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Wawrzuta D, Chojnacka M, Dembowska-Bagińska B, Raciborska A, Hutnik Ł, Cieślak M, Pędziwiatr K. Revisiting the role of radiotherapy in the treatment of neuroblastoma 4S: 30 years of institutional experience and systematic review. Clin Transl Radiat Oncol 2024; 47:100791. [PMID: 38745962 PMCID: PMC11090876 DOI: 10.1016/j.ctro.2024.100791] [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: 01/19/2024] [Revised: 04/22/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024] Open
Abstract
Background and purpose Neuroblastoma 4S is a rare subtype of metastatic neuroblastoma found in children younger than 12 months, characterized by liver, skin, or bone marrow metastases. While the prognosis for patients is generally favorable, rapid progression of liver metastases can lead to life-threatening organ insufficiency. In such cases, immediate treatment with chemotherapy or radiotherapy is necessary. Given the recent decline in radiotherapy utilization, this study aims to reassess its role, evaluating its effectiveness and toxicity. Materials and methods We conducted a systematic review and an institutional retrospective analysis to assess the use of radiotherapy for hepatomegaly in patients with neuroblastoma 4S. The study included data from 164 patients from the literature and 16 patients from our institutional cohort. We extracted and analyzed data on short- and long-term outcomes, as well as reports of radiotherapy-induced toxicity. Results Our institutional data showed that 81 % of patients responded to low-dose radiotherapy administered at a median dose of 450 cGy in three fractions, resulting in liver shrinkage and symptom resolution. Based on the systematic review, 1-year survival rate was 80 %, while 5-year survival rate was 75 %. No serious toxicity was observed with the current low-dose radiotherapy; however, one case of induced secondary malignancy was reported. Conclusion Radiation therapy is an effective treatment modality for hepatomegaly in patients with neuroblastoma 4S, with a success rate of about 80 %. Despite being administered to infants, a low dose of 450-600 cGy does not result in toxicity related to the kidneys, liver, or posture defects.
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Affiliation(s)
- Dominik Wawrzuta
- Department of Radiation Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Wawelska 15B, 02-034 Warsaw, Poland
| | - Marzanna Chojnacka
- Department of Radiation Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Wawelska 15B, 02-034 Warsaw, Poland
| | - Bożenna Dembowska-Bagińska
- Department of Oncology, Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Kasprzaka 17a, 01-211 Warsaw, Poland
| | - Łukasz Hutnik
- Clinical Department of Pediatric Oncology, Hematology, Clinical Transplantology and Pediatrics, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland
| | - Mariusz Cieślak
- Clinical Department of Pediatric Oncology, Hematology, Clinical Transplantology and Pediatrics, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091 Warsaw, Poland
| | - Katarzyna Pędziwiatr
- Department of Radiation Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Wawelska 15B, 02-034 Warsaw, Poland
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Nanda RH, Hua CH, Flampouri S, Eaton B, Kaste S, Patni T, Ronckers C, Constine LS, Marks LB, Esiashvili N. Risks of Spinal Abnormalities and Growth Impairment After Radiation to the Spine in Childhood Cancer Survivors: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:507-521. [PMID: 38069918 DOI: 10.1016/j.ijrobp.2023.10.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 05/19/2024]
Abstract
PURPOSE A PENTEC (Pediatric Normal Tissue Effects in the Clinic) review was performed to estimate the dose-volume effects of radiation therapy on spine deformities and growth impairment for patients who underwent radiation therapy as children. METHODS AND MATERIALS A systematic literature search was performed to identify published data for spine deformities and growth stunting. Data were extracted from 12 reports of children irradiated to the spine (N = 603 patients). The extracted data were analyzed to find associations between complication risks and the radiation dose (conventional fractionation throughout) as impacted by exposed volumes and age using the mixed-effects logistic regression model. When appropriate, corrections were made for radiation modality, namely orthovoltage beams. RESULTS In the regression analysis, the association between vertebral dose and scoliosis rate was highly significant (P < .001). Additionally, young age at time of radiation was highly predictive of adverse outcomes. Clinically significant scoliosis can occur with doses ≥15 Gy to vertebrae during infancy (<2 years of age). For children irradiated at 2 to 6 years of age, overall scoliosis rates of any grade were >30% with doses >20 Gy; grade 2 or higher scoliosis was correlated with doses ≥30 Gy. Children >6 years of age remain at risk for scoliosis with doses >30 Gy; however, most cases will be mild. There are limited data regarding the effect of dose gradients across the spine on degree of scoliosis. The risk of clinically meaningful height loss was minimal when irradiating small volumes of the spine up to 20 Gy (eg, flank irradiation), except in infants who are more vulnerable to lower doses. Growth stunting was more frequent when larger segments of the spine (eg, the entire spine or craniospinal irradiation) were irradiated before puberty to doses >20 Gy. The effect was modest when patients were irradiated after puberty to doses >20 Gy. CONCLUSIONS To reduce the risk of kyphoscoliosis and growth impairment, the dose to the spine should be kept to <20 Gy for children <6 years of age and to <10 to 15 Gy in infants. The number of vertebral bodies irradiated and dose gradients across the spine should also be limited when possible.
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Affiliation(s)
- Ronica H Nanda
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stella Flampouri
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Bree Eaton
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Sue Kaste
- Departments of Diagnostic Imaging and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Tushar Patni
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Cecile Ronckers
- Division of Childhood Cancer Epidemiology / German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medicin at the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Lawrence B Marks
- Department of Radiation Oncology, Lineberger Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Chang CW, Goette M, Kadom N, Wang Y, Wynne J, Wang T, Liu T, Esiashvili N, Zhou J, Eaton BR, Yang X. Early in vivo Radiation Damage Quantification for Pediatric Craniospinal Irradiation Using Longitudinal MRI for Intensity Modulated Proton Therapy. Adv Radiat Oncol 2023; 8:101267. [PMID: 37408668 PMCID: PMC10318210 DOI: 10.1016/j.adro.2023.101267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/28/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose Proton vertebral body sparing craniospinal irradiation (CSI) treats the thecal sac while avoiding the anterior vertebral bodies in an effort to reduce myelosuppression and growth inhibition. However, robust treatment planning needs to compensate for proton range uncertainty, which contributes unwanted doses within the vertebral bodies. This work aimed to develop an early in vivo radiation damage quantification method using longitudinal magnetic resonance (MR) scans to quantify the dose effect during fractionated CSI. Methods and Materials Ten pediatric patients were enrolled in a prospective clinical trial of proton vertebral body sparing CSI, in which they received 23.4 to 36 Gy. Monte Carlo robust planning was used, with spinal clinical target volumes defined as the thecal sac and neural foramina. T1/T2-weighted MR scans were acquired before, during, and after treatments to detect a transition from hematopoietic to less metabolically active fatty marrow. MR signal intensity histograms at each time point were analyzed and fitted by multi-Gaussian models to quantify radiation damage. Results Fatty marrow filtration was observed in MR images as early as the fifth fraction of treatment. Maximum radiation-induced marrow damage occurred 40 to 50 days from the treatment start, followed by marrow regeneration. The mean damage ratios were 0.23, 0.41, 0.59, and 0.54, corresponding to 10, 20, 40, and 60 days from the treatment start. Conclusions We demonstrated a noninvasive method for identifying early vertebral marrow damage based on radiation-induced fatty marrow replacement. The proposed method can be potentially used to quantify the quality of CSI vertebral sparing and preserve metabolically active hematopoietic bone marrow.
