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Al-Mistarehi AH, Parker M, Xia Y, Hasanzadeh A, Horowitz MA, Raj D, Papali P, Davidar AD, Redmond KJ, Bettegowda C, Witham T, Bydon A, Theodore N, Lubelski D. Survival Factors in 1580 Adults with Spinal Ependymoma: Insights from a Multicenter Oncology Database. World Neurosurg 2024:S1878-8750(24)01391-3. [PMID: 39142388 DOI: 10.1016/j.wneu.2024.08.036] [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: 06/21/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Using a multi-institutional oncology database, we investigate the survival rates and the impacts of demographic, clinical, and management characteristics on overall survival among adult patients diagnosed with spinal ependymoma. METHODS Utilizing the SEER registry, patients with histologically or radiologically confirmed ependymomas were included. Factors impacting overall survival were analyzed using Kaplan-Meier survival curves and log-rank statistical analyses. RESULTS A total of 1,580 patients were included. Their mean ± standard deviation age was 46.68 ± 15.96 years, and 51.1% were women. Gross total resection (GTR) was achieved in 66.4% of patients. The 5- and 10-year survival rates were 96.7% and 95.4%, respectively. A multivariable backward Cox regression showed that age ≥65 years was a significant predictor for mortality (hazard ratio [HR]: 3.93; 95% confidence interval [CI]: 2.21-7.00; P < 0.001). Likewise, tumor grade 3 (HR: 6.36; 95% CI: 1.95-20.76; P = 0.002), tumor grade 4 (HR: 7.74; 95% CI: 3.97-15.11; P < 0.001), presence of extra-neural metastasis (HR: 13.81; 95% CI: 3.67-51.96; P < 0.001), and receiving radiotherapy (HR: 2.50; 95% CI: 1.50-4.19; P < 0.001) were significant risk factors for mortality, while GTR was significantly associated with improved overall survival compared with subtotal resection or nonsurgical management (HR: 0.42; 95% CI: 0.25-0.73; P = 0.002). There were no significant effects for gender, race, marital status, income, residential area, chemotherapy, tumor size, and the presence of other benign or malignant tumors on the survival hazards (P > 0.05 for each). CONCLUSION Early diagnosis and surgical management of spinal ependymomas, such as GTR, were associated with remarkable survival benefits. Old age, high-grade spinal ependymoma, and extra-neural metastasis were associated with worse overall survival, whereas radiotherapy's role remains unclear.
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Affiliation(s)
| | - Megan Parker
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yuanxuan Xia
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alireza Hasanzadeh
- Advanced Diagnostic and Interventional Radiology Research Center, Medical School, Tehran University of Medical Sciences, Tehran, Iran
| | - Melanie Alfonzo Horowitz
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Divyaansh Raj
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pritika Papali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Daniel Davidar
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristin J Redmond
- Department of Radiation and Molecular Oncology, John Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Frisch S, Libuschewski H, Peters S, Gerß J, von Hoff K, Kortmann RD, Nemes K, Rutkowski S, Hasselblatt M, Pietsch T, Frühwald MC, Timmermann B. Radiation Therapy Plays an Important Role in the Treatment of Atypical Teratoid/Rhabdoid Tumors: Analysis of the EU-RHAB Cohorts and Their Precursors. Int J Radiat Oncol Biol Phys 2024; 119:1147-1157. [PMID: 38246248 DOI: 10.1016/j.ijrobp.2024.01.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE Atypical teratoid/rhabdoid tumor (AT/RT) is a rare malignancy of the central nervous system in young children with a dismal prognosis. Prognostic markers have been extensively investigated but have not been validated. The role of radiation therapy (RT) remains controversial. We evaluated the impact of RT as part of multimodality treatment by analyzing data of a European AT/RT cohort. METHODS AND MATERIALS We retrospectively analyzed data of the European Registry for Rhabdoid Tumors and its precursors. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Potential impact of prognostic factors was analyzed using univariable and multivariable Cox regression analyses with RT as a time-dependent factor. RESULTS Data of 186 children (118 male, 68 female) treated from 1990 to 2016 were evaluable. The median age at diagnosis was 1.57 years (range, 0.01-26.70 years); 47% (87/186) of the patients were under the age of 18 months. Sixty-nine percent (128/186) received RT (focal RT, n = 93; craniospinal treatment with local boost, n = 34; spinal irradiation, n = 1). The median follow-up duration of the entire cohort was 1.73 years (range, 0.06-20.11 years). The estimated PFS and OS rates were 48% (95% CI, 41%-55%) and 72% (95% CI, 65%-78%) at 1 year and 33% (95% CI, 26%-40%) and 49% (95% CI, 41%-56%) at 2 years, respectively. On multivariable analysis, RT was an independent significant prognostic factor for PFS (hazard ratio, 0.45; 95% CI, 0.27-0.75; P = .002) and OS (hazard ratio, 0.54; 95% CI, 0.32-0.93; P = .025). CONCLUSIONS This analysis confirms the relevance of local therapies. RT was an independent prognostic factor for outcomes in children experiencing AT/RT. However, long-term sequelae have to be carefully evaluated and considered given the young age at time of RT.
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Affiliation(s)
- Sabine Frisch
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany
| | - Hanna Libuschewski
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany
| | - Sarah Peters
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Katja von Hoff
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, and Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Rolf-Dieter Kortmann
- Department of Radiation Therapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Karolina Nemes
- University Children's Hospital Augsburg, Swabian Childrens Cancer Center, Augsburg, Germany
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Centre, Bonn, Germany
| | - Michael C Frühwald
- University Children's Hospital Augsburg, Swabian Childrens Cancer Center, Augsburg, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Essen, Germany; German Cancer Consortium (DKTK), Essen/Düsseldorf, University Hospital Essen, 45147 Essen, Germany.
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Yang Z, Jiang H, He D, Zhang S, Huang L, Gao P, Huang H, Cao J, Zhan Z. Developing a nomogram based on SEER database for predicting prognosis in choroid plexus tumors. Sci Rep 2024; 14:12219. [PMID: 38806680 PMCID: PMC11133321 DOI: 10.1038/s41598-024-63218-1] [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: 01/24/2024] [Accepted: 05/27/2024] [Indexed: 05/30/2024] Open
Abstract
Choroid plexus tumors (CPT) are rare and highly vascularized neoplasms that have three histologically confirmed diagnoses, including choroid plexus papilloma, atypical choroid plexus papilloma, and choroid plexus carcinoma (CPC). This study aimed to determine the epidemiology and survival of patients with CPTs and develop a nomogram to quantify the prognosis of the patients with CPT. Data of 808 patients who were diagnosed as CPT between 2000 and 2020 was obtained from the surveillance, epidemiology, and end results database. Descriptive analysis was used to assess the distribution and tumor-related characteristics of the patients with CPT. Independent prognostic factors for patients with CPT were identified by univariate and multivariate Cox regression analysis. The nomogram was established and evaluated by receiver operating characteristic curve, and decision curve analysis (DCA), calibration curves. The independent prognostic factors for patients with CPT are age, tumor size, surgery, chemotherapy, tumor number, pathologies, and race. For the prognostic nomogram, the area under the curve (AUC) of 60-, 120-, and 180-months were 0.855, 0.869 and 0.857 in the training set and 0.836, 0.864 and 0.922 in the test set. The DCA and calibration curve indicated the good performance of the nomogram. Patients with CPTs can be diagnosed at any age. Among the three histopathological tumors, patients with CPC had the worst prognosis. The nomogram was established to predict the prognosis of patients with CPT, which had satisfactory accuracy, and clinical utility may benefit for clinical decision-making.
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Affiliation(s)
- Zedi Yang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Heng Jiang
- Department of Neurosurgery, The Second Hospital of Jilin University, Changchun, 130041, China
| | - Ding He
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Sheng Zhang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Lei Huang
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun, 130021, China
| | - Peigeng Gao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Haiyan Huang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Junguo Cao
- Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China.
| | - Zhixin Zhan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China.
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Dos Santos ICL, da Silva Vargas Silva G, Murad LB, Murad LD. Nutritional status and inflammatory markers as survival predictors in pediatric central nervous system tumors. Clin Nutr ESPEN 2023; 57:89-95. [PMID: 37739738 DOI: 10.1016/j.clnesp.2023.06.020] [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] [Received: 12/03/2022] [Revised: 05/22/2023] [Accepted: 06/22/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Central nervous system tumors (CNS) are the second most common malignancies in childhood. Inflammation and changes in nutritional status play an important role and can be used as prognostic markers. Thus, this study aimed to evaluate the predictive ability of nutritional status and inflammatory markers on overall survival (OS) of pediatric patients with CNS. METHODS In this retrospective cohort study, 103 patients were followed for 5 years. Clinical, anthropometric, and hematological data were collected. Body mass index for age (BMI/A), neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation response index (SIRI) were calculated. OS curves were calculated using the Kaplan Meier method and evaluated using the Log-Rank test. The Cox proportional hazards model was performed to identify independent variables associated with prognostic factors, generating hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Nutritional status did not significantly affect OS. However, patients with NLR ≥2.18 and SIRI ≥1249.18 had significantly lower OS in 5 years. Only treatment and high NLR were identified as independent prognostic factors for worse OS. Treatment with exclusive radiotherapy or chemotherapy (HR: 16.22, 95% CI: 2.19-120.07) and NLR (HR: 1.94, 95% CI: 1.02-3.69) were identified as independent prognostic factors for worse OS at 5 years. CONCLUSION High pretreatment NLR was shown to be an independent prognostic factor for OS in pediatric patients with CNS.
