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Perez-Roca E, Negreiros T, Casavilca-Zambrano S, Ojeda-Medina L, Díaz-Coronado R. Prognostic factors of pediatric ependymomas at a National Cancer Reference Center in Peru. Front Oncol 2024; 13:1331790. [PMID: 38298447 PMCID: PMC10828566 DOI: 10.3389/fonc.2023.1331790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 02/02/2024] Open
Abstract
Background Ependymomas are central nervous system tumors that significantly impact the quality of life and carry a high mortality rate. Both the disease itself and its treatment cause significant morbidity. At a national level in Peru, there are no reports on clinical characteristics of the disease. Methods This retrospective study captured patient aged less than 19 years with a diagnosis of ependymoma from 2012 to 2022 at a tertiary center in Lima. Results 85 patients were included with a median follow-up time was 51.6 months. The 5-year overall survival and progression-free survival were 55.89% (95% CI: 44.28 - 65.99) and 37.71% (95% CI: 26,21-49,16) respectively. The main prognostic factors identified were completed treatment (p=0.019), adjuvant chemotherapy (p=0.048), presence of metastasis (p=0.012), and disease recurrence (p=0.02). Conclusions The survival of patients with ependymoma is below that reported in high-income countries. Incomplete treatment and treatment abandonment are factors that negatively impact the prognosis. Further studies are needed to identify barriers in the referral and treatment process for patients with ependymoma.
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Affiliation(s)
| | - Tatiana Negreiros
- Radiotherapy Department, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | - Luis Ojeda-Medina
- Neurosurgery Department, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Rosdali Díaz-Coronado
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Pediatric Oncology Department, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
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Boukaka RG, Szathmari A, Di Rocco F, Leblond P, Faure-Conter C, Claude L, Vasiljevic A, Beuriat PA, Mottolese C. Posterior fossa ependymoma in children: A long-term single-center experience. Neurochirurgie 2023; 69:101459. [PMID: 37295279 DOI: 10.1016/j.neuchi.2023.101459] [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: 12/14/2022] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Ependymomas in the posterior fossa have poor prognosis. This study reports a single-center pediatric series, focusing on the value of surgical resection. MATERIAL AND METHODS A single-center retrospective study included all patients operated on by the senior author (CM) for posterior fossa ependymoma from 2002 to 2018. Medical and surgical data were extracted from the hospital's medical database. RESULTS Thirty-four patients were included. Age ranged from 6 months to 18 years, with a median of 4.7 years. Fourteen patients underwent initial endoscopic third ventriculocisternostomy before the direct surgical resection. Surgical removal was complete in 27 patients. There were 32 surgeries for second-look, local recurrence or metastasis despite complementary chemotherapy and/or radiotherapy. Twenty patients were WHO grade 2 and 14 grade 3. Sixteen patients showed recurrence (47%). Overall survival was 61.8% at a mean 10.1 years' follow-up. Morbidities comprised facial nerve palsy, swallowing disorder, and transient cerebellar syndrome. Fifteen patients had normal schooling, 6 had special assistance; 4 patients reached university, 3 of whom experienced difficulties. Three patients had a job. CONCLUSION Posterior fossa ependymomas are aggressive tumors. Complete surgical removal is the most important prognostic factor, despite risk of sequelae. Complementary treatment is mandatory, but no targeted therapy has so far proved effective. It is important to continue the search for molecular markers in order to improve outcomes.
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Affiliation(s)
- R G Boukaka
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France
| | - A Szathmari
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France
| | - F Di Rocco
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - P Leblond
- Department of Pediatric Hematology and Oncology, institut d'hématologie et d'oncologie pédiatrique, 69008 Lyon, France
| | - C Faure-Conter
- Department of Pediatric Hematology and Oncology, institut d'hématologie et d'oncologie pédiatrique, 69008 Lyon, France
| | - L Claude
- Department of Radiotherapy, centre Léon-Bérard, 69008 Lyon, France
| | - A Vasiljevic
- Department of Pathology and Neuropathology, GHE, hospices civils de Lyon, 69500 Bron, France
| | - P-A Beuriat
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - C Mottolese
- Department of Pediatric Neurosurgery, hôpital Femme Mère Enfant, hospices civils de Lyon, 69500 Bron, France.