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Affiliation(s)
- Chih-Wei Chang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Matt Goette
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Yinan Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jacob Wynne
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Tonghe Wang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tian Liu
- Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York
| | - Natia Esiashvili
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jun Zhou
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Bree R. Eaton
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia
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Jiang Q, Gao H, Gao G, Li Y, Cheng H, Shi G, Shang A. Neuroblastoma of the lumbosacral canal in an adult: a case report and literature review. Front Neurol 2023; 14:1195664. [PMID: 37602246 PMCID: PMC10435846 DOI: 10.3389/fneur.2023.1195664] [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: 03/28/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Neuroblastoma (NB) is a leading cause of death in children. It usually occurs in the adrenal gland and rarely in the spinal canal. Here, we report the case of a 48-year-old male patient with abnormal thickening of the cauda equina nerve as revealed by lumbosacral magnetic resonance imaging. The patient's main clinical manifestations were numbness and pain in both lower limbs. The patient underwent surgical treatment; however, intraoperatively, an unclear border was observed between the cauda equina nerve and the tumor; therefore, the tumor was not forcibly excised. The postoperative pathological results were reported as NB. The disease known as NB, which is extremely rare. We believe that a pathological biopsy is extremely vital for diagnosing NB, and aggressive post-operative radio-chemotherapy could potentially prolong the patient's survival time.
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Affiliation(s)
| | - Haihao Gao
- Chinese PLA Medical School, Beijing, China
| | - Gan Gao
- Chinese PLA Medical School, Beijing, China
| | - Yang Li
- Department of Critical Care Medicine, Chinese PAP Beijing Corps Hospital, Beijing, China
| | | | | | - Aijia Shang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
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Variation in Proton Craniospinal Irradiation Practice Patterns in the United States: A Pediatric Proton Consortium Registry (PPCR) Study. Int J Radiat Oncol Biol Phys 2021; 112:901-912. [PMID: 34808253 DOI: 10.1016/j.ijrobp.2021.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/03/2021] [Accepted: 11/14/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Craniospinal irradiation (CSI) is commonly used for pediatric brain tumors with a propensity for spread in craniospinal fluid, principally medulloblastoma. Evolving technology has led to the use of highly conformal radiation therapy (RT) techniques for CSI, including proton therapy. Target delineation and plan coverage are critical for CSI, but there is ongoing controversy and variability in these realms, with little available data on practice patterns. We sought to characterize proton CSI practice patterns in the United States by examining CSI plans in the Pediatric Proton/Photon Consortium Registry (PPCR). MATERIALS AND METHODS PPCR was queried for data on proton CSI patients from 2015 to early 2020. Each plan was manually reviewed, determining patient position; prescription dose; and coverage of optic nerves, vertebral bodies, spinal nerve roots, sacral nerves, and cranial foramina, among other variables. Two radiation oncologists blinded to clinical data and treating institution assessed coverage at the 95% prescription isodose line and per published European Society for Paediatric Oncology guidelines. Variability in coverage was assessed with nonparametric tests and univariate and multivariate logistic regression. RESULTS PPCR supplied data for 450 patients, 384 of whom had an evaluable portion of a CSI plan. Most patients (90.3%) were supine. Optic nerves were fully covered in 48.2%; sacral nerves in 87.7%; cranial foramina in 69.3%; and spinal nerves in 95.6%. Vertebral body (VB) sparing was used in 18.6% of skeletally immature cases, increasing over time (P < .001). Coverage in all categories was significantly different among treating institutions, on univariate and multivariate analyses. Cribriform plate deficits were rare, with marginal misses of the foramen ovale (17.4%) and frontal lobe (12%) most common. CONCLUSION We found consistent variation based on treating institution in proton CSI practices including optic nerve, VB, sacral nerve, cranial, and spinal nerve coverage. These data may serve as a baseline quantification of current proton CSI practices in the United States as they continue to evolve.
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Yoo GS, Yu JI, Cho S, Han Y, Oh Y, Lim DH, Nam HR, Lee JW, Sung KW, Shin HJ. Chronological Analysis of Acute Hematological Outcomes after Proton and Photon Beam Craniospinal Irradiation in Pediatric Brain Tumors. Cancer Res Treat 2021; 54:907-916. [PMID: 34665955 PMCID: PMC9296930 DOI: 10.4143/crt.2021.332] [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: 03/15/2021] [Accepted: 10/14/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose This study aimed to compare the early hematological dynamics and acute toxicities between proton beam craniospinal irradiation (PrCSI) and photon beam craniospinal irradiation (PhCSI) for pediatric brain tumors. Materials and Methods We retrospectively reviewed patients with pediatric brain tumors who received craniospinal irradiation (CSI). The average change in hemoglobin levels (ΔHbavg), absolute lymphocyte counts (ΔALCavg), and platelet counts (ΔPLTavg) from baseline values was evaluated and compared between the PrCSI and PhCSI groups at 1 and 2 weeks after the initiation of CSI, 1 week before and at the end of radiotherapy, and 3–4 weeks after the completion of radiotherapy using t-test and mixed-model analysis. Results The PrCSI and PhCSI groups consisted of 36 and 30 patients, respectively. There were no significant differences in ΔHbavg between the two groups at any timepoint. However, ΔALCavg and ΔPLTavg were significantly lower in the PhCSI group than in PrCSI group at every timepoint, demonstrating that PrCSI resulted in a significantly lower rate of decline and better recovery of absolute lymphocyte and platelet counts. The rate of grade 3 acute anemia was significantly lower in the PrCSI group than in in the PhCSI group. Conclusion PrCSI showed a lower rate of decline and better recovery of absolute lymphocyte and platelet counts than PhCSI in the CSI for pediatric brain tumors. Grade 3 acute anemia was significantly less frequent in the PrCSI group than in the PhCSI group. Further large-scale studies are warranted to confirm these results.
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Affiliation(s)
- Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sungkoo Cho
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea
| | - Youngyih Han
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoonjin Oh
- Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Rim Nam
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Won Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki-Woong Sung
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Jin Shin
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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7
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Paulino AC, Suzawa HS, Dreyer ZE, Hanania AN, Chintagumpala M, Okcu MF. Scoliosis in Children Treated With Photon Craniospinal Irradiation for Medulloblastoma. Int J Radiat Oncol Biol Phys 2021; 109:712-717. [PMID: 33516438 DOI: 10.1016/j.ijrobp.2020.09.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Scoliosis is a well-recognized complication after abdominal radiation therapy but not reported frequently after craniospinal irradiation (CSI). We examined the incidence and risk factors for scoliosis after CSI in long-term survivors with medulloblastoma. METHODS AND MATERIALS The records of patients with medulloblastoma seen at one institution from 1996 to 2006 were analyzed for the use of CSI and development of scoliosis as documented on physical examination and spinal imaging. RESULTS We identified 35 children with medulloblastoma who were ≤12 years of age at time of CSI with a median 14.3 years (range, 5.8-19.3 years) of follow-up. Twenty-seven (77.1%) were male, and median age at CSI was 6.8 years (range, 2.8-12 years). The cumulative incidence of scoliosis at 15 years was 34.6%. The median time to develop scoliosis was 7.1 years (range, 5-11.7 years) after CSI. Treatment with high dose CSI (34.2-40 Gy) and presence of hemiplegia or hemiparesis were found to be risk factors for development of scoliosis. CONCLUSIONS Scoliosis is an underreported complication of photon craniospinal irradiation.