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Affiliation(s)
- Isabelle Cristine Lôpo Dos Santos
- Nutrition and Dietetics Section, Brazilian National Cancer Institute Jose Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
| | - Gabrielle da Silva Vargas Silva
- Nutrition and Dietetics Section, Brazilian National Cancer Institute Jose Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
| | - Leonardo Borges Murad
- Nutrition and Dietetics Section, Brazilian National Cancer Institute Jose Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
| | - Luana Dalbem Murad
- Nutrition and Dietetics Section, Brazilian National Cancer Institute Jose Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
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Wu HW, Wu CH, Lin SC, Wu CC, Chen HH, Chen YW, Lee YY, Chang FC. MRI features of pediatric atypical teratoid rhabdoid tumors and medulloblastomas of the posterior fossa. Cancer Med 2023; 12:10449-10461. [PMID: 36916326 DOI: 10.1002/cam4.5780] [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: 10/13/2022] [Revised: 02/08/2023] [Accepted: 02/25/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Atypical teratoid rhabdoid tumor (AT/RT) occurs at a younger age and is associated with a worse prognosis than medulloblastoma; however, these two tumor entities are mostly indistinguishable on neuroimaging. The aim of our study was to differentiate AT/RT and medulloblastoma based on their clinical and MRI features to enhance treatment planning and outcome prediction. METHODS From 2005-2021, we retrospectively enrolled 16 patients with histopathologically diagnosed AT/RT and 57 patients with medulloblastoma at our institute. We evaluated their clinical data and MRI findings, including lesion signals, intratumoral morphologies, and peritumoral/distal involvement. RESULTS The age of children with AT/RT was younger than that of children with medulloblastoma (2.8 ± 4.9 [0-17] vs. 6.5 ± 4.0 [0-18], p < 0.001), and the overall survival rate was lower (21.4% vs. 66.0%, p = 0.005). Regarding lesion signals on MRI, AT/RT had a lower ADCmin (cutoff value ≤544.7 × 10-6 mm2 /s, p < 0.001), a lower ADC ratio (cutoff value ≤0.705, p < 0.001), and a higher DWI ratio (cutoff value ≥1.595, p < 0.001) than medulloblastoma. Regarding intratumoral morphology, the "tumor central vein sign" was mostly exclusive to medulloblastoma (24/57, 42.1%; AT/RT 1/16, 6.3%; p = 0.007). Regarding peritumoral invasion on T2WI, AT/RT was more prone to invasion of the brainstem (p < 0.001) and middle cerebellar peduncle (p < 0.001) than medulloblastoma. CONCLUSIONS MRI findings of a lower ADC value, more peritumoral invasion, and absence of the "tumor central vein sign" may be helpful to differentiate AT/RT from medulloblastoma. These distinct MRI findings together with the younger age of AT/RT patients may explain the worse outcomes in AT/RT patients.
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Affiliation(s)
- Hsin-Wei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Chieh Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chun Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Hung Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wei Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu City, Taiwan
| | - Yi-Yen Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Tahta A, Akalan N. Prognostic value of Ki-67 index in primary intracranial tumors of infants. Childs Nerv Syst 2023; 39:369-377. [PMID: 36607388 DOI: 10.1007/s00381-022-05822-y] [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: 07/18/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Primary intracranial tumors are rare tumors in infants. They differ from those found in other pediatric age groups in terms of clinical presentation, histopathological diagnosis, adjuvant therapies, and outcome. Ki-67 index has also shown promising results as a prognostic factor in different types of intracranial tumors in children and adults. However, the importance and the best cutoff point of Ki-67 index in primary intracranial tumors of infants remains unclear. We aimed to analyze prognostic value of Ki-67 index in primary intracranial tumors of infants. METHODS This study retrospectively reviewed the records of 28 infants undergoing surgical resection for primary intracranial tumors between April 2016 and March 2021. We analyzed clinical characteristics, tumor location, extent of resection, histopathological diagnosis, Ki-67 index, and overall survival (OS). To define the most relevant cutoff value for Ki-67 index, "Cutoff Finder" was used. RESULTS The median age at diagnosis was 188 days for all patients. Fifteen of the patients were boys and 13 were girls. Tumors were located supratentorial in 13 patients and infratentorial in 15 patients. Gross total resection was performed in 7 of 13 supratentorial tumors and 9 of 15 infratentorial tumors. The mean Ki-67 index of the supratentorial tumors was 49.6%, the median was 55%; for infratentorial tumors, the mean was 49.9%, and the median was 70%. Tumor grade (p = 0.019) and Ki-67 index (p = 0.003) were found as significant predictors of OS in log-rank testing for Kaplan-Meier survival analysis. Univariate cox regression analysis identified high Ki-67 index as prognostic factor for worse OS, with hazard ratio of 8.852 (95% CI 1.95-64.80; p = 0.0108). High Ki-67 index was found as independent prognostic factor for worse OS in multivariate cox regression analysis (HR 7.036; 95% CI 1.229-65.82; p = 0.0457). CONCLUSION High-grade and high Ki-67 index were associated with worse outcome. Ki-67 index did show a distinct prognostic value for OS within our cohort at a cutoff value of 72.5%.
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Affiliation(s)
- Alican Tahta
- Istanbul Medipol University, School of Medicine, Department of Neurosurgery, TEM Goztepe exit, Bagcila, Istanbul, Turkey.
| | - Nejat Akalan
- Istanbul Medipol University, School of Medicine, Department of Neurosurgery, TEM Goztepe exit, Bagcila, Istanbul, Turkey
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Garcia MR, Bell L, Miller C, Segal D. A Case of Infant-Type Hemispheric Glioma with NTRK1 Fusion. Child Neurol Open 2022; 9:2329048X221146982. [PMID: 36601394 PMCID: PMC9806371 DOI: 10.1177/2329048x221146982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
The incidence of childhood central nervous system tumors in infants is about 6 per 100 000 children. Recent studies have showed recurrent fusion of the neurotrophic tyrosine receptor kinase (NTRK) gene in 10% of non-brainstem high grade glioma in very young children suggesting an oncogenic effect of the NTRK fusion genes. In this report, we present a rare, severe case of a full-term neonate who was noted to have widely splayed sutures and a bulging fontanelle at birth who was found to have infant-type hemispheric glioma with NTRK1 fusion with course complicated by seizures refractory to medical treatment. Patient was deemed a poor surgical candidate due to the size of the mass and thus parents opted for comfort care.
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Affiliation(s)
- Mekka R. Garcia
- Department of Neurology, New York University, New York, NY,
USA,Devorah Segal, Department of Neurology, New
York University, 160 East 32 Street, 3 Floor, New
York, NY 10016, USA.
| | - Lena Bell
- Department of Neurology, New York University, New York, NY,
USA
| | - Claire Miller
- Department of Neurology, New York University, New York, NY,
USA
| | - Devorah Segal
- Department of Neurology, New York University, New York, NY,
USA
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Posterior Fossa Tumours in the First Year of Life: A Two-Centre Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12030635. [PMID: 35328188 PMCID: PMC8947426 DOI: 10.3390/diagnostics12030635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Posterior fossa tumours (PFTs) in infants are very rare, and information on these tumours is scarce in the literature. This retrospective study reports their pathological characteristics and describes surgical aspects and treatment outcomes. A two-centre cohort of infants with PFTs treated from 2007 to 2018 was retrospectively reviewed. Patient characteristics, clinical, and treatment data were reviewed. Survival curves for progression-free survival (PFS) and overall survival (OS) were generated. Thirty-three infants were retrieved. There were 11 low grade and 22 high-grade tumours. The most common presenting symptom was intracranial hypertension. Fifteen children out of thirty-three progressed. Five-year PFS was significantly lower in children with high-grade tumours (38.3%) than those with low-grade tumours (69.3%), p = 0.030. High-grade pathology was the only predictor of progression (HR 3.7, 95% CI 1.1–13.31), p = 0.045. Fourteen children with high-grade tumours died, with a 5-year OS of 55.25%. PFTs in children below one year of age still represent a unique challenge. Infants with high-grade tumours display the worst outcomes and the lowest survival, indicating that more effective strategies are needed.
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Zahnreich S, Schmidberger H. Childhood Cancer: Occurrence, Treatment and Risk of Second Primary Malignancies. Cancers (Basel) 2021; 13:cancers13112607. [PMID: 34073340 PMCID: PMC8198981 DOI: 10.3390/cancers13112607] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/14/2022] Open
Abstract
Cancer represents the leading cause of disease-related death and treatment-associated morbidity in children with an increasing trend in recent decades worldwide. Nevertheless, the 5-year survival of childhood cancer patients has been raised impressively to more than 80% during the past decades, primarily attributed to improved diagnostic technologies and multiagent cytotoxic regimens. This strong benefit of more efficient tumor control and prolonged survival is compromised by an increased risk of adverse and fatal late sequelae. Long-term survivors of pediatric tumors are at the utmost risk for non-carcinogenic late effects such as cardiomyopathies, neurotoxicity, or pneumopathies, as well as the development of secondary primary malignancies as the most detrimental consequence of genotoxic chemo- and radiotherapy. Promising approaches to reducing the risk of adverse late effects in childhood cancer survivors include high precision irradiation techniques like proton radiotherapy or non-genotoxic targeted therapies and immune-based treatments. However, to date, these therapies are rarely used to treat pediatric cancer patients and survival rates, as well as incidences of late effects, have changed little over the past two decades in this population. Here we provide an overview of the epidemiology and etiology of childhood cancers, current developments for their treatment, and therapy-related adverse late health consequences with a special focus on second primary malignancies.
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10
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Feasibility of Proton Beam Therapy for Infants with Brain Tumours: Experiences from the Prospective KiProReg Registry Study. Clin Oncol (R Coll Radiol) 2021; 33:e295-e304. [PMID: 33820696 DOI: 10.1016/j.clon.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/16/2021] [Accepted: 03/09/2021] [Indexed: 11/22/2022]
Abstract
AIMS Proton beam therapy (PBT) has increasingly been applied for the treatment of young children when radiotherapy is needed. The treatment requires intensive multimodality care and is logistically demanding. In this analysis, we evaluated our experiences in treating infants with tumours of the central nervous system with PBT. MATERIALS AND METHODS Children younger than 2 years of age treated with PBT for central nervous system tumours enrolled in the prospective registry study KiProReg were retrospectively analysed. Information on patient characteristics, treatment, toxicities and outcome were evaluated. Adverse events were classified according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE V4.0) before, during and after PBT. RESULTS Between September 2013 and June 2018, 51 infants were eligible. The median age was 19 months (range 11-23 months) at the time of PBT. Tumour entities were ependymoma (51.0%), atypical teratoid rhabdoid tumour (39.0%), high-grade glioma (6.0%), pineoblastoma (2.0%) and medulloblastoma (2.0%). The prescribed median total dose was 54.0 Gy (range 45.0-59.4 Gy). Most received local radiotherapy. In four patients, craniospinal irradiation followed by a boost to the local tumour bed was applied. The median follow-up time was 42.0 months (range 7.3-86.2 months). The estimated 3-year local control, progression-free survival and overall survival rates for all patients were 62.7, 47.1 and 76.5%, respectively. During radiotherapy, 24 events of higher-grade (CTCAE ≥ °III) toxicities were reported. Interruption of radiotherapy for more than 2 days was due to infection (n = 3) or shunt complication (n = 2). Unexpected hospitalisation during radiotherapy affected 12 patients. Late adverse events attributable to radiotherapy included endocrinopathy (CTCAE °II; 7.8%), new onset of hearing loss (CTCAE °III; 5.8%) and visual impairment (CTCAE °IV; 1.9%). Transient radiation-induced imaging changes occurred in five patients (9.8%). CONCLUSIONS Our study indicates that PBT is feasible for very young children with central nervous system tumours, at least in the short term. However, it requires challenging interdisciplinary medical care and high logistical effort. For evaluation of late effects, longer follow-up and evaluation of neurocognitive outcome are desirable. More data have to be gathered to further define the role of radiotherapy in infants over time.