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Montgomery EY, Thirunavu V, Pagadala M, Shlobin NA, Plant-Fox AS, Lam S, DeCuypere M. Recurrent pediatric infratentorial ependymomas: a systematic review and meta-analysis on outcomes and molecular classification. J Neurosurg Pediatr 2023; 31:132-142. [PMID: 36433871 DOI: 10.3171/2022.10.peds22154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to summarize the prognosis of recurrent infratentorial ependymomas based on treatment and molecular characterization. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors searched the PubMed, Scopus, Embase, and Ovid databases for studies on recurrent infratentorial ependymomas in patients younger than 25 years of age. Exclusion criteria included case series of fewer than 5 patients and studies that did not provide time-dependent survival data. RESULTS The authors' database search yielded 482 unique articles, of which 18 were included in the final analysis. There were 479 recurrent infratentorial pediatric ependymomas reported; 53.4% were WHO grade II and 46.6% were WHO grade III tumors. The overall mortality for recurrent infratentorial pediatric ependymomas was 49.1% (226/460). The pooled mean survival was 30.2 months after recurrence (95% CI 22.4-38.0 months). Gross-total resection (GTR) was achieved in 243 (59.0%) patients at initial presentation. The mean survival postrecurrence for those who received initial GTR was 42.3 months (95% CI 35.7-47.6 months) versus 26.0 months (95% CI 9.6-44.6 months) for those who received subtotal resection (STR) (p = 0.032). There was no difference in the mean survival between patients who received GTR (49.3 months, 95% CI 32.3-66.3 months) versus those who received STR (41.4 months, 95% CI 11.6-71.2 months) for their recurrent tumor (p = 0.610). In the studies that included molecular classification data, there were 169 (83.3%) posterior fossa group A (PFA) tumors and 34 (16.7%) posterior fossa group B (PFB) tumors, with 28 tumors harboring a 1q gain. PFA tumors demonstrated worse mean postprogression patient survival (24.7 months, 95% CI 15.3-34.0 months) compared with PFB tumors (48.0 months, 95% CI 32.8-63.2 months) (p = 0.0073). The average postrecurrence survival for patients with 1q+ tumors was 14.7 months. CONCLUSIONS The overall mortality rate for recurrent infratentorial ependymomas was found to be 49.1%, with a pooled mean survival of 30.2 months in the included sample population. More than 80% of recurrent infratentorial ependymomas were of the PFA molecular subtype, and both PFA tumors and those with 1q gain demonstrated worse prognosis after recurrence.
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Affiliation(s)
| | - Vineeth Thirunavu
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Manasa Pagadala
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Nathan A Shlobin
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
| | - Ashley S Plant-Fox
- 3Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois; and
| | - Sandi Lam
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael DeCuypere
- 2Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Illinois
- 4Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Albiña P, Solis A, Lorenzoni J, Henny P, Manriquez M. Primary germinoma of the medulla oblongata: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21315. [PMID: 35733824 PMCID: PMC9204933 DOI: 10.3171/case21315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Primary central nervous system germinomas of the medulla oblongata are extremely rare and usually have been found in young female Asian patients. The authors present an illustrative case of a patient who presented with severe medullary and posterior cord syndrome, the first South American case published to date, to the authors’ knowledge. OBSERVATIONS Initially, the radiological differential diagnosis did not include this entity. The lesion was located at the obex and exhibited a well-delineated contrast enhancement without hydrocephalus. An emergency decompressive partial resection following functional limits was performed. After histological confirmation, radiotherapy was indicated, with complete remission achieved at a 6-month follow-up. The patient, however, continued to have a severe proprioceptive disorder. The literature review identified 21 other such patients. The mean age for this location was 23 years, with a strong female and Asian origin predilection. All tumors exhibited contrast enhancement, and only one presented with hydrocephalus. LESSONS In the absence of elevated tumor markers, radiological clues such as a well-delineated, contrast-enhanced lesion arising from the obex, without hydrocephalus, associated with demographic features such as young age, female sex, and Asian heritage, should evoke a high level of suspicion for this diagnosis. Gross total resection must not be attempted, because this tumor is potentially curable with high-dose radiotherapy.