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Affiliation(s)
- Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas; Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas.
| | - Hilary S Suzawa
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - ZoAnn E Dreyer
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Alexander N Hanania
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas
| | | | - Mehmet Fatih Okcu
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
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Witte ZW, Mahoney JM, Harris JA, Sheikh HP, Haghshenas V, Bucklen BS, Marco RA. Biomechanical investigation of potential prophylactic scoliosis treatments following various sizes of chest wall resection. Clin Biomech (Bristol, Avon) 2021; 87:105416. [PMID: 34171652 DOI: 10.1016/j.clinbiomech.2021.105416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 05/28/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND A well-known problematic sequela of chest wall resections is development of scoliosis. Despite the seriousness and frequency of scoliosis following chest well resection, the etiology and biomechanical information needed to understand this progression aren't well-known. METHODS Range of motion of six specimen (C7-L2) was captured using a custom-built six degrees-of-freedom machine in each of three physiological rotation axes. Left posterior ribs were sequentially resected 7cm from the rib head, starting at the 5th rib and continuing until the 10th rib. Injured specimen were instrumented with unilateral anterior rod fixation and then with additional unilateral posterior fixation, each starting at T4 and then extended distally as ribs were resected. Relative motion between the constructs' proximal and distal ends was measured in all three axes for the intact, injured, unilateral anterior, and unilateral anterior with unilateral posterior constructs. FINDINGS Raw motion of the injured specimen increased in a stepwise manner as ribs were resected. Averaged across all injury sizes, the unilateral anterior construct significantly reduced motion by 47.0±13.4% in lateral bending (P=.001). The combined anterior-posterior construct significantly reduced motion by 57.6±15.9% in flexion/extension (P<.001), 70.3±12.2% in lateral bending (P<.001), and 51.1±14.5% in axial rotation (P<.001). Combined anterior-posterior fixation was significantly more stable than anterior-only fixation in flexion/extension (P=.002). INTERPRETATION Regardless of injury size, posterior rib resection did not create significant immediate instability of the thoracic spine. Concurrent spinal stabilization was shown to maintain thoracic spine stability. Combined anterior-posterior fixation proved to be significantly more rigid than an anterior-only construct.
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Affiliation(s)
| | - Jonathan M Mahoney
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA.
| | - Jonathan A Harris
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Hassaan P Sheikh
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Varan Haghshenas
- Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Brandon S Bucklen
- Musculoskeletal Education and Research Center, A Division of Globus Medical Inc., Audubon, PA, USA
| | - Rex A Marco
- Spine Surgery and Musculoskeletal Oncology, Houston Methodist Hospital, Houston, TX, USA
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Tang J, Zhang D, Xu YY, Xu XK, Wang FH, Zeng JH, Liang JH, Liu W, Li L. Clinical characteristics and therapeutic outcomes of mediastinal neuroblastoma with intraspinal extension: a retrospective study. Transl Pediatr 2021; 10:715-722. [PMID: 34012821 PMCID: PMC8107862 DOI: 10.21037/tp-20-268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Mediastinal neuroblastoma (NB) can invade the spinal canal and result in spinal cord compression. Some patients go on to develop severe spinal deformities after decompression of the spinal cord. The optimal therapeutic strategy for mediastinal NB with intraspinal extension is still unclear. Our study is to assess the therapeutic strategies for such patients. METHODS A total of 77 patients suffered mediastinal tumors with intraspinal extension between March 2015 and Aug 2019 were enrolled in the study. According to the primary therapy, NB were classified into 4 groups: chemotherapy, video-assisted thoracoscopic surgery (VATS)/thoracotomy, neurosurgical decompression, and a combined thoracic-neurosurgical approach. Clinical features, including patient demographics, neurologic recovery and survival rate, were assessed. RESULTS Among the 77 patients suffered mediastinal tumors with intraspinal extension, neurological symptoms were present in 44 patients. Neurological deficits improved in 76.5% of patients who underwent neurosurgical intervention and 50% of the other patients (P=0.094). Compression manifestations of ≤4 weeks duration showed an improved outcome compared to a longer compression time, with complete recovery of neurological function in 60% of patients versus 28.6% for patients with a longer symptom duration (P=0.04). NB constituted 49.4% of the 77 patients. An overall survival rate of 90.0%±9.5% was achieved for patients in the combined thoracic-neurosurgical group, 59.5%±15.0% in the thoracotomy group, 40.0%±29.7% in laminectomy group, and 37.0%±20.2% in the chemotherapy group. Complete regression of the tumor was demonstrated in 80% of combined group, which was greater than that of patients in the other groups (P=0.001). CONCLUSIONS Neurological recovery was correlated with the type of initial treatment and the duration of neurological symptoms. Mediastinal NB with intraspinal extension can be effectively managed with a combined neurosurgical and thoracic surgical approach.
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Affiliation(s)
- Jue Tang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Dan Zhang
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ying-Yi Xu
- Department of Anesthesia, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Xin-Ke Xu
- Department of Neurosurgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Feng-Hua Wang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jia-Hang Zeng
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jiang-Hua Liang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Wei Liu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Le Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou, China
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An Analysis of Vertebral Body Growth after Proton Beam Therapy for Pediatric Cancer. Cancers (Basel) 2021; 13:cancers13020349. [PMID: 33477867 PMCID: PMC7832908 DOI: 10.3390/cancers13020349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/03/2022] Open
Abstract
Simple Summary Radiotherapy has a key role in treatment of pediatric cancer and has greatly improved survival in recent years. However, vertebrae are often included in the irradiated area, and this may affect growth after treatment. In this study, we examined the relationship of the dose of proton beam therapy with subsequent growth of 353 vertebral bodies in 23 children (10 boys, 13 girls) with a median age at treatment of 4 years old and a median observation period of 13.9 months. Most importantly, we found that the growth rate of vertebral bodies decreased even at a low proton beam therapy dose, which indicates the need for careful planning of the irradiation area in this patient population. Growth inhibition was clearly dose-dependent, and proton beam therapy had the same growth inhibitory effect as photon radiotherapy, at least within the irradiated field. Abstract Impairment of bone growth after radiotherapy for pediatric bone cancer is a well-known adverse event. However, there is limited understanding of the relationship between bone growth and irradiation dose. In this study, we retrospectively analyzed bone growth impairment after proton beam therapy for pediatric cancer. A total of 353 vertebral bodies in 23 patients under 12 years old who received proton beam therapy were evaluated. Compared to the non-irradiated vertebral body growth rate, the irradiated vertebral body rate (%/year) was significantly lower: 77.2%, 57.6%, 40.8%, 26.4%, and 14.1% at 10, 20, 30, 40, and 50 Gy (RBE) irradiation, respectively. In multivariate analysis, radiation dose was the only factor correlated with vertebral body growth. Age, gender, and vertebral body site were not significant factors. These results suggest that the growth rate of the vertebral body is dose-dependent and decreases even at a low irradiated dose. This is the first report to show that proton beam therapy has the same growth inhibitory effect as photon radiotherapy within the irradiated field.
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11
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Oshiro Y, Mizumoto M, Pan H, Kaste SC, Gajjar A, Merchant TE. Spinal changes after craniospinal irradiation in pediatric patients. Pediatr Blood Cancer 2020; 67:e28728. [PMID: 33009883 DOI: 10.1002/pbc.28728] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND To evaluate long-term degenerative changes in bone and soft tissue after craniospinal irradiation (CSI). PROCEDURE An analysis was performed for 892 vertebral bodies in 220 pediatric patients treated with CSI. To analyze vertebral growth, vertebral body height was calculated. Signal changes for vertebral bodies on MRI, scoliosis and kyphosis, degenerative changes of vertebral bones and discs, and wedging or vertebral height loss were analyzed on images, and factors that influenced these changes were investigated. RESULTS Vertebral growth was significantly correlated with radiation dose and growth hormone (GH) deficiency. Growth rate was significantly worse at a dose >39 Gy. Fatty marrow change was found in 83% of patients, 31% had disc degenerative changes, 13% had degenerative changes of spinal bones, 17% had wedging or spinal height loss, and 27% had scoliosis. CONCLUSIONS Vertebral bone growth was significantly reduced when high doses were administered, and adequate GH replacement was important for bone growth. Even with symmetrical irradiation, the risk of scoliosis is high after CSI. There was also frequent progression of spinal demineralization and degenerative changes after CSI. Therefore, careful attention should be paid to spinal symptoms as pediatric patients grow into adulthood.
