etoposide (100 mg/m2, days 1, 2 & 3) to a four-course induction of vincristine (1.5 mg/m2 × 10 wkly) and carboplatin (550 mg/m2 q 3 weekly) as part of 18-month continuing treatment programme. Patients were recruited after imaging diagnosis, resection or biopsy with progressive disease/symptoms. Some 497 newly diagnosed patients (M/F 231/266; median age 4.26 years (interquartile range (IQR) 2.02-7.06)) were randomised to receive vincristine carboplatin (VC) (n = 249) or VC plus etoposide (VCE) during induction (n = 248), stratified by age and tumour site. FINDINGS No differences between the two arms were found in term of survival and radiological response. Response and non-progression rates at 24 weeks for VC and VCE, were 46% versus 41%, and 93% versus 91% respectively; 5-year Progression-Free Survival (PFS) and Overall Survival (OS) were 46% (StDev 3.5) versus 45% (StDev 3.5) and 89% (StDev 2.1) versus 89% (StDev 2.1) respectively. Age and diencephalic syndrome are adverse clinical risk factors for PFS and OS. 5-year OS for patients in early progression at week 24 were 46% (StDev 13.8) and 49% (StDev 16.5) in the two arms, respectively. INTERPRETATION The addition of etoposide to VC did not improve PFS or OS. High non-progression rates at 24 weeks justify retaining VC as standard first-line therapy. Infants with diencephalic syndrome and early progression need new treatments to be tested. Future trials should use neurological/visual and toxicity outcomes and be designed to discriminate between the impact on disease outcomes of 'duration of therapy' and 'age at stopping therapy'.
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Affiliation(s)
- Astrid K Gnekow
- Swabian Children's Cancer Center, Klinikum Augsburg, Germany
| | - David A Walker
- Children's Brain Tumour Research Centre, University of Nottingham, UK.
| | - Daniela Kandels
- Children's Brain Tumour Research Centre, University of Nottingham, UK
| | | | | | | | | | | | | | | | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomo-pathological Sciences, University Sapienza Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - René Schmidt
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Andreas Faldum
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Denise Kilmartin
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Angela De Paoli
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
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Wan MJ, Ullrich NJ, Manley PE, Kieran MW, Goumnerova LC, Heidary G. Long-term visual outcomes of optic pathway gliomas in pediatric patients without neurofibromatosis type 1. J Neurooncol 2016; 129:173-8. [DOI: 10.1007/s11060-016-2163-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 06/01/2016] [Indexed: 01/18/2023]
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Helfferich J, Nijmeijer R, Brouwer OF, Boon M, Fock A, Hoving EW, Meijer L, den Dunnen WFA, de Bont ESJM. Neurofibromatosis type 1 associated low grade gliomas: A comparison with sporadic low grade gliomas. Crit Rev Oncol Hematol 2016; 104:30-41. [PMID: 27263935 DOI: 10.1016/j.critrevonc.2016.05.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 03/24/2016] [Accepted: 05/12/2016] [Indexed: 11/29/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder, associated with a variable clinical phenotype including café-au-lait spots, intertriginous freckling, Lisch nodules, neurofibromas, optic pathway gliomas and distinctive bony lesions. NF1 is caused by a mutation in the NF1 gene, which codes for neurofibromin, a large protein involved in the MAPK- and the mTOR-pathway through RAS-RAF signalling. NF1 is a known tumour predisposition syndrome, associated with different tumours of the nervous system including low grade gliomas (LGGs) in the paediatric population. The focus of this review is on grade I pilocytic astrocytomas (PAs), the most commonly observed histologic subtype of low grade gliomas in NF1. Clinically, these PAs have a better prognosis and show different localisation patterns than their sporadic counterparts, which are most commonly associated with a KIAA1549:BRAF fusion. In this review, possible mechanisms of tumourigenesis in LGGs with and without NF1 will be discussed, including the contribution of different signalling pathways and tumour microenvironment. Furthermore we will discuss how increased understanding of tumourigenesis may lead to new potential targets for treatment.