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Affiliation(s)
- Pablo Albiña
- Neuroanatomy Lab, Department of Anatomy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Neurosurgery, Hospital Barros Luco Trudeau, Santiago, Chile
| | - Aracelly Solis
- Intensive Care Unit, National Institute of Neurosurgery Dr. Asenjo, Santiago, Chile
| | - Jose Lorenzoni
- Department of Neurosurgery, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Henny
- Neuroanatomy Lab, Department of Anatomy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Interdisciplinary Center for Neuroscience, NeuroUC, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
| | - María Manriquez
- Department of Pathology, Military Hospital of Santiago, Santiago, Chile
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Napieralska A, Mizia-Malarz A, Stolpa W, Pawłowska E, Krawczyk MA, Konat-Bąska K, Kaczorowska A, Brąszewski A, Harat M. Polish Multi-Institutional Study of Children with Ependymoma-Clinical Practice Outcomes in the Light of Prospective Trials. Diagnostics (Basel) 2021; 11:diagnostics11122360. [PMID: 34943596 PMCID: PMC8700631 DOI: 10.3390/diagnostics11122360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022] Open
Abstract
We performed a multi-institutional analysis of 74 children with ependymoma to evaluate to what extent the clinical outcome of prospective trials could be reproduced in routine practice. The evaluation of factors that correlated with outcome was performed with a log rank test and a Cox proportional-hazard model. Survival was estimated with the Kaplan–Meier method. The majority of patients had brain tumours (89%). All had surgery as primary treatment, with adjuvant radiotherapy (RTH) and chemotherapy (CTH) applied in 78% and 57%, respectively. Median follow-up was 80 months and 18 patients died. Five- and 10-year overall survival (OS) was 83% and 73%. Progression was observed in 32 patients, with local recurrence in 28 cases. The presence of metastases was a negative prognostic factor for OS. Five- and 10-year progression-free survival (PFS) was 55% and 40%, respectively. The best outcome in patients with non-disseminated brain tumours was observed when surgery was followed by RTH (+/−CTH afterwards; p = 0.0001). Children under 3 years old who received RTH in primary therapy had better PFS (p = 0.010). The best outcome of children with ependymoma is observed in patients who received radical surgery followed by RTH, and irradiation should not be omitted in younger patients. The role of CTH remains debatable.
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Affiliation(s)
- Aleksandra Napieralska
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, 44-101 Gliwice, Poland
- Correspondence:
| | - Agnieszka Mizia-Malarz
- Department of Pediatrics, Medical University of Silesia, 40-752 Katowice, Poland; (A.M.-M.); (W.S.)
| | - Weronika Stolpa
- Department of Pediatrics, Medical University of Silesia, 40-752 Katowice, Poland; (A.M.-M.); (W.S.)
| | - Ewa Pawłowska
- Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Małgorzata A. Krawczyk
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Katarzyna Konat-Bąska
- Wroclaw Comprehensive Cancer Center, 53-413 Wrocław, Poland;
- Department of Oncology, Wroclaw Medical University, 53-413 Wrocław, Poland
| | - Aneta Kaczorowska
- Department of Children Oncology and Haematology, Wroclaw Medical University, 53-413 Wrocław, Poland;
| | - Arkadiusz Brąszewski
- Department of Neurooncology and Radiosurgery, Franciszek Lukaszczyk Memorial Oncology Center, 85-796 Bydgoszcz, Poland; (A.B.); (M.H.)
| | - Maciej Harat
- Department of Neurooncology and Radiosurgery, Franciszek Lukaszczyk Memorial Oncology Center, 85-796 Bydgoszcz, Poland; (A.B.); (M.H.)