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Affiliation(s)
- Yoshiko Oshiro
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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12
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Hell AK, Kühnle I, Lorenz HM, Braunschweig L, Lüders KA, Bock HC, Kramm CM, Ludwig HC, Tsaknakis K. Spinal Deformities after Childhood Tumors. Cancers (Basel) 2020; 12:cancers12123555. [PMID: 33260742 PMCID: PMC7759932 DOI: 10.3390/cancers12123555] [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: 10/30/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary A significant number of children surviving intra- or juxta-spinal tumors develop secondary spinal deformities and disabilities. This retrospective non-comparative study focuses on deformity analysis, age, and skeletal maturity dependent treatment options and results. Patients who developed severe scoliosis, pathological kyphosis, and/or lordosis were either treated conservatively or surgically by using growth-friendly spinal implants in younger children or definite spinal fusion during puberty. Despite severe spinal deformity, some patients were not surgically corrected in order to preserve mobility through trunk motion or malignant tumor progression. Growth-friendly spinal implants and spinal fusions were able to significantly reduce pathological curves. The first method, with bilateral rib-to-pelvis fixation, still allows spinal magnetic resonance imaging or neurosurgical intervention if needed. Severe ad hoc curve correction enhances the risk of neurological deterioration because of prior spinal cord impairment. The data of this study may help to improve the individual patient care. Abstract Childhood tumors of the central nervous system (CNS) and other entities affecting the spine are rare. Treatment options vary from surgical biopsy to partial, subtotal, and total resection, to radiation, to chemotherapy. The aim of this study is to investigate spinal deformity and subsequent surgical interventions in this patient cohort. A retrospective review at our institution identified children with CNS tumors, spinal tumors, and juxta-spinal tumors, as well as spinal deformities. Tumor entity, treatment, mobilization, and radiographic images were analyzed relative to the spinal deformity, using curve angles in two planes. Conservative or surgical interventions such as orthotic braces, growth-friendly spinal implants, and spinal fusions were evaluated and analyzed with respect to treatment results. Tumor entities in the 76 patients of this study included CNS tumors (n = 41), neurofibromatosis with spinal or paraspinal tumors (n = 14), bone tumors (n = 12), embryonal tumors (n = 7), and others (n = 2). The initial treatment consisted of surgical biopsy (n = 5), partial, subtotal, or total surgical resection (n = 59), or none (n = 12), followed by chemotherapy, radiotherapy, or both (n = 40). Out of 65 evaluated patients, 25 revealed a moderate or severe scoliotic deformity of 71° (range 21–116°), pathological thoracic kyphosis of 66° (range 50–130°), and lordosis of 61° (range 41–97°). Surgical treatment was performed on 21 patients with implantation of growth-friendly spinal implants (n = 9) as well as twelve dorsal spinal fusions (two with prior halo distraction). Surgical interventions significantly improved spinal deformities without additional neurological impairment. With the increasing number of children surviving rare tumors, attention should be focused on long-term problems such as spinal deformities and consequent disabilities. A significant number of children with CNS tumors, spinal tumors or juxta-spinal tumors required surgical intervention. Early information about spinal deformities and a close follow-up are mandatory for this patient group.
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Affiliation(s)
- Anna K. Hell
- Pediatric Orthopedics, Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen; 37075 Göttingen, Germany; (H.M.L.); (L.B.); (K.A.L.); (K.T.)
- Correspondence: ; Tel.:+49-551-39-8701; Fax: +49-551-39-20558
| | - Ingrid Kühnle
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen; 37075 Göttingen, Germany; (I.K.); (C.M.K.)
| | - Heiko M. Lorenz
- Pediatric Orthopedics, Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen; 37075 Göttingen, Germany; (H.M.L.); (L.B.); (K.A.L.); (K.T.)
| | - Lena Braunschweig
- Pediatric Orthopedics, Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen; 37075 Göttingen, Germany; (H.M.L.); (L.B.); (K.A.L.); (K.T.)
| | - Katja A. Lüders
- Pediatric Orthopedics, Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen; 37075 Göttingen, Germany; (H.M.L.); (L.B.); (K.A.L.); (K.T.)
| | - Hans Christoph Bock
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Medical Center Göttingen, 37075 Göttingen, Germany; (H.C.B.); (H.C.L.)
| | - Christof M. Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen; 37075 Göttingen, Germany; (I.K.); (C.M.K.)
| | - Hans Christoph Ludwig
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University Medical Center Göttingen, 37075 Göttingen, Germany; (H.C.B.); (H.C.L.)
| | - Konstantinos Tsaknakis
- Pediatric Orthopedics, Department of Trauma, Orthopedic and Plastic Surgery, University Medical Center Göttingen; 37075 Göttingen, Germany; (H.M.L.); (L.B.); (K.A.L.); (K.T.)
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13
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Antal Z, Balachandar S. Growth Disturbances in Childhood Cancer Survivors. Horm Res Paediatr 2019; 91:83-92. [PMID: 30739101 DOI: 10.1159/000496354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 12/14/2018] [Indexed: 11/19/2022] Open
Abstract
Survival from childhood cancer has improved dramatically over the last few decades, resulting in an increased need to address the long-term follow-up and care of childhood cancer survivors. Appropriate linear growth is an important measure of health, with alterations of growth in children and short adult height in those who have completed growth serving as potential indicators of the sequelae of the underlying diagnosis or the cancer treatments. It is therefore critical that clinicians, particularly endocrinologists, be familiar with the patterns of altered growth which may be seen following diagnosis and treatment for childhood cancer. In this article, we will review the growth alterations seen in childhood cancer survivors, focusing on risk factors and considerations in evaluation and care.
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Affiliation(s)
- Zoltan Antal
- Division of Pediatric Endocrinology, Department of Pediatrics, Weill Cornell Medicine, New York, New York, USA, .,Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA,
| | - Sadana Balachandar
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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14
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Sankey EW, Park C, Howell EP, Pennington Z, Abd-El-Barr M, Karikari IO, Shaffrey CI, Gokaslan ZL, Sciubba D, Goodwin CR. Importance of Spinal Alignment in Primary and Metastatic Spine Tumors. World Neurosurg 2019; 132:118-128. [PMID: 31476476 DOI: 10.1016/j.wneu.2019.08.161] [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] [Received: 04/02/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 12/12/2022]
Abstract
Spinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.
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Affiliation(s)
- Eric W Sankey
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Christine Park
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth P Howell
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Muhammad Abd-El-Barr
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Isaac O Karikari
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Brown University, Providence, Rhode Island, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Spine Division, Duke University Medical Center, Durham, North Carolina, USA.
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15
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Bagley AF, Grosshans DR, Philip NV, Foster J, McAleer MF, McGovern SL, Lassen-Ramshad Y, Mahajan A, Paulino AC. Efficacy of proton therapy in children with high-risk and locally recurrent neuroblastoma. Pediatr Blood Cancer 2019; 66:e27786. [PMID: 31050179 PMCID: PMC6588416 DOI: 10.1002/pbc.27786] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/11/2019] [Accepted: 04/15/2019] [Indexed: 11/11/2022]
Abstract
PURPOSE Proton therapy is currently used in the management of pediatric tumors to decrease late toxicities. However, one of the criticisms of proton therapy is the limited data regarding efficacy on disease control. The purpose of this study was to examine local and distant control rates after proton therapy for neuroblastoma. METHODS AND MATERIALS Eighteen patients with high-risk (n = 16) and locally recurrent neuroblastoma (n = 2) were treated with curative intent and received proton therapy to the primary site and up to three post-induction MIBG-avid metastatic sites. Primary sites (n = 18) were treated to 21-36 Gy (relative biological effectiveness [RBE]), and metastatic sites (n = 16) were treated to 21-24 Gy (RBE). Local control and survival rates were calculated using the Kaplan-Meier method. RESULTS With a median follow-up of 60.2 months, two- and five-year local control rates at the irradiated primary site were 94% and 87%, respectively. No failures at irradiated distant metastatic sites were observed. The five-year progression-free survival (PFS) was 64%, and the five-year overall survival (OS) was 94%. The extent of surgical resection was not associated with local control, PFS, or OS. No radiation-related nephropathy or hepatopathy was reported. CONCLUSIONS Excellent local control was achieved using proton therapy to the primary and post-induction MIBG-positive distant sites. The predominant site of failure is progression in post-induction non-MIBG-avid distant sites. Although proton therapy provides high rates of local control with acceptable toxicity for neuroblastoma, further advances in systemic therapy are needed for the improved control of systemic disease.