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Abstract
Central nervous system (CNS) tumors, including brain and spinal cord tumors, are the most common solid tumors of childhood. Within the neonatal population, however, CNS tumors are relatively rare. These often carry a dismal prognosis in part due to the limited therapeutic options available for newborns and the unique biology of these tumors compared with those seen in older infants and children. This article reviews neonatal CNS tumors, specifically their clinical presentation, imaging findings, treatment, prognosis, and associated genetic syndromes. The unique psychosocial and emotional challenges facing clinicians and families are discussed as well.
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Affiliation(s)
- Shubin Shahab
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA; Emory University School of Medicine, 1760 Haygood Drive Northeast HSRB E397, Atlanta, GA 30322, USA.
| | - Jason Fangusaro
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 1405 Clifton Road Northeast, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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12
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Abstract
The current 5-year survival rate for cancer in infants is greater than 75% in developed countries. However, survivors of neonatal malignancies have an increased risk of late effects from their tumor or its treatment, which may lead to long-term morbidity and/or early mortality. This article reviews surgical approaches and chemotherapeutic agents commonly used in neonatal malignancies and their associated late effects. It also reviews the increased risk for late effects associated with radiation at a young age and hematopoietic stem cell transplantation at a young age.. It highlights the importance of survivor-specific multidisciplinary care in the long-term management of neonatal cancer survivors.
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Affiliation(s)
- Sanyukta K. Janardan
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, 2015 Uppergate Drive, 4th Floor, Atlanta, GA 30322, USA
| | - Karen E. Effinger
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, 2015 Uppergate Drive, 4th Floor, Atlanta, GA 30322, USA,Corresponding author. Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, 2015 Uppergate Drive, Fourth Floor, Atlanta, GA 30322.
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13
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Ruiz-Garcia H, Huayllani MT, Incontri D, Whaley JJ, Marenco-Hillembrand L, Ebot J, Chaichana KL, Sheehan J, Quiñones-Hinojosa A, Trifiletti DM. Intraventricular choroid plexus tumors: clinical characteristics and impact of current management on survival. J Neurooncol 2020; 149:283-292. [PMID: 32897467 DOI: 10.1007/s11060-020-03603-8] [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: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Choroid plexus tumors (CPTs) represent one of the most common intraventricular tumors. Although most are benign, they often reach considerable sizes before clinical manifestation, challenging their surgical management. We aim to describe the clinical characteristics and the impact of current management on the survival of patients harboring intraventricular CPT. METHODS The National Cancer Database (NCDB) was queried to identify biopsy-proven intraventricular CPT patients (2004-2015). Demographic and patterns of care were described, the log-rank method was used to independently analyze survival according to age, WHO grade and extent of resection (EOR). Multivariate analysis was performed to investigate the impact of prognostic factors on overall survival (OS). RESULTS A total of 439 CPT patients with known WHO grade were included. WHO grade I tumors were more frequent in adults, while WHO grade III tumors were more common in pediatric population. Most CPTs were benign, with a median tumor size of 3-4 cm. Mean tumor size in pediatric population was greater than in adult population (4.39 cm vs. 2.7 cm; p < 0.01). Frequency was similar between males and females (51.7% vs. 48.3%; p > 0.0.5). Five- and ten-year OS among all patients was 87% and 84%, respectively. EOR was not associated with survival for any WHO grade. On multivariable analysis, only patient age (p = 0.022), WHO grade (p = 0.003) and medical comorbidity scores (p = 0.002) were independently associated with OS after diagnosis. CONCLUSION Patients with CPTs present at different stages of life, with sizable tumor burden and distinct WHO grade prevalence. Considering their favorable survival, efforts to improve tumor control should be meticulously weighed against the long-term risk associated with surgery, radiation, and chemotherapy.
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Affiliation(s)
- Henry Ruiz-Garcia
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Maria T Huayllani
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Diego Incontri
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Juan J Whaley
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - James Ebot
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA. .,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA.
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14
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Sultana N, Sun C, Katsube T, Wang B. Biomarkers of Brain Damage Induced by Radiotherapy. Dose Response 2020; 18:1559325820938279. [PMID: 32694960 PMCID: PMC7350401 DOI: 10.1177/1559325820938279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy remains currently a critical component for both primary and metastatic brain tumors either alone or in combination with surgery, chemotherapy, and molecularly targeted agents, while it could cause simultaneously normal brain tissue injury leading to serious health consequences, that is, development of cognitive impairments following cranial radiotherapy is considered as a critical clinical disadvantage especially for the whole brain radiotherapy. Biomarkers can help to detect the accurate physiology or conditions of patients with brain tumor and develop effective treatment procedures for these patients. In the near future, biomarkers will become one of the prime driving forces of cancer treatment. In this minireview, we analyze the documented work on the acute brain damage and late consequences induced by radiotherapy, identify the biomarkers, in particular, the predictive biomarkers for the damage, and summarize the biological significance of the biomarkers. It is expected that translation of these research advance to radiotherapy would assist stratifying patients for optimized treatment and improving therapeutic efficacy and the quality of life.
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Affiliation(s)
- Nahida Sultana
- Institute of Food and Radiation Biology, Atomic Energy Research Establishment, Bangladesh Atomic Energy Commission, Dhaka, People’s Republic of Bangladesh
| | - Chao Sun
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
| | - Takanori Katsube
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Bing Wang
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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15
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Abstract
Pediatric brain tumors are the leading cause of cancer-related death in children. Recent advances in sequencing techniques, and collaborative efforts to encode the mutational landscape of various tumor subtypes, have resulted in the identification of recurrent mutations that may present as actionable targets in these tumors. A number of molecularly targeted agents are approved or in development for the treatment of various tumor types in adult patients. Similarly, these agents are increasingly being incorporated into pediatric clinical trials, allowing for a targeted approach to treatment. However, due to the genetic heterogeneity of these tumors, focused clinical trials in pediatric patients are challenging and regulatory hurdles may delay access to therapeutic compounds that are in regular use in adult patients. The tumor site-agnostic clinical development of TRK inhibitors for pediatric solid tumors is a current example of how the combination of genetic testing and innovative clinical trial design can accelerate the clinical development of targeted agents for pediatric patients.
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Affiliation(s)
- Miriam Bornhorst
- Department of Pediatric Hematology-Oncology, Center for Cancer and Immunology Research and Neuroscience Research, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA.,Center for Cancer and Immunology Research and Neuroscience Research, The Brain Tumor Institute, Children's National Medical Center, Washington, DC, USA.,Center for Cancer and Immunology Research and Neuroscience Research, Gilbert Family Neurofibromatosis Institute, Children's National Medical Center, Washington, DC, USA
| | - Eugene I Hwang
- Department of Pediatric Hematology-Oncology, Center for Cancer and Immunology Research and Neuroscience Research, Children's National Medical Center, 111 Michigan Ave, NW, Washington, DC, 20010, USA. .,Center for Cancer and Immunology Research and Neuroscience Research, The Brain Tumor Institute, Children's National Medical Center, Washington, DC, USA.
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16
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Toescu SM, James G, Phipps K, Jeelani O, Thompson D, Hayward R, Aquilina K. Intracranial Neoplasms in the First Year of Life: Results of a Third Cohort of Patients From a Single Institution. Neurosurgery 2019; 84:636-646. [PMID: 29617945 DOI: 10.1093/neuros/nyy081] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 02/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Brain tumors in the first year of life are rare and their management remains challenging. OBJECTIVE To report on the contemporary management of brain tumors in infants with reference to previous series from our institution. METHODS Retrospective cohort study design. Electronic/paper case note review of all brain tumors diagnosed at our institution in children aged <1 yr since the publication of our previous series. RESULTS Ninety-eight patients were seen. The most common presentations were with vomiting and macrocrania, at a median age of 184 d. Sixty-two percent of tumors were supratentorial. Ninety-one patients underwent 230 procedures; 7 patients had no surgery. One hundred eighteen operations were directly on brain tumors (biopsy 37, subtotal resection 47, gross total resection 34). Ninety-one cerebrospinal fluid diversions, 9 endoscopic procedures, and 13 preoperative embolizations were performed. Operative mortality was 4.4%. Tumor types in order of frequency were choroid plexus papillomas (CPP, 17), primitive neuroectodermal tumor (12), atypical teratoid/rhabdoid tumor (10), high-grade glioma (9), optic glioma (9), ependymoma (8), low-grade glioma (6), pilocytic astrocytoma (6), choroid plexus carcinoma (5), and teratoma (5), with 11 miscellaneous tumors. Survival was 93% at 1 mo (91/98), 64% at 1 yr (61/95), 44% at 5 yr (32/73), 28% at 10 yr (16/58). No patients with CPP or low-grade glioma died. Five-year survival rates were lowest for anaplastic ependymoma, primitive neuroectodermal tumor, and atypical teratoid/rhabdoid tumor. Seventy-seven percent of children reaching school age were in mainstream schooling. CONCLUSION Overall survival from neonatal brain tumors remains similar to previous series; analysis of tumor subtypes reveals improvements for CPP and gliomas. Despite increasing operative intervention, operative mortality continues to decline for this group of challenging patients.