- Department of Oncology and Brachytherapy, Nicolas Copernicus University, Collegium Medicum, 85-067 Bydgoszcz, Poland
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Sabin ND, Hwang SN, Klimo P, Chambwe N, Tatevossian RG, Patni T, Li Y, Boop FA, Anderson E, Gajjar A, Merchant TE, Ellison DW. Anatomic Neuroimaging Characteristics of Posterior Fossa Type A Ependymoma Subgroups. AJNR Am J Neuroradiol 2021; 42:2245-2250. [PMID: 34674998 DOI: 10.3174/ajnr.a7322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/09/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Posterior fossa type A (PFA) ependymomas have 2 molecular subgroups (PFA-1 and PFA-2) and 9 subtypes. Gene expression profiling suggests that PFA-1 and PFA-2 tumors have distinct developmental origins at different rostrocaudal levels of the brainstem. We, therefore, tested the hypothesis that PFA-1 and PFA-2 ependymomas have different anatomic MR imaging characteristics at presentation. MATERIALS AND METHODS Two neuroradiologists reviewed the preoperative MR imaging examinations of 122 patients with PFA ependymomas and identified several anatomic characteristics, including extension through the fourth ventricular foramina and encasement of major arteries and tumor type (midfloor, roof, or lateral). Deoxyribonucleic acid methylation profiling assigned ependymomas to PFA-1 or PFA-2. Information on PFA subtype from an earlier study was also available for a subset of tumors. Associations between imaging variables and subgroup or subtype were evaluated. RESULTS No anatomic imaging variable was significantly associated with the PFA subgroup, but 5 PFA-2c subtype ependymomas in the cohort had a more circumscribed appearance and showed less tendency to extend through the fourth ventricular foramina or encase blood vessels, compared with other PFA subtypes. CONCLUSIONS PFA-1 and PFA-2 ependymomas did not have different anatomic MR imaging characteristics, and these results do not support the hypothesis that they have distinct anatomic origins. PFA-2c ependymomas appear to have a more anatomically circumscribed MR imaging appearance than the other PFA subtypes; however, this needs to be confirmed in a larger study.
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Affiliation(s)
- N D Sabin
- From the Departments of Diagnostic Imaging (N.D.S., S.N.H., E.A.)
| | - S N Hwang
- From the Departments of Diagnostic Imaging (N.D.S., S.N.H., E.A.)
| | - P Klimo
- Surgery (P.K., F.A.B.,), St. Jude Children's Research Hospital, Memphis, Tennessee
- Semmes Murphey (P.K., F.A.B.), Memphis, Tennessee
| | | | | | | | - Y Li
- Biostatistics (T.P., Y.L.)
| | - F A Boop
- Surgery (P.K., F.A.B.,), St. Jude Children's Research Hospital, Memphis, Tennessee
- Semmes Murphey (P.K., F.A.B.), Memphis, Tennessee
| | - E Anderson
- From the Departments of Diagnostic Imaging (N.D.S., S.N.H., E.A.)