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Affiliation(s)
- Alexander F. Bagley
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David R. Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy V. Philip
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer Foster
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan L. McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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16
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Medek S, De B, Pater L, Breneman J, Mahajan A, Wolden S, Vatner RE. Practice Patterns Among Radiation Oncologists Treating Pediatric Patients With Proton Craniospinal Irradiation. Pract Radiat Oncol 2019; 9:441-447. [PMID: 31279941 DOI: 10.1016/j.prro.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/11/2019] [Accepted: 06/21/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Craniospinal irradiation (CSI) is an important component of therapy for many pediatric central nervous system malignancies. Proton therapy is increasingly available and used for minimizing radiation exposure to normal tissues. The absence of an exit dose with proton therapy mandates decisions regarding coverage of the vertebral bodies (VB) in non-skeletally mature patients. Although the contents within the thecal sac represent the true clinical target volume (CTV), some physicians target the entire VB in growing children because of concerns over asymmetrical growth. This study aims to assess current practice patterns regarding VB coverage for pediatric patients undergoing CSI. METHODS AND MATERIALS Pediatric radiation oncologists were identified from the Particle Therapy Co-Operative Group pediatric subcommittee membership or affiliation with US proton centers. Potential participants were contacted by e-mail with a link to an institutional review board-approved, anonymized web-based survey distributed in June 2017 with follow-up in October 2017. The survey used skip logic and included up to 11 questions regarding practice patterns. RESULTS Thirty-three physicians responded to the survey (39%), 5 of which were excluded for lack of recent pediatric proton CSI experience. Of the 28 included responses, 23 physicians sometimes treat the entire VB and 5 physicians report always treating the entire VB. Most common responses regarding anterior CTV expansion for uncertainty were no expansion (n = 9) and 3 to 4 mm (n = 8). Most physicians modify the anterior CTV margin to protect normal structures, most commonly esophagus (n = 15), thyroid (n = 6), heart (n = 5), bowel (n = 4), and pharynx (n = 2). CONCLUSIONS Vertebral body coverage in proton CSI varies among radiation oncologists in respect to target delineation, CTV expansions, and modifications for organs at risk. These data suggest the radiation oncology community may benefit from a standardized approach to pediatric proton-based CSI.
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Affiliation(s)
- Sara Medek
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brian De
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - John Breneman
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Suzanne Wolden
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ralph E Vatner
- Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, Ohio; Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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17
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Hoeben BA, Carrie C, Timmermann B, Mandeville HC, Gandola L, Dieckmann K, Ramos Albiac M, Magelssen H, Lassen-Ramshad Y, Ondrová B, Ajithkumar T, Alapetite C, Balgobind BV, Bolle S, Cameron AL, Davila Fajardo R, Dietzsch S, Dumont Lecomte D, van den Heuvel-Eibrink MM, Kortmann RD, Laprie A, Melchior P, Padovani L, Rombi B, Scarzello G, Schwarz R, Seiersen K, Seravalli E, Thorp N, Whitfield GA, Boterberg T, Janssens GO. Management of vertebral radiotherapy dose in paediatric patients with cancer: consensus recommendations from the SIOPE radiotherapy working group. Lancet Oncol 2019; 20:e155-e166. [DOI: 10.1016/s1470-2045(19)30034-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/30/2018] [Accepted: 01/02/2019] [Indexed: 12/15/2022]
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18
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Dose Sculpting Intensity Modulated Radiation Therapy for Vertebral Body Sparing in Children With Neuroblastoma. Int J Radiat Oncol Biol Phys 2018; 101:550-557. [DOI: 10.1016/j.ijrobp.2018.02.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/14/2018] [Accepted: 02/07/2018] [Indexed: 11/22/2022]
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19
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Ferris MJ, Tian S, Switchenko JM, Madden NA, Eaton BR, Esiashvili N. Musculoskeletal outcomes and the effect of radiation to the vertebral bodies on growth trajectories for long-term survivors of high-risk neuroblastoma. JOURNAL OF RADIATION ONCOLOGY 2018; 7:187-193. [PMID: 34178250 PMCID: PMC8225230 DOI: 10.1007/s13566-018-0349-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 03/19/2018] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Here, we report musculoskeletal outcomes and the impact of radiotherapy dose on vertebral body growth for an institutional series of long-term survivors of high-risk neuroblastoma. METHODS We conducted a retrospective study of 23 patients who were disease-free and at least 36 months from the end of treatment. The patients were initially treated from July 2003 to May 2012. Patient records were reviewed for growth percentiles (obtained at approximately 6-month intervals from onset of treatment to the last follow-up) and musculoskeletal comorbidities. RT plans and most recent surveillance CT scans were reviewed for locations of in-field vertebral bodies and corresponding vertebral growth patterns. RESULTS The median follow-up was 7.93 years. The median prescribed radiation dose was 21.6 Gy. Musculoskeletal abnormalities included scoliosis (5 patients), muscular hypoplasia (3), and hypodontia (1). The median growth percentile at treatment onset was 35.5 (range, 4.7-100) versus 10 (0-94.1) at the last follow-up. The median numbers of vertebral bodies encompassed (by at least half of their volume) by the 5-, 10-, 15-, and 20-Gy isodose lines were 7 (mean, 6.78), 7 (6.56), 6 (6.17), and 6 (5.52), respectively. Sixteen patients (70.0%) had in-field abnormalities in vertebral body growth, manifesting as stretches of successive vertebral bodies at the same height, while normally there is a gradual vertebral body height increase progressing caudally down the spinal column. CONCLUSIONS Musculoskeletal abnormalities, below average height, and stunted in-field vertebral body growth are routine in long-term survivors of high-risk neuroblastoma. Sparing vertebral bodies when feasible may lead to improvement in patient growth trajectories.
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Affiliation(s)
- Matthew J. Ferris
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- The Emory Clinic, 1365 Clifton Road NE, Atlanta, GA 30322, USA
| | - Sibo Tian
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jeffrey M. Switchenko
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Biostatistics & Bioinformatics, Emory University, Atlanta, GA, USA
| | - Nicholas A. Madden
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Bree R. Eaton
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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20
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Ajithkumar T, Horan G, Padovani L, Thorp N, Timmermann B, Alapetite C, Gandola L, Ramos M, Van Beek K, Christiaens M, Lassen-Ramshad Y, Magelssen H, Nilsson K, Saran F, Rombi B, Kortmann R, Janssens GO. SIOPE - Brain tumor group consensus guideline on craniospinal target volume delineation for high-precision radiotherapy. Radiother Oncol 2018; 128:192-197. [PMID: 29729847 DOI: 10.1016/j.radonc.2018.04.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 04/14/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To develop a consensus guideline for craniospinal target volume (TV) delineation in children and young adults participating in SIOPE studies in the era of high-precision radiotherapy. METHODS AND MATERIALS During four consensus meetings (Cambridge, Essen, Liverpool, and Marseille), conventional field-based TV has been translated into image-guided high-precision craniospinal TV by a group of expert paediatric radiation oncologists and enhanced by MRI images of liquor distribution. RESULTS The CTVcranial should include the whole brain, cribriform plate, most inferior part of the temporal lobes, and the pituitary fossa. If the full length of both optic nerves is not included, the dose received by different volumes of optic nerve should be recorded to correlate with future patterns of relapse (no consensus). The CTVcranial should be modified to include the dural cuffs of cranial nerves as they pass through the skull base foramina. Attempts to spare the cochlea by excluding CSF within the internal auditory canal should be avoided. The CTVspinal should include the entire subarachnoid space, including nerve roots laterally. The lower limit of the spinal CTV is at the lower limit of the thecal sac, best visible on MRI scan. There is no need to include sacral root canals in the spinal CTV. CONCLUSION This consensus guideline has the potential to improve consistency of craniospinal TV delineation in an era of high-precision radiotherapy. This proposal will be incorporated in the RTQA guidelines of future SIOPE-BTG trials using CSI.