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Affiliation(s)
- Jelte Helfferich
- Department of Paediatrics, Beatrix Children's Hospital, Paediatric Oncology/Hematology Division, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Neurology, Paediatric Neurology Division, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Ronald Nijmeijer
- Department of Pathology and Medical Biology, Pathology Division, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Oebele F Brouwer
- Department of Neurology, Paediatric Neurology Division, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Maartje Boon
- Department of Neurology, Paediatric Neurology Division, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Annemarie Fock
- Department of Neurology, Paediatric Neurology Division, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Eelco W Hoving
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisethe Meijer
- Department of Paediatrics, Beatrix Children's Hospital, Paediatric Oncology/Hematology Division, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wilfred F A den Dunnen
- Department of Pathology and Medical Biology, Pathology Division, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eveline S J M de Bont
- Department of Paediatrics, Beatrix Children's Hospital, Paediatric Oncology/Hematology Division, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Doganis D, Pourtsidis A, Tsakiris K, Baka M, Kouri A, Bouhoutsou D, Varvoutsi M, Servitzoglou M, Dana H, Kosmidis H. Optic pathway glioma in children: 10 years of experience in a single institution. Pediatr Hematol Oncol 2016; 33:102-8. [PMID: 27007263 DOI: 10.3109/08880018.2016.1155101] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Optic pathway glioma (OPG) is a rare brain tumor that occurs more commonly during early childhood and is frequently associated with neurofibromatosis type 1 (NF1). In this study, our aim was to describe the characteristics, management, and outcome of patients with OPG. We retrospectively analyzed the clinical charts of all children diagnosed with OPG at our institution from 2003 to 2013. Twenty children (11 boys and 9 girls, median age: 5 and 3/12 years; NF1: 15/20) were diagnosed with OPG. The diagnosis was based on magnetic resonance imaging (MRI) findings. A biopsy was useful in 3 patients. The main reason for seeking medical advice was decreased vision (7/20 patients), whereas in 10/20 patients, the diagnosis was established during the routine follow-up for their NF1. Fifteen patients demonstrated MRI findings of optic nerve involvement and/or chiasmal tumor, whereas in 5 children, postchiasmal structures were also involved. Sixteen patients (16/20) received carboplatin-based regimens, whereas 4/20 patients were only under close observation. Six patients showed deterioration of visual acuity and/or imaging findings at the end of treatment and/or during their follow-up. Three of them (3/6) underwent tumor resection, whereas 1 (1/6) received radiation treatment. None of our patients had total blindness from both eyes. Half of our patients were diagnosed during follow-up for their NF1, the incidence of which was high in our group. Our data suggest that chemotherapy helps in the preservation of vision in the majority of children.
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Affiliation(s)
- Dimitrios Doganis
- a Department of Oncology , P. & A. Kyriakou Children's Hospital , Athens , Greece
| | - Apostolos Pourtsidis
- a Department of Oncology , P. & A. Kyriakou Children's Hospital , Athens , Greece
| | - Kleonikos Tsakiris
- b Department of Ophthalmology , P. & A. Kyriakou Children's Hospital , Athens , Greece
| | - Margarita Baka
- a Department of Oncology , P. & A. Kyriakou Children's Hospital , Athens , Greece
| | - Agathi Kouri
- b Department of Ophthalmology , P. & A. Kyriakou Children's Hospital , Athens , Greece
| | - Despina Bouhoutsou
- a Department of Oncology , P. & A. Kyriakou Children's Hospital , Athens , Greece
| | - Maria Varvoutsi
- a Department of Oncology , P. & A. Kyriakou Children's Hospital , Athens , Greece
| | - Marina Servitzoglou
- a Department of Oncology , P. & A. Kyriakou Children's Hospital , Athens , Greece