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Hammad M, Hosny M, Khalil EM, Alfaar AS, Fawzy M. Pediatric ependymoma: A single-center experience from a developing country. Indian J Cancer 2020; 58:378-386. [PMID: 33402598 DOI: 10.4103/ijc.ijc_373_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Ependymomas are the third most common pediatric central nervous system (CNS) tumors, accounting for 6-12% of brain tumors in children. Management of these tumors remains challenging and recurrence occurs in over 50% of cases, mainly when complete resection is not achieved before radiotherapy. The 5-year overall survival (OS) ranges from 39 to 64%, with a 5-year progression-free survival (PFS) rate of 23-45%. The study aimed to describe the OS and PFS rates of cases of pediatric ependymoma. It also aimed to evaluate the effects of different variables on disease outcomes. Variables examined included patient age, the extent of surgical resection, radiotherapy and chemotherapy delivered, the histopathological subtype of the tumor, primary tumor location, and extent of the disease at presentation. Last, the challenges that potentially compromise treatment outcomes in resource-limited countries were to be highlighted. Methods This is a retrospective cohort study, representing a single-center experience that included 47 pediatric patients treated at the National Cancer Institute, Cairo University, between January 2009 and December 2014. Results Median follow-up stood at 23.5 months (range: 2-77 months). The average 3-year OS and PFS rates were 43.7 and 43.3%, respectively. Conclusion The extent of surgical excision (maximal resection) and the adequacy of postoperative radiotherapy were the only two factors that had significantly affected the outcome. Understandably, treatment outcomes for ependymomas in developing countries still lag behind best reported outcomes, mainly due to inadequate surgical excision and postoperative radiotherapy.
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Affiliation(s)
- Mahmoud Hammad
- Department of Pediatric Oncology and Hematology, National Cancer Institute (NCI), Cairo University; Department of Pediatric Oncology and Hematology, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
| | - Maryhan Hosny
- Department of Pediatric Oncology and Hematology, National Cancer Institute (NCI), Cairo University; Department of Pediatric Oncology and Hematology, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
| | - Ehab M Khalil
- Department of Radiation Oncology and Nuclear Medicine, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Ahmad S Alfaar
- Department of Ophthalmology, Charité-Universtätsmedizin Berlin (Charité Medical University - Berlin), Berlin; Department of Ophthalmology, University of Leipzig, Leipzig, Sachsen, Germany
| | - Mohamed Fawzy
- Department of Pediatric Oncology and Hematology, National Cancer Institute (NCI), Cairo University; Department of Pediatric Oncology and Hematology, Children's Cancer Hospital of Egypt (CCHE/57357), Cairo, Egypt
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Ahmed SI, Javed G, Laghari AA, Bareeqa SB, Aziz K, Khan M, Samar SS, Humera RA, Khan AR, Farooqui MO, Shahbaz A. Third Ventricular Tumors: A Comprehensive Literature Review. Cureus 2018; 10:e3417. [PMID: 30542631 PMCID: PMC6284874 DOI: 10.7759/cureus.3417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid cysts, choroid plexus papillomas, and ependymomas, or secondary tumors, such as craniopharyngiomas, optic nerve gliomas, pineal tumors, and meningiomas. Third ventricular tumors are uncommon, and their treatment involves significant morbidity and mortality. The colloid cyst has a better surgical outcome and many approaches are available to achieve a complete cure. Choroid plexus papilloma is also a common tumor documented with its treatment majorly based on surgical resection. In addition to multiple treatment options for craniopharyngiomas, surgery is the most preferred treatment option. Ependymomas also have few treatment options, with surgical resection adopted as the first line of treatment.
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Affiliation(s)
- Syed Ijlal Ahmed
- Neurosurgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Gohar Javed
- Neurosurgery, The Aga Khan University, Karachi, PAK
| | | | | | - Kashif Aziz
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
| | - Mehreen Khan
- Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Syeda Sana Samar
- Internal Medicine, Jinnah Sindh Medical University, Karachi , PAK
| | | | - Alizay Rashid Khan
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | | | - Amir Shahbaz
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
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Lillard JC, Venable GT, Khan NR, Tatevossian RG, Dalton J, Vaughn BN, Klimo P. Pediatric Supratentorial Ependymoma: Surgical, Clinical, and Molecular Analysis. Neurosurgery 2018; 85:41-49. [DOI: 10.1093/neuros/nyy239] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/09/2018] [Indexed: 12/31/2022] Open
Abstract
Abstract
BACKGROUND
Pediatric supratentorial ependymomas (SEs) have distinct molecular and behavioral differences from their infratentorial counterparts.
OBJECTIVE
To present our experience with pediatric SEs over a 24-yr period.