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Affiliation(s)
| | - Gail Horan
- Department of Oncology, Cambridge University Hospitals, United Kingdom
| | - Laetitia Padovani
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, France
| | - Nicky Thorp
- Department of Oncology, Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | - Claire Alapetite
- Radiation Oncology department and Proton Centre, Institute Curie, Paris and Orsay, France
| | - Lorenza Gandola
- Department of Radiation Oncology, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Ramos
- Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | | | | | | | - Henriette Magelssen
- Department of Oncology, Oslo University Hospital (The Norwegian Radium Hospital), Norway
| | - Kristina Nilsson
- Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology, Clinical Oncology, Uppsala University Hospital, Sweden
| | - Frank Saran
- Department of Oncology, Royal Marsden Hospital, Sutton, United Kingdom
| | - Barbara Rombi
- Proton Therapy Center, Santa Chiara Hospital, Trento, Italy
| | - Rolf Kortmann
- Department of Radiation Oncology, University of Leipzig, Germany
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, and Princess Maxima Center for Pediatric Oncology, The Netherlands
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23
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Kraal K, Blom T, van Noesel M, Kremer L, Caron H, Tytgat G, van der Pal H. Treatment and outcome of neuroblastoma with intraspinal extension: A systematic review. Pediatr Blood Cancer 2017; 64. [PMID: 28150396 DOI: 10.1002/pbc.26451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/09/2022]
Abstract
We performed a systematic review to define the long-term health problems and optimal treatment strategy for patients with neuroblastoma with intraspinal extension. Of 685 identified studies, 28 were included in this review. The burden of long-term health problems is high; a median of 50% of patients suffered from neurological motor deficit, 34% from sphincter dysfunction, and 30% from spinal deformity. The currently available literature remains suboptimal as a guide for treatment of NBL with intraspinal extension. More well-designed, prospective studies are needed to determine the optimal treatment strategy.
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Affiliation(s)
- Kathelijne Kraal
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Thomas Blom
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Max van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Leontien Kremer
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Huib Caron
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands
| | - Heleen van der Pal
- Department of Medical Oncology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
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Claude L, Laprie A. [Which dose constraints on which critical organs in paediatric radiation therapy?]. Cancer Radiother 2015; 19:484-8. [PMID: 26344444 DOI: 10.1016/j.canrad.2015.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/12/2015] [Accepted: 07/22/2015] [Indexed: 01/18/2023]
Abstract
Cancers in childhood are rare, representing 1% of all the cancers in developing countries. On the whole, the overall survival approaches 75% at 5 years. The radiation dose decrease in lots of indications as well as better optimized planning treatments lead to decrease the long-term toxicities in some indications. However, the radiation toxicity remains frequent, often specific of pediatric situations. Long-term toxicities are mainly neurologic, sensitive, endocrine, or linked to growth impairment (bones or muscular). Radio-induced second-cancers are also frequent after a long follow-up after cancer in childhood but will not be discussed here. Doses to critical organs as well as the most frequent radio-induced late-effects will be discussed in this paper.
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Affiliation(s)
- L Claude
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
| | - A Laprie
- Département de radiothérapie, institut Claudius-Regaud à l'institut universitaire du cancer Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France; Université Toulouse-III-Paul-Sabatier, place du Dr-Joseph-Baylac, 31024 Toulouse cedex 3, France; Inserm U825, place du Dr-Joseph-Baylac, 31024 Toulouse cedex 3, France
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Long-term side effects of radiotherapy for pediatric localized neuroblastoma : results from clinical trials NB90 and NB94. Strahlenther Onkol 2015; 191:604-12. [PMID: 25896312 DOI: 10.1007/s00066-015-0837-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/25/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Neuroblastoma (NB) is the most frequent indication for extracranial pediatric radiotherapy. As long-term survival of high-risk localized NB has greatly improved, we reviewed treatment-related late toxicities in pediatric patients who received postoperative radiotherapy (RT) for localized NB within two French prospective clinical trials: NB90 and NB94. PATIENTS AND METHODS From 1990-2000, 610 children were enrolled. Among these, 35 were treated with induction chemotherapy, surgery, and RT. The recommended RT dose was 24 Gy at ≤ 2 years, 34 Gy at > 2 years, ± a 5 Gy boost in both age groups. RESULTS The 22 patients still alive after 5 years were analyzed. The median follow-up time was 14 years (range 5-21 years). Late effects after therapy occurred in 73 % of patients (16/22), within the RT field for 50 % (11/22). The most frequent in-field effects were musculoskeletal abnormalities (n = 7) that occurred only with doses > 31 Gy/1.5 Gy fraction (p = 0.037). Other effects were endocrine in 3 patients and second malignancies in 2 patients. Four patients presented with multiple in-field late effects only with doses > 31 Gy. CONCLUSION After a median follow-up of 14 years, late effects with multimodality treatment were frequent. The most frequent effects were musculoskeletal abnormalities and the threshold for their occurrence was 31 Gy.
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Escalas C, Bourdet C, Fayech C, Demoor-Goldschmidt C. [Long-term effects of radiation on the spine - Results of a cohort of symptomatic survivors of childhood and review of the literature]. Bull Cancer 2015; 102:684-90. [PMID: 25869962 DOI: 10.1016/j.bulcan.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of the present retrospective study was to describe the clinical, radiological and bone characteristics of long-term survivors who have received radiotherapy involving some part of the vertebral column for certain childhood tumors. PATIENTS AND METHODS Monocentric descriptive study of a cohort of patients followed at Gustave-Roussy in the framework of long-term monitoring treated for a solid tumor in childhood with radiotherapy on part of the spine and having back pain and/or spinal deformity have been addressed in the Service of Musculoskeletal Rehabilitation at the Cochin Hospital. For each patient, were performed standardized radiographs of the entire spine and spinal MRI. RESULTS Eighteen patients were evaluated (average age of 35.4 ± 6.9 years; mean age at radiation therapy: 3.6 ± 2.8 years). Original tumors were nephroblastoma (9 cases), neuroblastoma (4 cases) and medulloblastoma (3 cases). Of the 15 patients analyzed by X-rays of the entire spine, 67% (10/15) patients had scoliosis (2 with a Cobb angle > 20°), 73% (11/15) had an abnormal thoracic kyphosis, 67% (10/15) had abnormal lumbar lordosis. Of the 16 patients analyzed by MRI, 75% (12/16) had discopathies or anomalies of the discal plate, 63% (10/16) had mild abnormalities of bone marrow. Muscle abnormalities were common (81%, 13/16). CONCLUSION The main risk factors of spinal deformities are intraductal tumor, spinal surgery, spinal radiotherapy and a young age at the time of the cancer. These cured children require dedicated monitoring. Currently, this risk is reduced with the actual techniques of radiotherapy.
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Affiliation(s)
- Cécile Escalas
- Université Paris V, hôpital Cochin, service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, 75014 Paris, France
| | - Christopher Bourdet
- Université Paris V, hôpital Cochin, service de radiologie B, 75014 Paris, France
| | - Chiraz Fayech
- Gustave-Roussy, département de cancérologie de l'enfant et de l'adolescent, 94805 Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- Institut de cancérologie de l'Ouest-Nantes, service de radiothérapie, 44800 Saint-Herblain, France; Faculté de médecine de Nantes, 44000 Nantes, France.