| | - Helen Dana
- a Department of Oncology , P. & A. Kyriakou Children's Hospital , Athens , Greece
| | - Helen Kosmidis
- a Department of Oncology , P. & A. Kyriakou Children's Hospital , Athens , Greece
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Blanchard G, Lafforgue MP, Lion-François L, Kemlin I, Rodriguez D, Castelnau P, Carneiro M, Meyer P, Rivier F, Barbarot S, Chaix Y. Systematic MRI in NF1 children under six years of age for the diagnosis of optic pathway gliomas. Study and outcome of a French cohort. Eur J Paediatr Neurol 2016; 20:275-281. [PMID: 26774135 DOI: 10.1016/j.ejpn.2015.12.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/13/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND/PURPOSE Optic pathway glioma (OPG) is the most common central nervous system tumor in children with neurofibromatosis type 1 (NF1), affecting 15-20% of patients. We reviewed the medical records of children systematically screened by ophthalmologic and MRI examinations to determine the influence of screening on the therapeutic management of children with OPG. METHODS Data were collected on 306 newly diagnosed cases screened with systematic MRI from January 2001 to July 2007. In the OPG group, we distinguished the asymptomatic or symptomatic groups according to their initial status. RESULTS Forty-five patients had confirmed OPG (14.7%). Thirty-six patients (80%) were asymptomatic and nine (20%) were symptomatic at the time of diagnosis with visual symptoms in six cases. The average age at OPG diagnosis was 3.4 years with six patients (13%) over six years old. Average follow-up was 7.7 years. Progression was observed in 16 cases (35%). Most patient conditions were managed conservatively (87%). Six children (13%) were treated with chemotherapy due to worsening visual function. All of these children had severe or mild visual impairment at the end of follow-up. CONCLUSION Our study does not support a clear benefit of systematic MRI screening in NF1 children under six years old. Systematic neuroimaging in our study did not influence therapeutic management. Although OPG diagnosis was made early, treatment with chemotherapy did not improve the final visual outcome. If MRI remains the best tool for the diagnosis of cerebral and spinal pathologies in the NF1 population, our current study questions the usefulness of systematic MRI screening for OPG diagnosis. Conversely, this study suggests that the indication of neuroimaging should be dictated by the results of annual clinical and ophthalmological assessments.
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Affiliation(s)
- Gaelle Blanchard
- Service de neurologie pédiatrique, Hôpital Femme, Mère, Enfant, Bron, France
| | | | | | - Isabelle Kemlin
- AP-HP, Service de Neurologie Pédiatrique et Centre de Référence des Neurofibromatoses, Hôpital Armand Trousseau, CHU Paris Est, Paris, France
| | - Diana Rodriguez
- AP-HP, Service de Neurologie Pédiatrique et Centre de Référence des Neurofibromatoses, Hôpital Armand Trousseau, CHU Paris Est, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, Paris, France; Inserm U1141, Paris, France
| | - Pierre Castelnau
- Unité de Neuropédiatrie et Handicaps, Hôpital d'Enfants Gatien de Clocheville, CHU de Tours, France; Inserm, Imagerie et Cerveau, UMR 930, CHRU de Tours, Hôpital Bretonneau, Tours, France; Université de Tours, François Rabelais, Tours, France
| | - Maryline Carneiro
- CHRU de Montpellier, Neuropédiatrie & Centre de Référence des Troubles du Langage, Montpellier, France
| | - Pierre Meyer
- CHRU de Montpellier, Neuropédiatrie & Centre de Référence des Troubles du Langage, Montpellier, France
| | - François Rivier
- CHRU de Montpellier, Neuropédiatrie & Centre de Référence des Troubles du Langage, Montpellier, France; Université de Montpellier, UFR de Médecine, Montpellier, France; U1046 Inserm, UMR9214 CNRS, PhyMedExp, Université de Montpellier, Montpellier, France
| | | | - Yves Chaix
- Hôpital des Enfants, CHU Purpan, Toulouse, France; Inserm, Imagerie Cérébrale et Handicaps Neurologiques UMR 825, CHU Purpan, Toulouse, France; Université de Toulouse III - Paul Sabatier, Toulouse, France.
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