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Affiliation(s)
- Sebastian M Toescu
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Gregory James
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Kim Phipps
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Owase Jeelani
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Dominic Thompson
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Richard Hayward
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
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17
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Quinn TJ, Almahariq MF, Siddiqui ZA, Thompson AB, Hamstra DA, Kabolizadeh P, Gowans KL, Chen PY. Trimodality therapy for atypical teratoid/rhabdoid tumor is associated with improved overall survival: A surveillance, epidemiology, and end results analysis. Pediatr Blood Cancer 2019; 66:e27969. [PMID: 31464041 DOI: 10.1002/pbc.27969] [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: 07/01/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumors (AT/RTs) are rare aggressive central nervous system tumors. The use of radiation therapy (RT) remains controversial, especially for patients younger than three years of age. The purpose of the current investigation is to robustly analyze the impact of RT among pediatric AT/RT patients using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS SEER 18 Custom Data registries were queried for AT/RT (ICD-0-3 9508/3). A total of 190 pediatric AT/RT patients were identified, of whom 102 underwent surgery + chemotherapy and 88 underwent trimodality therapy. Univariate and multivariable analyses using Kaplan-Meier and Cox proportional hazards regression modeling were performed. Propensity-score matched analysis with inverse probability of treatment weighting was performed to account for indication bias. The landmark method was used to account for immortal time bias. RESULTS The majority of patients were <3 years old (75.8%). Patients <3 were more likely to be treated without RT as compared with older patients (62% vs 38%). Doubly robust MVA identified distant disease as a negative prognostic factor (HR 2.1, P = 0.003), whereas trimodality therapy was strongly protective (HR 0.39, P < 0.001). Infants (<1), toddlers (1-2), and older children (3+) all benefited from trimodality therapy, with largest benefit for infants (HR 0.34, P = 0.02) and toddlers (HR 0.31, P < 0.001). CONCLUSION The current study provides further evidence that trimodality therapy improves clinical outcomes among patients with AT/RT. This finding was most pronounced for younger patients; therefore, further studies are needed to confirm this finding in this vulnerable population.
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Affiliation(s)
- Thomas J Quinn
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | | | - Zaid A Siddiqui
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Andrew B Thompson
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Daniel A Hamstra
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | | | - Kate L Gowans
- Department of Pediatric Hematology/Oncology, Beaumont Health, Royal Oak, Michigan
| | - Peter Y Chen
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
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18
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Girardi F, Allemani C, Coleman MP. Worldwide Trends in Survival From Common Childhood Brain Tumors: A Systematic Review. J Glob Oncol 2019; 5:1-25. [PMID: 31682549 PMCID: PMC6882508 DOI: 10.1200/jgo.19.00140] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The histology of brain tumors determines treatment and predicts outcome. Population-based survival reflects the effectiveness of a health care system in managing cancer. No systematic review of worldwide variation and time trends in survival from brain tumors in children is currently available. PATIENTS AND METHODS We considered longitudinal, observational studies comprising children diagnosed with intracranial astrocytic or embryonal tumors. We searched six electronic databases from database inception to September 30, 2018, using complex search strategies. The outcome measure was 5-year survival, estimated through a time-to-event analysis. This study is registered with PROSPERO, number CRD42018111981. RESULTS Among 5,244 studies, we identified 47 eligible articles that provided 228 survival estimates. Only five studies were entirely or partially conducted in low-income or middle-income countries. Five-year survival from embryonal tumors increased from 37% in 1980 to approximately 60% in 2009. Although survival for medulloblastoma improved substantially (from 29% to 73% during 1959-2009), survival for primitive neuroectodermal tumors wavered over time (1973-2009) and between countries. Five-year survival from astrocytoma changed very little over the 27 years between 1982 and 2009 (from 78% to 89%). Interpretation of the literature was made difficult by the heterogeneity of study designs. CONCLUSION Survival has improved for embryonal tumors, but little change has been observed for astrocytic tumors. We found a striking gap in knowledge about survival from childhood brain tumor subtypes in middle-income and low-income countries, where half of these tumors are diagnosed. Larger studies are needed, including in under-represented countries and based on standardized data collection, to provide up-to-date survival estimates.
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Affiliation(s)
- Fabio Girardi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia Allemani
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michel P. Coleman
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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19
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Survival of infants ≤24 months of age with brain tumors: A population-based study using the SEER database. PLoS One 2019; 14:e0223051. [PMID: 31553771 PMCID: PMC6760899 DOI: 10.1371/journal.pone.0223051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/12/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Brain tumors are the most common solid malignancy and leading cause of cancer-related deaths in infants. Current epidemiological data is limited by low numbers of reported cases. This study used a population-based approach with analysis of contemporary and historical survival curves to provide up-to-date prognostication. METHODS Observational cohort analysis was performed using the Surveillance, Epidemiology and End Results (SEER) database. Infants with brain tumors diagnosed from 1973 to 2013 were categorized by the most common tumor types (diffuse astrocytic and oligodendroglioma, choroid plexus, embryonal, ependymal, medulloblastoma and pilocytic astrocytoma). The 1, 5 and 10 year survival was stratified by decade, with trends in management and outcomes analyzed. RESULTS We identified 2996 affected infants satisfying inclusion criteria. All tumor types, except embryonal and choroid plexus, demonstrated improving survival with time. Infants with embryonal tumors showed a decline in survival from the 1970s to 1990s (p = 0.009), whereas infants with choroid plexus tumors had no change in survival. Infants with ependymal tumors experienced the greatest improvement in survival from 1980s to 1990s and 1990s to 2000s (p = 0.0001, p = 0.01), with 5-year survival probability improving from 28% (95% CI 15-42%) in the 1980s to 77% (95% CI 69-83%) the 2000s. The use of radiation declined from 1970 to 2000 for all tumors; however, radiation treatment for embryonal and ependymal subtypes increased after 2000. CONCLUSIONS While overall survival for infants with brain tumors has improved from the 1970s onwards, not every tumor type has seen a statistically significant change. Given changes in management and survival, prognostication of infants with brain tumor should be updated.
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20
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Liu APY, Hastings C, Wu S, Bass JK, Heitzer AM, Ashford J, Vestal R, Hoehn ME, Ghazwani Y, Acharya S, Conklin HM, Boop F, Merchant TE, Gajjar A, Qaddoumi I. Treatment burden and long-term health deficits of patients with low-grade gliomas or glioneuronal tumors diagnosed during the first year of life. Cancer 2019; 125:1163-1175. [PMID: 30620400 DOI: 10.1002/cncr.31918] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 10/16/2018] [Accepted: 11/01/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Low-grade gliomas (LGGs) and low-grade glioneuronal tumors (LGGNTs) diagnosed during the first year of life carry unique clinical characteristics and challenges in management. However, data on the treatment burden, outcomes, and morbidities are lacking. METHODS A retrospective study of LGGs and LGGNTs diagnosed in patients younger than 12 months at St. Jude Children's Research Hospital (1986-2015) was conducted. RESULTS For the 51 patients (including 31 males), the mean age at diagnosis was 6.47 months (range, 0.17-11.76 months), and the mean follow-up period was 11.8 years (range, 0.21-29.19 years). Tumor locations were hypothalamic/optic pathway (61%), hemispheric (12%), brainstem (12%), cerebellar (8%), and spinal (8%). There were 41 patients with histological diagnoses: 28 had World Health Organization grade 1 tumors, 6 had grade 2 tumors, and 7 had an LGG/LGGNT not definitively graded. Forty-one patients required an active intervention at diagnosis. Throughout their treatment course, 41 patients eventually underwent tumor-directed surgeries (median, 2 surgeries; range, 1-6), 39 received chemotherapy (median, 2 regimens; range, 1-13), and 21 received radiotherapy. Forty patients experienced disease progression (median, 2 progressions; range, 1-18). Ten patients died of progression (n = 5), malignant transformation (n = 2), a second cancer (n = 2), or a shunt infection (n = 1). The 10-year overall survival, progression-free survival, and radiation-free survival rates were 85% ± 5.3%, 16.9% ± 5.3%, and 51.2% ± 7.5%, respectively. Forty-nine patients experienced health deficits (eg, endocrinopathies, obesity, seizures, visual/hearing impairments, neurocognitive impairments, and cerebrovascular disease). Predictors of progression and toxicities were defined. CONCLUSIONS Infantile LGG/LGGNT is a chronic, progressive disease universally associated with long-term morbidities and requires multidisciplinary intervention.
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Affiliation(s)
- Anthony P Y Liu
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Camden Hastings
- Pediatric Oncology Education Program, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shengjie Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Johnnie K Bass
- St. Jude Children's Research Hospital, Rehabilitation Services, Memphis, Tennessee
| | - Andrew M Heitzer
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jason Ashford
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Robert Vestal
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Mary E Hoehn
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Yahya Ghazwani
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sahaja Acharya
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Heather M Conklin
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Frederick Boop
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey Clinic, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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21
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Abstract
Congenital brain tumors are rare, representing <2% of all childhood brain tumors. Of these, ependymoblastoma is a profoundly aggressive embryonal brain tumor that is included in the diagnostic entity known as an embryonal tumor with multilayered rosettes. This report of a congenital ependymoblastoma diagnosed at birth aims to highlight how much remains unknown about embryonal tumor with multilayered rosettes and the devastating prognosis of this condition. Despite recent advancements made in identifying molecular targets for therapy, this tumor continues to have a high rate of recurrence with few successful treatment options, especially when diagnosed in the newborn period.
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22
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Vairy S, Jouan L, Bilodeau M, Dormoy-Raclet V, Gendron P, Couture F, Léveillé F, Tihy F, Lemyre E, Bouron-Dal Soglio D, Jabado N, Kleinman CL, Marzouki M, Cellot S. Novel PDE10A-BRAF Fusion With Concomitant NF1 Mutation Identified in an Undifferentiated Sarcoma of Infancy With Sustained Response to Trametinib. JCO Precis Oncol 2018; 2:1-13. [DOI: 10.1200/po.18.00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stéphanie Vairy
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Loubna Jouan
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Mélanie Bilodeau
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Virginie Dormoy-Raclet
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Patrick Gendron
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Françoise Couture
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - France Léveillé
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Frédérique Tihy
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Emmanuelle Lemyre
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Dorothée Bouron-Dal Soglio
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Nada Jabado
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Claudia L. Kleinman
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Monia Marzouki
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Sonia Cellot
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
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High-grade glioma in very young children: a rare and particular patient population. Oncotarget 2017; 8:64564-64578. [PMID: 28969094 PMCID: PMC5610026 DOI: 10.18632/oncotarget.18478] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/17/2017] [Indexed: 01/05/2023] Open
Abstract
In the past years, pediatric high-grade gliomas (HGG) have been the focus of several research articles and reviews, given the recent discoveries on the genetic and molecular levels pointing out a clinico-biological uniqueness of the pediatric population compared to their adult counterparts with HGG. On the other hand, there are only scarce data about HGG in very young children (below 3 years of age at diagnosis) due to their relatively low incidence. However, the few available data suggest further distinction of this very rare subgroup from older children and adults at several levels including their molecular and biological characteristics, their treatment management, as well as their outcome. This review summarizes and discusses the current available knowledge on the epidemiological, neuropathological, genetic and molecular data of this subpopulation. We discuss these findings and differences compared to older patients suffering from the same histologic disease. In addition, we highlight the particular clinical and neuro-radiological findings in this specific subgroup of patients as well as their current management approaches and treatment outcomes.