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Scalabre A, Parot R, Hameury F, Cunin V, Jouve JL, Chotel F. Prognostic risk factors for the development of scoliosis after chest wall resection for malignant tumors in children. J Bone Joint Surg Am 2014; 96:e10. [PMID: 24430419 DOI: 10.2106/jbjs.l.01535] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical resection of a malignant tumor of the chest wall in children may result in the development of progressive scoliosis. The aim of this study was to identify the risk factors associated with scoliosis following resection of a tumor of the chest wall and to evaluate the prevalence and characteristics of the scoliosis. METHODS Forty children who underwent resection of a malignant tumor of the chest wall from 1984 to 2005 were included in a multicenter, retrospective cohort study. The mean age of the patients at the time of surgery was 9.8 years (range, 0.2 to nineteen years). Resections were classified with the use of the following scheme: the number of resected ribs was noted in Roman numerals, and the level of the resection was identified by dividing the thorax into three sectors (A [anterior], B [lateral], and C [posterior]) in the horizontal plane. One to five ribs (mean, 2.3 ribs) were resected. Patients with scoliosis were compared with patients who did not have scoliosis through the use of univariate and multivariate analyses. The mean duration of follow-up was 8.5 years (range, three to twenty-three years). RESULTS Patients who had a tumor resection during a rapid-growth period (patient age of less than six years or between twelve and fifteen years) had a 5.8 times higher risk of scoliosis. The resection of three or more ribs in the posterior sector (C) was the primary risk factor for scoliosis, with an odds ratio of 18.9. Seventeen (43%) of the children developed scoliosis, which was convex toward the resection side without vertebral rotation in all of them. CONCLUSIONS The risk of scoliosis following the resection of a primary malignant tumor of the chest wall in children was shown to be higher when resection was performed during a rapid-growth period and when the resection involved three or more ribs in the posterior sector.
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Affiliation(s)
- Aurélien Scalabre
- Hôpital Femme Mère Enfant, Department of Pediatric Surgery, 59 Bd Pinel, 69500 Bron, France. E-mail address for A. Scalabre: . E-mail address for F. Hameury: . E-mail address for V. Cunin: vincent.c
| | - Roger Parot
- Clinique du Val d'Ouest, Department of Pediatric Surgery, 39 Chemin de la Vernique, 69130 Ecully, France. E-mail address:
| | - Frédéric Hameury
- Hôpital Femme Mère Enfant, Department of Pediatric Surgery, 59 Bd Pinel, 69500 Bron, France. E-mail address for A. Scalabre: . E-mail address for F. Hameury: . E-mail address for V. Cunin: vincent.c
| | - Vincent Cunin
- Hôpital Femme Mère Enfant, Department of Pediatric Surgery, 59 Bd Pinel, 69500 Bron, France. E-mail address for A. Scalabre: . E-mail address for F. Hameury: . E-mail address for V. Cunin: vincent.c
| | - Jean-Luc Jouve
- Hôpital de la Timone, Department of Pediatric Orthopedic Surgery, 264 Rue Saint Pierre, 13385 Marseille, France. E-mail address:
| | - Franck Chotel
- Hôpital Femme Mère Enfant, Department of Pediatric Surgery, 59 Bd Pinel, 69500 Bron, France. E-mail address for A. Scalabre: . E-mail address for F. Hameury: . E-mail address for V. Cunin: vincent.c
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McMullen K, Buchsbaum J, Douglas J, McDonald M, Johnstone P. Growth abnormalities of the spine after radiation therapy: Respecting the past while moving forward in proton craniospinal irradiation. Pract Radiat Oncol 2013; 3:337-43. [DOI: 10.1016/j.prro.2012.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 10/23/2012] [Accepted: 10/23/2012] [Indexed: 10/27/2022]
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Historical trends in the use of radiation therapy for pediatric cancers: 1973-2008. Int J Radiat Oncol Biol Phys 2012; 85:e151-5. [PMID: 23273995 DOI: 10.1016/j.ijrobp.2012.10.007] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/01/2012] [Accepted: 10/02/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE This study was undertaken to assess historical trends in the use of radiation therapy (RT) for pediatric cancers over the past 4 decades. METHODS The National Cancer Institute's Surveillance, Epidemiology, and End Results database of the 9 original tumor registries (SEER-9) was queried to identify patients aged 0 to 19 years with acute lymphoblastic leukemia, acute myeloid leukemia, bone and joint cancer, cancer of the brain and nervous system, Hodgkin lymphoma, neuroblastoma, non-Hodgkin lymphoma, soft tissue cancer, Wilms tumor, or retinoblastoma from 1973 to 2008. Patients were grouped into 4-year time epochs. The number and percentage of patients who received RT as part of their initial treatment were calculated per epoch by each diagnosis group from 1973 to 2008. RESULTS RT use for acute lymphoblastic leukemia, non-Hodgkin lymphoma, and retinoblastoma declined sharply from 57%, 57%, and 30% in 1973 to 1976 to 11%, 15%, and 2%, respectively, in 2005 to 2008. Similarly, smaller declines in RT use were also seen in brain cancer (70%-39%), bone cancer (41%-21%), Wilms tumor (75%-53%), and neuroblastoma (60%-25%). RT use curves for Wilms tumor and neuroblastoma were nonlinear with nadirs in 1993 to 1996 at 39% and 19%, respectively. There were minimal changes in RT use for Hodgkin lymphoma, soft tissue cancer, or acute myeloid leukemia, roughly stable at 72%, 40%, and 11%, respectively. Almost all patients treated with RT were given external beam RT exclusively. However, from 1985 to 2008, treatments involving brachytherapy, radioisotopes, or combination therapy increased in frequency, comprising 1.8%, 4.6%, and 11.9% of RT treatments in brain cancer, soft tissue cancer, and retinoblastoma, respectively. CONCLUSIONS The use of RT is declining over time in 7 of 10 pediatric cancer categories. A limitation of this study is a potential under-ascertainment of RT use in the SEER-9 database including the delayed use of RT.
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Abstract
BACKGROUND The concept of modulating spinal growth to correct scoliosis is intriguing, and this study proposes a new model. Inhibition of vertebral growth on the convex side of a curve would allow continued normal growth on the concave side to correct the scoliosis. In an earlier study, we induced bony bridges across the physis of the femur producing an epiphysiodesis in rabbits by using a stimulator modified to deliver a current of 50 muA. This study builds on this finding to design a model with an aim of inhibiting growth in a unilateral peripheral portion of the vertebral endplate physis, which induces asymmetric spinal growth. METHODS The study was conducted with 8-week-old rabbits; 6 were treated with electrical current through an implantable 4-lead device; 3 were age-matched normal rabbits. The device was implanted and delivered a constant current of 50 muA from each electrode, continuously for 6 weeks. Weekly radiograph monitoring and endpoint histology were carried out. RESULTS Spinal growth was modified by inducing asymmetric growth of the vertebra of young rabbits using electric stimulators delivering 50 muA of direct current through electrodes implanted in a left peripheral portion of the endplate physis. CONCLUSIONS This concept study, based on our earlier study, involved a method and device for inhibiting growth in one aspect of the vertebral endplate using electrical current at an amplitude that induced a hemiepiphysiodesis. Our results showed that this technique both establishes an in vivo model of scoliosis and suggests that if this technique were applied to an existing curve it could potentially induce asymmetrical growth of the spine, thereby correcting scoliosis by continuing the normal growth on the concavity of the curve. CLINICAL RELEVANCE A potential new method for modulating spinal growth was developed, and, with further research, this method may be useful in treating children with scoliosis by delivering a growth-inhibiting current to the physeal areas of vertebra through electrodes placed percutaneously.