METHODS
Clinical, operative, and radiographic information was abstracted retrospectively. Our primary outcomes were progression-free survival (PFS) and overall survival (OS). Detection of C11orf95-RELA rearrangement was performed using interphase fluorescence in situ hybridization (iFISH).
RESULTS
Seventy-three patients were identified (41 female, 32 male); median age was 6.7 yrs (range, 1 mo-18.8 yr); median follow-up was 8.3 yrs (range, 2.0-26.3). Fifty-eight (79.5%) of 73 patients underwent gross total resection (GTR); no patient with subtotal resection had greater than 1 cm3 of residual tumor; 42 patients (57.5%) experienced subsequent disease progression with 17 patients ultimately dying of their disease. Median PFS was 3.7 yrs. Molecular analysis was available for 51 patients (70%). On bivariate analysis, PFS and OS were not statistically affected by age, tumor grade, or extent of resection, although there was a clinically significant trend for the latter in favor of aggressive resection on PFS (P = .061). Children with RELA fusion had significantly higher PFS (P = .013) than those without, although there was no difference in OS when compared with those with no C11orf95-RELA fusion or C11orf95 gene rearrangement alone.
CONCLUSION
In our series, GTR may be associated with better PFS, but did not impact OS. Surprisingly, RELA fusion was not found to be a negative prognostic factor, raising the possibility that the deleterious effects may be overcome by aggressive resection.
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Affiliation(s)
- Jock C Lillard
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ruth G Tatevossian
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James Dalton
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
- Semmes Murphey, Memphis, Tennessee
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Quantitative imaging analysis of posterior fossa ependymoma location in children. Childs Nerv Syst 2016; 32:1441-7. [PMID: 27117266 PMCID: PMC4967400 DOI: 10.1007/s00381-016-3092-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Imaging descriptions of posterior fossa ependymoma in children have focused on magnetic resonance imaging (MRI) signal and local anatomic relationships with imaging location only recently used to classify these neoplasms. We developed a quantitative method for analyzing the location of ependymoma in the posterior fossa, tested its effectiveness in distinguishing groups of tumors, and examined potential associations of distinct tumor groups with treatment and prognostic factors. METHODS Pre-operative MRI examinations of the brain for 38 children with histopathologically proven posterior fossa ependymoma were analyzed. Tumor margin contours and anatomic landmarks were manually marked and used to calculate the centroid of each tumor. Landmarks were used to calculate a transformation to align, scale, and rotate each patient's image coordinates to a common coordinate space. Hierarchical cluster analysis of the location and morphological variables was performed to detect multivariate patterns in tumor characteristics. The ependymomas were also characterized as "central" or "lateral" based on published radiological criteria. Therapeutic details and demographic, recurrence, and survival information were obtained from medical records and analyzed with the tumor location and morphology to identify prognostic tumor characteristics. RESULTS Cluster analysis yielded two distinct tumor groups based on centroid location The cluster groups were associated with differences in PFS (p = .044), "central" vs. "lateral" radiological designation (p = .035), and marginally associated with multiple operative interventions (p = .064). CONCLUSIONS Posterior fossa ependymoma can be objectively classified based on quantitative analysis of tumor location, and these classifications are associated with prognostic and treatment factors.