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Pediatric central nervous system tumors in the first 3 years of life: pre-operative mean platelet volume, neutrophil/lymphocyte count ratio, and white blood cell count correlate with the presence of a central nervous system tumor. Childs Nerv Syst 2017; 33:233-238. [PMID: 27942922 DOI: 10.1007/s00381-016-3301-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study is to describe the relationship of pre-operative complete blood count parameters [mean platelet volume (MPV), neutrophil/lymphocyte count ratio (NLCR), and white blood cell count (WBC)], with the clinical, radiological, and histopathological features and the management options for patients under 3 years of age with a newly diagnosed central nervous system tumors. METHODS Children with central nervous system (CNS) tumors in the first 3 years of life admitted in the Erciyes University Hospital between April 2004 and April 2014 were enrolled in this study. The CBC parameters were compared with those of an age- and sex-matched normal control group. RESULTS In the study group, the means of MPV and WBC were 8.00 ± 1.24 fl, and 10,855 ± 3642/mm3 respectively; the median (25-75%) of NLCR was 0.98 (0.66-1.46). For the control group, the means of MPV and WBC were 6.8 ± 0.73 fl and 8565 ± 2522/mm3; the median (25-75%) of NLCR was 0.52 (0.36-0.70). The MPV, WBC, and NLCR were higher in the study group. The median overall survival (OS) of the patients was 60 months (range 0-81.6 months); and median event free survival (EFS) was 24 months (range 0-70.1 months). The formulation of MPV, NLCR, and WBC was found to be predictive for the diagnosis of CNS tumor in children with nonspecific symptoms. The univariate and multiple binary regression analyses showed a positive association of MPV, NLCR, and WBC and the risk of a diagnosis of CNS tumor. There was no relationship between MPV, WBC, NLCR, and histological subgroups. However, there were no associations between CBC parameters and OS or EFS of the patients. CONCLUSIONS By causing suspicion, MPV, NLCR, and WBC may provide both an earlier radiological investigation decision and thereby an early diagnosis of CNS tumor in children with nonspecific symptoms in the first 3 years of life.
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Bornhorst M, Hwang EI. Experimental Therapeutic Trial Design for Pediatric Brain Tumors. J Child Neurol 2016; 31:1421-32. [PMID: 26353880 DOI: 10.1177/0883073815604221] [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: 03/18/2015] [Accepted: 08/11/2015] [Indexed: 11/17/2022]
Abstract
Pediatric brain tumors are the leading cause of cancer-related death during childhood. Since the first pediatric brain tumor clinical trials, the field has seen improved outcomes in some, but not all tumor types. In the past few decades, a number of promising new therapeutic agents have emerged, yet only a few of these agents have been incorporated into clinical trials for pediatric brain tumors. In this review, the authors discuss the process of and challenges in pediatric clinical trial design; this will allow for highly efficient and effective clinical trials with appropriate endpoints to ensure rapid and safe investigation of novel therapeutics for children with brain tumors.
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Affiliation(s)
- Miriam Bornhorst
- Department of Pediatric Hematology-Oncology, Children's National Medical Center, Washington, DC, USA Brain Tumor Institute, Washington, DC, USA
| | - Eugene I Hwang
- Department of Pediatric Hematology-Oncology, Children's National Medical Center, Washington, DC, USA Gilbert Family Neurofibromatosis Institute, Centers for Cancer and Immunology Research & Neuroscience Research, Children's National Medical Center, Washington, DC, USA
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Tresman R, Brown M, Fraser F, Skinner R, Bailey S. A School Passport as Part of a Protocol to Assist Educational Reintegration After Medulloblastoma Treatment in Childhood. Pediatr Blood Cancer 2016; 63:1636-42. [PMID: 27196034 DOI: 10.1002/pbc.26071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/12/2016] [Accepted: 04/14/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medulloblastoma is the most common malignant brain tumour in children and is treated with a combination of surgery, radiotherapy and chemotherapy. These children frequently experience long-term cognitive, social and physical sequelae, which significantly affect school reintegration. AIM This study aimed to explore school-return experiences to create a more structured school reintegration protocol for children postmedulloblastoma. METHODS A cohort of nine patients who had completed treatment and for whom full neuropsychometric data were available was included in the study (median time since diagnosis 8 years). Data were collected using qualitative parental questionnaires, semistructured interviews with teachers (n = 12) and healthcare professionals (HCPs) (n = 6) involved in their school reintegration. Thematic analysis was employed. A focus group with five HCPs was then used for data validation. RESULTS This study uncovered the following four main subjects: (1) Information sharing; (2) education and empowerment (of educational professionals (EP) and parents); (3) communication between parents, HCPs and EPs; and (4) long-term difficulties. DISCUSSION Implementation of a standardised protocol delivered within the structure of a school passport document would aid uniform follow-up. The proposed multistage protocol includes early communication and reintegration planning followed by meetings at school re-entry. Follow-up meetings are suggested to reduce information loss and reassess the child's needs. Hospital support at school transitions, inclusion of school data in long-term clinical follow-up and long-term rehabilitation are also recommended. Each stage would be supported by school passport documentation and would facilitate school and parental empowerment, paramount to the long-term sustainability of successful schooling.
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Affiliation(s)
- Rachel Tresman
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Morven Brown
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Faye Fraser
- Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Roderick Skinner
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom.,Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Simon Bailey
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
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Munjal S, Chatterjee U, Vinchon M, Chatterjee S. Infant brain tumours: a tale of two cities. Childs Nerv Syst 2016; 32:1633-40. [PMID: 27299432 DOI: 10.1007/s00381-016-3135-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/30/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Infantile brain tumours (age < 1 year) are increasingly being diagnosed due to advances in prenatal and perinatal diagnostic imaging. We present here our retrospective study of 64 infant brain tumours that brings to the fore the epidemiology, clinical presentation, pathology and outcome of this unique subset of paediatric brain tumours presenting to two tertiary referral centres in Kolkata in India and Lille in France between the years 1999 and 2014. METHODS Data was retrospectively collected from Kolkata (n = 30) and Lille (n = 34) for patients presenting with infant brain tumours and analysed for factors such as age at presentation, clinical features, gender, location of tumour, pathology, management and outcome. Follow-up was available for all patients. RESULTS Mean age at presentation was 6.8 months at Kolkata and 6.3 months at Lille. More than two-thirds of tumours in both the groups were supratentorial and presented with signs of raised intracranial pressure. There was also a similar proportion of tumours presenting as congenital tumours. At Kolkata, germ cell tumours (n = 7) were the most common while low-grade gliomas (n = 11) formed the largest group at Lille. Kolkata had a higher incidence of high-grade gliomas (n = 5) and PNETs (n = 4) while ATRT (n = 3) and choroid plexus carcinoma (n = 4) were more common at Lille. Surgery was the mainstay of treatment at both centres. CONCLUSION Brain tumours in infants presenting to tertiary centres in Europe and India are challenging to manage and usually have dismal prognosis. These tumours differ markedly in the pathology and, therefore, overall outcome. Surgery forms mainstay of treatment. Radiotherapy is best avoided in this age group.
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Affiliation(s)
- Satyashiva Munjal
- Department of Neurosurgery, Park Clinic, 4, Gorky Terrace, Kolkata, 700017, West Bengal, India
| | | | - Matthieu Vinchon
- Department of Pediatric Neurosurgery, University Hospital, Lille, France
| | - Sandip Chatterjee
- Department of Neurosurgery, Park Clinic, 4, Gorky Terrace, Kolkata, 700017, West Bengal, India.
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Long-term survival following additive radiotherapy in patients with atypical teratoid rhabdoid tumors. Strahlenther Onkol 2016; 192:569-81. [PMID: 27272756 DOI: 10.1007/s00066-016-0978-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Atypical teratoid rhabdoid tumor (ATRT) is a highly aggressive disease of embryonic origin accounting for <5% of all pediatric central nervous system (CNS) tumors. PATIENTS AND METHODS We describe a series of five cases of CNS ATRT. The first three patients underwent subtotal tumor resection. Gross total resection of the tumor was achieved in the fourth and fifth patients. Only 4 patients received chemotherapy, whereas all 5 patients received additive radiotherapy (RT). The latter included three dimensional (3D) conformal RT or intensity modulated RT (IMRT) with a median dose of 54 Gy (range 50.4-59.0 Gy) applied in daily fractions of 1.8 Gy. The median interval between surgery and RT was 5 months (range 2-11 months). RESULTS Two months after completion of RT, 4 patients had achieved complete radiologic remission. The median event-free survival period was 46 months (range 10-90 months). However, the first patient died 17 months after developing an out-of-field recurrence. The third patient developed a recurrence 11 months after salvage RT. The other 3 patients (cases 2, 4, and 5) remain alive with no evidence of disease 59, 46 and 90 months after therapy, respectively. CONCLUSION Overall, the 5 patients survived for a median of 48 months (range 25-90 months) from the time of initial diagnosis and they tolerated the RT well, without severe acute or late onset toxicities. The results imply a potential survival gain after irradiation at acceptable toxicity level.
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Wong K, Cheng J, Bowlin K, Olch A. Adaptation of vacuum-assisted mouthpiece head immobilization system for precision infant brain radiation therapy. Pract Radiat Oncol 2016; 6:425-428. [PMID: 27156425 DOI: 10.1016/j.prro.2016.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Our purpose was to describe an adaptation of a commercially available mouthpiece for vacuum-assisted mouthpiece immobilization for radiation therapy in infants. METHODS AND MATERIALS An infant diagnosed with a brain tumor required radiation therapy. After reviewing dental literature about obturators, we designed a modification for the smallest commercially available mouthpiece tray. RESULTS The patient was simulated with the adapted mouthpiece tray. We achieved excellent immobilization and had small daily image guided treatment position shifts. Our patient tolerated treatment well without injury to oral cavity or mucosa. CONCLUSIONS Head immobilization with a vacuum-assisted modified mouthpiece has not been described in infants. Our modification is a novel and safe and permits effective and accurate immobilization for infants for radiation therapy. New manufacturing technologies may allow creation of individualized mouthpieces.