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Normal tissue development, homeostasis, senescence, and the sensitivity to radiation injury across the age spectrum. Semin Radiat Oncol 2010; 20:12-20. [PMID: 19959027 DOI: 10.1016/j.semradonc.2009.08.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Late effects in normal tissues following radiotherapy vary across the age spectrum. It seems that sensitivity to radiation injury is a function of the developmental dynamics and status of the organ, its regenerative potential, and ultimately the extent to which it has begun to senesce. For instance, organ maturational processes in children can be impaired or even disabled by radiation therapy, leading to a spectrum of effects that differ from those in adults, in which the capacity and means for tissues to repair damage are the predominant predictor for chronic injury. Thus, radiation-induced impairment of growth and maturation is unique to children, whereas organ damage, with tissue-specific dysfunction in repair processes, is common to both children and adults. Finally, the susceptibility to late effects in the elderly seems to involve not only a decline in their ability to repair damage, but also cell attrition, all intertwined with effects of comorbid illness that are frequent in this age group. The challenge for clinicians is to understand these differences in the sensitivity to radiation damage with respect to age to formulate a basis for modulating therapy that can rationally minimize late effects and maximize a survivor's quality of life.
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Aydin GB, Kutluk MT, Buyukpamukcu M, Akyuz C, Yalcin B, Varan A. Neurological complications of neuroblastic tumors: experience of a single center. Childs Nerv Syst 2010; 26:359-65. [PMID: 19714340 DOI: 10.1007/s00381-009-0979-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 06/23/2009] [Indexed: 10/20/2022]
Abstract
AIM This study aims to evaluate the prevalence and clinical characteristics of neurological complications in patients with newly diagnosed neuroblastic tumors (NT). PATIENTS AND METHOD Hospital file search was performed in patients with NT, and neurological complications, clinical, and treatment features were analyzed. RESULTS Out of 523 patients with NT, 19 patients had Horner's syndrome, 9 patients had opsoclonus-myoclonus-ataxia syndrome (OMA), 11 patients had central nervous system (CNS) involvement, and 49 patients had spinal cord compression (SCC) at diagnosis. During follow-up, seven more patients had CNS metastases. Survival rates were poor in patients with CNS involvement; all died at a median of 7.9 months after diagnosis. The neurological symptoms and signs of patients with SCC were mild, moderate, and severe in 13, 9, and 22 patients, respectively. Sphincter deficiency and sensory loss were diagnosed in 52.3% and 43.2% of patients. The neurological deficits of 11/17 patients who had symptoms less than 4 weeks were completely resolved or improved. The incidence of sequelae after laminectomy, radiotherapy, and chemotherapy were 46.2%, 66.6%, and 13.6%, respectively. CONCLUSION The prevalence rates of Horner's syndrome, OMA, CNS metastasis, and SCC were found to be 3.6%, 1.8%, 2.2%, and 9.4%, respectively. Metastasis to the CNS indicated a very poor prognosis. No differences in neurological improvement in patients with SCC were found between those treated with radiotherapy, laminectomy, or chemotherapy alone, but laminectomy and radiotherapy caused significant late sequelae. Early diagnosis and proper management is critical to avoid long-term sequelae in patients with SCC.
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Affiliation(s)
- G Burca Aydin
- Department of Pediatric Oncology, Ankara Oncology Research Hospital, 06070, Demetevler, Ankara, Turkey.
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Abstract
Although scoliosis at birth is rare, conditions at birth and in the newborn period predispose newborns to the development of scoliosis in later life. Scoliosis is congenital when associated with abnormal vertebral segmentation regardless of the age of diagnosis. Other conditions may predispose neonates to vertebral damage or the development of sustained uneven forces on the developing spine. Although it is difficult to know which newborns will progress to developing scoliosis, it is important to be aware of risk factors to provide anticipatory education for parents and to arrange appropriate follow-up after discharge. This article reviews the embryology of vertebral formation and risk factors for the development of scoliosis. The discussion includes the incidence, risk factors, genetics, associated problems, physical examination, and nursing implications of the infant with congenital scoliosis.
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South M, Chiu JK, Teh BS, Bloch C, Schroeder TM, Paulino AC. Supine Craniospinal Irradiation Using Intrafractional Junction Shifts and Field-in-Field Dose Shaping: Early Experience at Methodist Hospital. Int J Radiat Oncol Biol Phys 2008; 71:477-83. [DOI: 10.1016/j.ijrobp.2007.10.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 10/04/2007] [Accepted: 10/06/2007] [Indexed: 11/24/2022]
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Abstract
This paper deals with some of the musculo-skeletal complication that can occur after cancer treatment. In particular, we focus on Cancer Treatment Induced Bone Loss (CTIBL) and the musculo-skeletal complications that can occur in patients treated for extremity sarcoma. In addition we discuss peripheral neuropathy, musculo-skeletal pain and briefly mention some of the complications related to radiotherapy. CTIBL is mostly studied in breast cancer and prostate cancer survivors. The cause in these groups is mainly due to treatment induced hypogonadism. Other causes of CTIBL are indirect or direct cause of chemotherapy, physical inactivity and inadequate intake of vitamin D and calcium. Treatment of CTIBL consists of diet and lifestyle changes and pharmacological intervention. Extremity bone sarcomas constitute a special group since they often experience mutilating surgery and heavy combination chemotherapy. The treatment results in worse function than the normal population and the amputated usually have lower physical functioning than patients treated with limb sparing surgery (LSS). However, most studies fail to show differences in quality of life between the amputated and LSS. Most of the studies performed on musculo-skeletal sequelae have been done on survivors of childhood cancer, breast cancer or prostate cancer. More studies among the other cancer groups are needed to reveal the extent and prevalence of these complications.
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Affiliation(s)
- Liv Hege Aksnes
- Cancer Clinic, Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway.
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Nathan PC, Ness KK, Greenberg ML, Hudson M, Wolden S, Davidoff A, Laverdiere C, Mertens A, Whitton J, Robison LL, Zeltzer L, Gurney JG. Health-related quality of life in adult survivors of childhood Wilms tumor or neuroblastoma: A report from the childhood cancer survivor study. Pediatr Blood Cancer 2007; 49:704-15. [PMID: 16830322 DOI: 10.1002/pbc.20949] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Long-term survivors of Wilms tumor and neuroblastoma may experience significant late adverse effects from their disease and its therapy. Little is known, however, about the health-related quality of life experienced by these survivors. PROCEDURE Health-related quality of life, measured by the 36-Item Short Form Health Survey (SF-36), was assessed from self-report in adult survivors of Wilms tumor (N = 654) and neuroblastoma (N = 432) who participated in the Childhood Cancer Survivor Study. RESULTS More than 90% of the study population was 18-34 years old at interview, and 58% were females. There was no significant difference on any SF-36 subscale or summary scale between the two diagnostic groups. On average, survivors reported no decrement on the Physical Component Summary scale of the SF-36 when compared to population norms. However, both groups scored significantly below the population mean score (50) on the Mental Component Summary Scale of the SF-36 (Wilms tumor mean = 41.66, standard error = 2.19, P < 0.0001; neuroblastoma mean = 42.41, standard error = 2.23, P < 0.0001) reflecting decreased emotional health. Independent risk factors for lower scores on this scale included female gender, Native American race, unemployment, and household income below $20,000. CONCLUSIONS Adult survivors of childhood Wilms tumor and neuroblastoma do not differ from population norms on most health-related quality of life (HRQL) measures. These data, however, indicate that the emotional well being of adult survivors may be compromised. Health care providers should be aware of the risk of adverse outcomes in emotional health even many years after treatment and cure.
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Affiliation(s)
- Paul C Nathan
- The Hospital for Sick Children, Toronto, Ontario, Canada.
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