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Affiliation(s)
- Kenneth Wong
- Radiation Oncology Program, Division of Hematology Oncology, Children's Hospital Los Angeles, Los Angeles, California; Department of Radiation Oncology, University of Southern California, Los Angeles, California.
| | - Justine Cheng
- Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kristine Bowlin
- Radiation Oncology Program, Division of Hematology Oncology, Children's Hospital Los Angeles, Los Angeles, California
| | - Arthur Olch
- Radiation Oncology Program, Division of Hematology Oncology, Children's Hospital Los Angeles, Los Angeles, California; Department of Radiation Oncology, University of Southern California, Los Angeles, California
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Prognosis of atypical teratoid rhabdoid tumors (AT/RT) treated with multimodal therapy protocols. Report of our series. Neurocirugia (Astur) 2016; 27:87-94. [DOI: 10.1016/j.neucir.2015.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/03/2014] [Accepted: 01/14/2015] [Indexed: 11/21/2022]
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Lumbar spinal atypical teratoid rhabdoid tumor. J Clin Neurosci 2015; 22:1988-9. [DOI: 10.1016/j.jocn.2015.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/20/2015] [Indexed: 11/17/2022]
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Spennato P, Nicosia G, Quaglietta L, Donofrio V, Mirone G, Di Martino G, Guadagno E, del Basso de Caro ML, Cascone D, Cinalli G. Posterior fossa tumors in infants and neonates. Childs Nerv Syst 2015; 31:1751-72. [PMID: 26351228 DOI: 10.1007/s00381-015-2783-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 06/02/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Management of posterior fossa tumors in infants and neonates is challenging. The characteristics of the young babies make surgery very difficult, sometimes precluding a safe complete removal. METHODS A review of the literature was undertaken to examine the incidence, histology, surgical aspects, and prognosis of posterior fossa tumors in the first year of life. Therapeutical strategies of the most frequent tumor types are also discussed in detail. RESULTS Histology is dominated by tumors with aggressive behavior, such as medulloblastomas, atypical teratoid/rhabdoid tumors, and anaplastic ependymomas. The most important surgical considerations in small children are the small circulating blood volume; the poor thermoregulation; and incomplete maturation of the brain, of the skull, and of the soft tissue. Treatment toxicity is inversely related to the age of the patients. Radiation therapy is usually considered as contraindicated in young children, with few exceptions. Proton therapy is a promising tool, but access to this kind of treatment is still limited. The therapeutic limitations of irradiation render resection of this tumor and adjuvant chemotherapy often the only therapeutic strategy in many cases. CONCLUSIONS The overall prognosis remains dismal because of the prevalent aggressive histologies, the surgical challenges, and the limitations of adjuvant treatment. Nevertheless, the impressive improvements in anesthesiology and surgical techniques allow, in the vast majority of the cases, complete removal of the lesions with minor sequelae in high-volume referral pediatric centers.
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Affiliation(s)
- Pietro Spennato
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giancarlo Nicosia
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia Quaglietta
- Division of Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Vittoria Donofrio
- Division of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Mirone
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuliana Di Martino
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Daniele Cascone
- Division of Neuroradiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Division of Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.
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Haskins CP, Jyoti B, Hines M, Simoneaux V, Buchsbaum JC. Single Center Results following Proton Beam Therapy in Children with Atypical Teratoid Rhabdoid Tumors of the Central Nervous System. Int J Part Ther 2015. [DOI: 10.14338/ijpt-14-00028.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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Johnston DL, Keene D, Kostova M, Lafay-Cousin L, Fryer C, Scheinemann K, Carret AS, Fleming A, Percy V, Afzal S, Wilson B, Bowes L, Zelcer S, Mpofu C, Silva M, Larouche V, Brossard J, Strother D, Bouffet E. Survival of children with medulloblastoma in Canada diagnosed between 1990 and 2009 inclusive. J Neurooncol 2015; 124:247-53. [DOI: 10.1007/s11060-015-1831-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/26/2015] [Indexed: 11/28/2022]
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Yu J, Shi WE, Zhao R, Gao X, Li H. Epidemiology of brain tumors in children aged two and under: A 10-year single-institute study. Oncol Lett 2015; 9:1651-1656. [PMID: 25789017 PMCID: PMC4356287 DOI: 10.3892/ol.2015.2943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/22/2015] [Indexed: 02/07/2023] Open
Abstract
The aim of present study was to evaluate the incidence, clinical symptoms, pathological characteristics, surgical treatment strategies and prognosis of brain tumors in children aged two and under. The current study obtained data regarding 32 consecutive infants and young children aged two years and under, who were treated for brain tumors in the Children’s Hospital of Fudan University (Shanghai, China) between 2003 and 2013. The types of tumor, clinical manifestations, location, histological features, applied treatment strategies and outcomes were retrospectively evaluated. The male to female ratio was 1.13:1, and among a total of 32 tumors, 14 (43.8%) were suptratentorial and 18 (56.3%) were infratentorial. Intracranial hypertension was the most common onset symptom, and astrocytoma was the most common tumor type (10 cases; 31.3%), followed by ependymoma (nine cases; 28.1%) and medulloblastoma (six cases; 18.8%). Surgical tumor resection was performed in 20 patients (62.5%), who experienced a mean post-operative survival time of 67.6 months. By contrast, conservative treatment with medications was administered in 12 patients (37.5%), with a mean survival time of 25.3 months. Furthermore, four patients underwent conservative therapy combined with ventriculoperitoneal shunting to relieve intracranial pressure arising from cerebrospinal fluid accumulation, resulting in a mean survival time of 10.5 months. In conclusion, the present study indicates that surgical tumor resection may improve the overall prognosis of infants and young children aged two years and under who presented with brain tumors. In addition, ventriculoperitoneal shunts may facilitate pre- and post-operative improvement in clinical symptoms by relieving intracranial pressure; however, the shunts do not appear to increase long-term survival. Furthermore, high surgical risk is an important prognostic factor in this pediatric patient population.
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Affiliation(s)
- Jianzhong Yu
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
| | - W E Shi
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
| | - Rui Zhao
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
| | - Xiaofeng Gao
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
| | - Hao Li
- Department of Neurosurgery, Children's Hospital of Fudan University, Shanghai 201102, P.R. China
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Lundar T, Due-Tønnessen BJ, Egge A, Krossnes B, Stensvold E, Due-Tønnessen P, Brandal P. Neurosurgical treatment of brain tumors in the first 6 months of life: long-term follow-up of a single consecutive institutional series of 30 patients. Childs Nerv Syst 2015; 31:2283-90. [PMID: 26174616 PMCID: PMC4642591 DOI: 10.1007/s00381-015-2792-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/09/2015] [Indexed: 11/24/2022]
Abstract
OBJECT The aim of this study is to delineate the long-term results for patients going through surgery for pediatric brain tumors in the first 6 months of life. METHODS Thirty consecutive children (1-182 days old) who underwent primary resection for a brain tumor during the years 1973-2012 were included in this retrospective study on surgical morbidity, mortality rate, academic achievement, and/or work participation. Gross motor function and activities of daily life were scored according to the Barthel index. RESULTS Of the 30 patients, 11 children had surgery in the first 3 months of life (1 to 88 days) and 19 were aged 3 to 6 months (94-182 days) at the time of surgery. The male/female ratio was 1.0 (15/15). No patients were lost to follow-up. Two patients died in the postoperative period (30 days). Another eight patients died during the follow-up. Twenty patients are alive, with follow-up times from 2 to 38 years, median 13 years. Among the 28 children who survived the primary resection, eight underwent repeat surgery from 6 months to 5 years after the first operation. Two children were operated three times, and one of these also a fourth time. Gross total resection (GTR) was achieved in 20 of the primary resections, subtotal resection (STR) in 6, and in the last 4, only a biopsy or a partial resection was performed. Nine children received adjuvant chemotherapy and three of these also radiotherapy (in the years 1979-1987). Among the 20 survivors, the Barthel index is normal (100) in 18 patients, 40 in one, and 20 in the last one. Eight tumors were located to the posterior fossa, and 22 were supratentorial. Eighteen tumors were histologically low-grade (WHO grade I-II), most of these were plexus papillomas (7) or astrocytomas (7), and 12 were high-grade (WHO grade III-IV); PNET/medulloblastomas (6), ependymoma (2), glioblastoma (2), teratoma, and plexus carcinoma. CONCLUSION Infants with brain tumors may clearly benefit from surgical resection with favorable results even for prolonged periods of time. Ten children died, two of them with prolonged survival for 9 and 29 years. Among the 20 survivors, a stable very long-term result appears obtainable in 18 also when it comes to quality of life. Four of the survivors have been treated for highly malignant tumors with a follow-up of 5, 11, 14, and 26 years. One of our infant patients treated for GBM in 1982, lived for 29 years, however, with a progressive decline in the quality of life probably due to postoperative whole-brain radiation.
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Affiliation(s)
- Tryggve Lundar
- Department of Neurosurgery, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.
| | | | - Arild Egge
- />Department of Neurosurgery, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Bård Krossnes
- />Department of Pathology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Einar Stensvold
- />Department of Pediatrics, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Paulina Due-Tønnessen
- />Department of Radiology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Petter Brandal
- />Department of Oncology, Oslo University Hospital, Postboks 4950 Nydalen, 0424 Oslo, Norway
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Johnson KJ, Cullen J, Barnholtz-Sloan JS, Ostrom QT, Langer CE, Turner MC, McKean-Cowdin R, Fisher JL, Lupo PJ, Partap S, Schwartzbaum JA, Scheurer ME. Childhood brain tumor epidemiology: a brain tumor epidemiology consortium review. Cancer Epidemiol Biomarkers Prev 2014; 23:2716-36. [PMID: 25192704 PMCID: PMC4257885 DOI: 10.1158/1055-9965.epi-14-0207] [Citation(s) in RCA: 235] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Childhood brain tumors are the most common pediatric solid tumor and include several histologic subtypes. Although progress has been made in improving survival rates for some subtypes, understanding of risk factors for childhood brain tumors remains limited to a few genetic syndromes and ionizing radiation to the head and neck. In this report, we review descriptive and analytical epidemiology childhood brain tumor studies from the past decade and highlight priority areas for future epidemiology investigations and methodological work that is needed to advance our understanding of childhood brain tumor causes. Specifically, we summarize the results of a review of studies published since 2004 that have analyzed incidence and survival in different international regions and that have examined potential genetic, immune system, developmental and birth characteristics, and environmental risk factors. Cancer Epidemiol Biomarkers Prev; 23(12); 2716-36. ©2014 AACR.
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Affiliation(s)
- Kimberly J Johnson
- Brown School Masters of Public Health Program, Washington University in St. Louis, St. Louis, Missouri
| | - Jennifer Cullen
- American Childhood Cancer Organization, Kensington, Maryland
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Chelsea E Langer
- Centre for Research in Environmental Epidemiology, Carrer Doctor Aiguader, Barcelona, Spain. Universitat Pompeu Fabra, Plaça de la Mercè, Barcelona, Spain. CIBER Epidemiología y Salud Pública, Carrer Casanova, Barcelona, Spain
| | - Michelle C Turner
- Centre for Research in Environmental Epidemiology, Carrer Doctor Aiguader, Barcelona, Spain. Universitat Pompeu Fabra, Plaça de la Mercè, Barcelona, Spain. CIBER Epidemiología y Salud Pública, Carrer Casanova, Barcelona, Spain. McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - James L Fisher
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas. Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Sonia Partap
- Division of Neurology, Stanford University, Palo Alto, California
| | - Judith A Schwartzbaum
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas. Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
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Teo WY, Ross J, Bollo RJ, Seow WT, Tan AM, Kang SG, Kim DS, Li XN, Lau CC, Mohila CA, Adesina AM, Su JM. Atypical location and clinical behavior of a subset of intracranial germ cell tumors in children younger than 3 years of age. J Neurosurg Pediatr 2014; 14:348-55. [PMID: 25062305 DOI: 10.3171/2014.6.peds13651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe a series of 15 intracranial germ cell tumors (IGCTs) excluding mature teratomas; 3 cases in children younger than 3 years of age who were treated at 3 different international institutions over the course of 20 years, and 12 from a PubMed search. These tumors, with possible in utero origins, often occur in atypical locations. The clinical behavior differed significantly from these tumors' counterparts in older children. In this young age group germinoma is highly aggressive, whereas nongerminomatous germ cell tumors may be cured without radiotherapy. Ongoing genomic studies reveal insights to attain an understanding of the biology of these tumors. New treatment strategies are needed to improve outcomes for IGCTs in this age group, particularly for germinomas.
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Affiliation(s)
- Wan-Yee Teo
- Department of Pediatrics, Division of Hematology-Oncology
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Cheung MR. Receiver operating characteristic curve analysis of SEER medulloblastoma and primitive neuroectodermal tumor (PNET) outcome data: identification and optimization of predictive models. Asian Pac J Cancer Prev 2014; 15:6781-5. [PMID: 25169525 DOI: 10.7314/apjcp.2014.15.16.6781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study used receiver operating characteristic curves to analyze Surveillance, Epidemiology and End RESULTS (SEER) medulloblastoma (MB) and primitive neuroectodermal tumor (PNET) outcome data. The aim of this study was to identify and optimize predictive outcome models. MATERIALS AND METHODS Patients diagnosed from 1973 to 2009 were selected for analysis of socio-economic, staging and treatment factors available in the SEER database for MB and PNET. For the risk modeling, each factor was fitted by a generalized linear model to predict the outcome (brain cancer specific death, yes/no). The area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. A Monte Carlo algorithm was used to estimate the modeling errors. RESULTS There were 3,702 patients included in this study. The mean follow up time (S.D.) was 73.7 (86.2) months. Some 40% of the patients were female and the mean (S.D.) age was 16.5 (16.6) years. There were more adult MB/PNET patients listed from SEER data than pediatric and young adult patients. Only 12% of patients were staged. The SEER staging has the highest ROC (S.D.) area of 0.55 (0.05) among the factors tested. We simplified the 3-layered risk levels (local, regional, distant) to a simpler non-metastatic (I and II) versus metastatic (III) model. The ROC area (S.D.) of the 2-tiered model was 0.57 (0.04). CONCLUSIONS ROC analysis optimized the most predictive SEER staging model. The high under staging rate may have prevented patients from selecting definitive radiotherapy after surgery.
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Affiliation(s)
- Min Rex Cheung
- New York City Cyberknife Center, Flushing, New York, USA E-mail :
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Gabriel A, Batey J, Capogreco J, Kimball D, Walters A, Tubbs RS, Loukas M. Adult brain cancer in the U.S. black population: a Surveillance, Epidemiology, and End Results (SEER) analysis of incidence, survival, and trends. Med Sci Monit 2014; 20:1510-7. [PMID: 25151984 PMCID: PMC4156338 DOI: 10.12659/msm.890762] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Despite much epidemiological research on brain cancer in the United States, the etiology for the various subtypes remains elusive. The black population in the United States currently experiences lower incidence but higher survival rates when compared to other races. Thus, the aim of this study is to analyze the trends in incidence and survival for the 6 most common primary brain tumors in the black population of the United States. Material/Methods The Surveillance, Epidemiology, and End Results (SEER) database was utilized in this study to analyze the incidence and survival rates for the 6 most common brain tumor subtypes. Joinpoint 3.5.2 software was used to analyze trends in the incidence of diagnosis from 1973 to 2008. A Kaplan-Meier curve was generated to analyze mean time to death and survival at 60 months. Results Joinpoint analysis revealed that per year the incidence of brain cancer in the U.S. black population increased by 0.11 between 1973 and 1989. After this period, a moderate decrease by 0.06 per annum was observed from 1989 to 2008. Lymphoma was the most common primary tumor subtype for black individuals ages 20–34, and glioblastoma was identified as the most common tumor subtype for black individuals in the age groups of 35–49, 50–64, 65–79, and 80+. Conclusions This population-based retrospective study of brain cancer in black adults in the United States revealed significant sex and age differences in the incidence of the 6 most common brain tumor subtypes from 1973 to 2008.
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Affiliation(s)
- Abigail Gabriel
- School of Medicine, St. George's University, St. George, Grenada
| | - Jason Batey
- School of Medicine, St. George's University, St. George, Grenada
| | - Joseph Capogreco
- School of Medicine, St. George's University, St. George, Grenada
| | - David Kimball
- School of Medicine, St. George's University, St. George, Grenada
| | - Andy Walters
- School of Medicine, St. George's University, St. George, Grenada
| | - R Shane Tubbs
- Department of Pediatric Neurosurgery, Childrens Hospital, Birmingham , USA
| | - Marios Loukas
- School of Medicine, St. George's University, St. George, Grenada
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Girard E, Ditzler S, Lee D, Richards A, Yagle K, Park J, Eslamy H, Bobilev D, Vrignaud P, Olson J. Efficacy of cabazitaxel in mouse models of pediatric brain tumors. Neuro Oncol 2014; 17:107-15. [PMID: 25140037 DOI: 10.1093/neuonc/nou163] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is an unmet need in the treatment of pediatric brain tumors for chemotherapy that is efficacious, avoids damage to the developing brain, and crosses the blood-brain barrier. These experiments evaluated the efficacy of cabazitaxel in mouse models of pediatric brain tumors. METHODS The antitumor activity of cabazitaxel and docetaxel were compared in flank and orthotopic xenograft models of patient-derived atypical teratoid rhabdoid tumor (ATRT), medulloblastoma, and central nervous system primitive neuroectodermal tumor (CNS-PNET). Efficacy of cabazitaxel and docetaxel were also assessed in the Smo/Smo spontaneous mouse medulloblastoma tumor model. RESULTS This study observed significant tumor growth inhibition in pediatric patient-derived flank xenograft tumor models of ATRT, medulloblastoma, and CNS-PNET after treatment with either cabazitaxel or docetaxel. Cabazitaxel, but not docetaxel, treatment resulted in sustained tumor growth inhibition in the ATRT and medulloblastoma flank xenograft models. Patient-derived orthotopic xenograft models of ATRT, medulloblastoma, and CNS-PNET showed significantly improved survival with treatment of cabazitaxel. CONCLUSION These data support further testing of cabazitaxel as a therapy for treating human pediatric brain tumors.
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Affiliation(s)
- Emily Girard
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
| | - Sally Ditzler
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
| | - Donghoon Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
| | - Andrew Richards
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
| | - Kevin Yagle
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
| | - Joshua Park
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
| | - Hedieh Eslamy
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
| | - Dmitri Bobilev
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
| | - Patricia Vrignaud
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
| | - James Olson
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington (E.G., S.D., A.R., J.O.); Department of Radiology, University of Washington, Seattle, Washington (D.L., K.Y., J.P., H.E.); Sanofi Oncology, Global Oncology Division, Cambridge, Massachusetts 02142 (D.B.); Oncology/Translational and Experimental Medicine, Sanofi Inc, Vitry sur Seine, France (P.V.)
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Ostrom QT, Chen Y, M de Blank P, Ondracek A, Farah P, Gittleman H, Wolinsky Y, Kruchko C, Cohen ML, Brat DJ, Barnholtz-Sloan JS. The descriptive epidemiology of atypical teratoid/rhabdoid tumors in the United States, 2001-2010. Neuro Oncol 2014; 16:1392-9. [PMID: 24847086 DOI: 10.1093/neuonc/nou090] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumor is a rare malignant CNS tumor that most often affects children ≤ 3 years old. The Central Brain Tumor Registry of the United States contains the largest aggregation of population-based incidence data for primary CNS tumors in the US. Its data were used to describe the incidence, associated trends, and relative survival after diagnosis of atypical teratoid/rhabdoid tumor. METHODS Using data from 50 cancer registries between 2001 and 2010, age-adjusted incidence rates per 100 000 and 95% CIs were calculated by sex, race, Hispanic ethnicity, age at diagnosis, and location of tumor in the CNS for children aged 0 to 19 years. Relative survival rates and 95% CIs were also calculated. RESULTS The average annual age-adjusted incidence rate was 0.07 (95% CI: 0.07, 0.08). Incidence rates did not significantly vary by sex, race, or ethnicity. Age had a strong effect on incidence rate, with highest incidence among children <1 year, and decreasing incidence with increasing age. The 6-month, 1-year, and 5-year relative survival rates for all ages were 65.0%, 46.8%, and 28.3%, respectively. Atypical teratoid/rhabdoid tumor can occur anywhere in the CNS, but supratentorial tumors were more common with increasing age. CONCLUSION We confirm differences in survival by age at diagnosis, treatment pattern, and location of tumor in the brain. This contributes to our understanding of these tumors and may stimulate research leading to improved treatment of this devastating childhood disease.
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Affiliation(s)
- Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Yanwen Chen
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Peter M de Blank
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Annie Ondracek
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Paul Farah
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Haley Gittleman
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Yingli Wolinsky
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Carol Kruchko
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Mark L Cohen
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Daniel J Brat
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (Q.T.O., Y.C., H.G., Y.W., J.S.B.-S.); Central Brain Tumor Registry of the United States, Hinsdale, Illinois (Q.T.O., Y.C., H.G., Y.W., C.K., J.S.B.-S.); Division of Pediatric Hematology-Oncology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio (P.M.d.B.); The Ohio State University, Columbus, Ohio (A.O.); Case Western Reserve University, Cleveland, Ohio (P.F.); Department of Pathology, University Hospitals Case Medical Center, Cleveland, Ohio (M.L.C.); Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Emory University Hospital, Atlanta, Georgia (D.J.B.)
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Cheung MR. Surveying and optimizing the predictors for ependymoma specific survival using SEER data. Asian Pac J Cancer Prev 2014; 15:867-70. [PMID: 24568509 DOI: 10.7314/apjcp.2014.15.2.867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) ependymoma data to identify predictive models and potential disparity in outcome. MATERIALS AND METHODS This study analyzed socio-economic, staging and treatment factors available in the SEER database for ependymoma. For the risk modeling, each factor was fitted by a Generalized Linear Model to predict the outcome ('brain and other nervous systems' specific death in yes/no). The area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate the modeling errors. Risk of ependymoma death was computed for the predictors for comparison. RESULTS A total of 3,500 patients diagnosed from 1973 to 2009 were included in this study. The mean follow up time (S.D.) was 79.8 (82.3) months. Some 46% of the patients were female. The mean (S.D.) age was 34.4 (22.8) years. Age was the most predictive factor of outcome. Unknown grade demonstrated a 15% risk of cause specific death compared to 9% for grades I and II, and 36% for grades III and IV. A 5-tiered grade model (with a ROC area 0.48) was optimized to a 3-tiered model (with ROC area of 0.53). This ROC area tied for the second with that for surgery. African-American patients had 21.5% risk of death compared with 16.6% for the others. Some 72.7% of patient who did not get RT had cerebellar or spinal ependymoma. Patients undergoing surgery had 16.3% risk of death, as compared to 23.7% among those who did not have surgery. CONCLUSION Grading ependymoma may dramatically improve modeling of data. RT is under used for cerebellum and spinal cord ependymoma and it may be a potential way to improve outcome.
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Affiliation(s)
- Min Rex Cheung
- FROS Radiation Oncology Cyberknife Center of New York, NY, USA E-mail :
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Are pediatric brain tumors on the rise in the USA? Significant incidence and survival findings from the SEER database analysis. Childs Nerv Syst 2014; 30:147-54. [PMID: 24162619 DOI: 10.1007/s00381-013-2307-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Central nervous system tumors are the second most common form of cancer in children between the ages of 1 and 19 years. We aimed to provide the most recent data on the incidence and survival of these tumors in the USA and to assess the literature. METHODS Frequency, rates, and survival sessions were calculated using the November 2008 submission for the US Surveillance Epidemiology and End Results Program. Data were collected and analyzed for children and adolescents aged 1 to 19 years with primary brain tumors. RESULTS We found that the incidence rate of all pediatric brain tumors has been on a gradual but steady increase from 1973 to 2008 (p < 0.001). The average annual increase was 1.37 %. Our survival analysis of the individual tumors revealed that the 5-year overall survival for children diagnosed between 1974 and 1978 with medulloblastoma was 43.7 %. However, this increased to 62.8 % for children diagnosed between 1999 and 2003. A similar survival trend was also observed when all the other pediatric brain cancer histologies were collectively analyzed (p < 0.001). CONCLUSIONS From our study, we can conclude that contrary to previous reports indicating a plateau in the incidence rates of pediatric brain tumors since the mid-1980s, there has been an increase from 1973 to 2008. Potential causes include environmental carcinogens, but more research is needed to investigate the factors behind this sustained rise in incidence over the years.
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Al-Hussaini M, Swaidan M, Al-Jumaily U, Musharbash A. Central nervous system tumors in the first year of life: a clinical and pathologic experience from a single cancer center. Childs Nerv Syst 2013; 29:1883-91. [PMID: 23525892 DOI: 10.1007/s00381-013-2081-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 03/06/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE This study aims to review our experience with central nervous system (CNS) tumors occurring during the first year of life and to report differing features found in our series. METHODS This is a retrospective study of infants with CNS tumors diagnosed at our institution from 2006 to 2011. RESULTS A total of 19 cases were identified, with a median age of 232 days and predominance of male gender. Males were younger than females at the time of diagnosis (p value = 0.039). There were 13 low-grade tumors, glial tumors being the most common (11/13, p value = 0.003) and six high-grade tumors, atypical teratoid rhabdoid tumor being the most common (4/6). Low-grade tumors predominated in the supratentorial region, while high-grade tumors were seen in the infratentorial area (p value = 0.035). Males had a predilection to have more supratentorial tumors (p value = 0.058). Four patients underwent gross total resection, and eight received chemotherapy; none received radiotherapy. Two patients had spinal cord tumors; both were of pilomyxoid astrocytoma histology. Rare tumors included hemangiopericytoma (n = 1) and atypical choroid plexus tumor (n = 1), both occurring in the supratentorial area and affecting the youngest patients in this group; they were diagnosed prenatally and at 107 days, respectively. The median progression-free and overall survivals were 269 and 667 days, respectively. Among all tested parameters, only the grade of the tumor affected the outcome. CONCLUSIONS Diagnosis and management of infant's CNS tumors remain challenging. Pathologists should be aware of the diversity of histological types. Assigning appropriate tumor grade is fundamental in predicting the outcome.
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Affiliation(s)
- Maysa Al-Hussaini
- Department of Pathology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan,
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Villano JL, Parker CK, Dolecek TA. Descriptive epidemiology of ependymal tumours in the United States. Br J Cancer 2013; 108:2367-71. [PMID: 23660944 PMCID: PMC3681017 DOI: 10.1038/bjc.2013.221] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Ependymomas are rare primary gliomas that commonly affect both children and adults, but unique as survival is worse in children. Methods: Data on brain and central nervous system primary malignant and non-malignant ependymal tumours from the Central Brain Tumor Registry of the United States analytic data set and primary malignant ependymal tumours from the SEER 13 registries research data file were used to evaluate incidence and survival, respectively. Results: The 2004–2009 average annual age-adjusted incidence rate of ependymal tumours was 0.41/100 000. Spinal cord/cauda equina was the primary site at diagnosis for 50–60% of ependymal tumours in adult age groups in contrast to about 20% in children and adolescents. Ependymoma was the most frequent histology in all age groups; however, anaplastic ependymoma comprised about 30% in cases 0–19 years of age compared with about 3–5% in adult age groups. Overall, relative survival was favourable with rates at ∼85% and 75% at 3 and 10 years post diagnosis, respectively. However, children and adolescents, the oldest adult age group, cases diagnosed with anaplastic ependymoma and/or tumour location in a brain site had lowest survival rates. Conclusion: Paediatric cases had worse outcomes compared with adults for numerous reasons including having a higher percentage of anaplastic ependymomas and greater percentage of cases of intracranial disease.
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Affiliation(s)
- J L Villano
- Departments of Medicine and Neurology, Division of Oncology, University of Kentucky, Lexington, KY, USA.
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Heck JE, Lombardi CA, Cockburn M, Meyers TJ, Wilhelm M, Ritz B. Epidemiology of rhabdoid tumors of early childhood. Pediatr Blood Cancer 2013; 60:77-81. [PMID: 22434719 PMCID: PMC3399923 DOI: 10.1002/pbc.24141] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 02/23/2012] [Indexed: 01/29/2023]
Abstract
BACKGROUND Rhabdoid tumors are a rare and aggressive cancer subtype which is usually diagnosed in early childhood. Little is known about their etiology. The purpose of this study was to describe the epidemiology of rhabdoid tumors and examine their relation to perinatal characteristics. METHODS We identified 44 atypical teratoid/rhabdoid tumors (AT/RT) of the central nervous system (CNS) and 61 rhabdoid sarcomas (renal and extra-renal non-CNS tumors) from California Cancer Registry records of diagnoses 1988-2007 among children <6 years of age. We randomly selected 208,178 controls from California birthrolls. Multivariable logistic regression was used to examine associations between rhabdoid tumors and perinatal characteristics. RESULTS After adjustment for demographic characteristics, low birthweight (<2,500 g) strongly increased risk for developing both rhabdoid sarcomas (OR = 2.43, 95% CI 1.09, 5.41) and AT/RT (OR = 2.99, 95% CI 1.31, 6.84). Both preterm delivery (<37 weeks gestation, OR = 2.63, 95% CI 1.34, 5.17) and late term delivery (>42 weeks, OR = 3.66, 95% CI 1.54, 8.71) also increased risk of rhabdoid sarcomas. Rhabdoid sarcoma cases (OR = 3.08, 95% CI 1.11, 8.55) and AT/RT cases (OR = 3.16, 95% CI 1.23, 8.13) also were more likely to be multiple births. CONCLUSION The excess of twin pregnancies may suggest an association with infertility treatments. This is the first population-based epidemiologic study to examine these rare tumors.
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Affiliation(s)
- Julia E Heck
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA.
| | - Christina A Lombardi
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA
| | - Myles Cockburn
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Travis J Meyers
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA
| | - Michelle Wilhelm
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA
| | - Beate Ritz
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA
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Horowitz DP, Sharma CS, Connolly E, Gidea-Addeo D, Deutsch I. Secretory carcinoma of the breast: Results from the survival, epidemiology and end results database. Breast 2012; 21:350-3. [DOI: 10.1016/j.breast.2012.02.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/23/2012] [Accepted: 02/26/2012] [Indexed: 02/09/2023] Open
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Samkari A, Hwang E, Packer RJ. Medulloblastoma/Primitive neuroectodermal tumor and germ cell tumors: the uncommon but potentially curable primary brain tumors. Hematol Oncol Clin North Am 2012; 26:881-95. [PMID: 22794288 DOI: 10.1016/j.hoc.2012.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article presents an overview of medulloblastomas, central nervous system primitive neuroectodermal tumors, and germ cell tumors for the practicing oncologist. Discussion includes the definition of these tumors, histopathologic findings, molecular and genetic characteristics, prognoses, and evolution of treatment.
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Affiliation(s)
- Ayman Samkari
- The Brain Tumor Institute, Division of Neurology, Children's National Medical Center, Washington, DC 20010, USA
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