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Barszczyk M, Buczkowicz P, Castelo-Branco P, Mack SC, Ramaswamy V, Mangerel J, Agnihotri S, Remke M, Golbourn B, Pajovic S, Elizabeth C, Yu M, Luu B, Morrison A, Adamski J, Nethery-Brokx K, Li XN, Van Meter T, Dirks PB, Rutka JT, Taylor MD, Tabori U, Hawkins C. Telomerase inhibition abolishes the tumorigenicity of pediatric ependymoma tumor-initiating cells. Acta Neuropathol 2014; 128:863-77. [PMID: 25120190 PMCID: PMC4286630 DOI: 10.1007/s00401-014-1327-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/02/2014] [Accepted: 07/23/2014] [Indexed: 12/17/2022]
Abstract
Pediatric ependymomas are highly recurrent tumors resistant to conventional chemotherapy. Telomerase, a ribonucleoprotein critical in permitting limitless replication, has been found to be critically important for the maintenance of tumor-initiating cells (TICs). These TICs are chemoresistant, repopulate the tumor from which they are identified, and are drivers of recurrence in numerous cancers. In this study, telomerase enzymatic activity was directly measured and inhibited to assess the therapeutic potential of targeting telomerase. Telomerase repeat amplification protocol (TRAP) (n = 36) and C-circle assay/telomere FISH/ATRX staining (n = 76) were performed on primary ependymomas to determine the prevalence and prognostic potential of telomerase activity or alternative lengthening of telomeres (ALT) as telomere maintenance mechanisms, respectively. Imetelstat, a phase 2 telomerase inhibitor, was used to elucidate the effect of telomerase inhibition on proliferation and tumorigenicity in established cell lines (BXD-1425EPN, R254), a primary TIC line (E520) and xenograft models of pediatric ependymoma. Over 60 % of pediatric ependymomas were found to rely on telomerase activity to maintain telomeres, while no ependymomas showed evidence of ALT. Children with telomerase-active tumors had reduced 5-year progression-free survival (29 ± 11 vs 64 ± 18 %; p = 0.03) and overall survival (58 ± 12 vs 83 ± 15 %; p = 0.05) rates compared to those with tumors lacking telomerase activity. Imetelstat inhibited proliferation and self-renewal by shortening telomeres and inducing senescence in vitro. In vivo, Imetelstat significantly reduced subcutaneous xenograft growth by 40 % (p = 0.03) and completely abolished the tumorigenicity of pediatric ependymoma TICs in an orthotopic xenograft model. Telomerase inhibition represents a promising therapeutic approach for telomerase-active pediatric ependymomas found to characterize high-risk ependymomas.
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Affiliation(s)
- Mark Barszczyk
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Pawel Buczkowicz
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Division of Pathology, The Hospital for Sick Children, Toronto, ON Canada
| | - Pedro Castelo-Branco
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Regenerative Medicine Program, Department of Medicine and Biomedical Sciences, Centre for Molecular and Structural Biomedicine, CBME/IBB, University of Algarve, Faro, Portugal
| | - Stephen C. Mack
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Vijay Ramaswamy
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Joshua Mangerel
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Sameer Agnihotri
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Marc Remke
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Brian Golbourn
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
| | - Sanja Pajovic
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Cynthia Elizabeth
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Man Yu
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Betty Luu
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Andrew Morrison
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Jennifer Adamski
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON Canada
| | - Kathleen Nethery-Brokx
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
| | - Xiao-Nan Li
- Brain Tumor Program, Texas Children’s Cancer Center, Houston, TX USA
| | - Timothy Van Meter
- Division of Pediatric Hematology-Oncology, Virginia Commonwealth University, Richmond, VA USA
| | - Peter B. Dirks
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Division of Surgery, The Hospital for Sick Children, Toronto, ON Canada
| | - James T. Rutka
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Division of Surgery, The Hospital for Sick Children, Toronto, ON Canada
| | - Michael D. Taylor
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Division of Surgery, The Hospital for Sick Children, Toronto, ON Canada
| | - Uri Tabori
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON Canada
| | - Cynthia Hawkins
- The Arthur and Sonia Labatt Brain Tumor Research Centre, The Hospital for Sick Children, Toronto, ON Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON Canada
- Division of Pathology, The Hospital for Sick Children, Toronto, ON Canada
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Yang T, Wu L, Yang C, Deng X, Xu Y. Clinical features and long-term outcomes of intraspinal ependymomas in pediatric patients. Childs Nerv Syst 2014; 30:2073-81. [PMID: 25142688 DOI: 10.1007/s00381-014-2528-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The aim of this study was to discuss the clinical manifestations, radiological features, treatment, and long-term outcomes of intraspinal ependymomas (Word Health Organization grade II) in pediatric patients. METHODS The data of 15 pediatric patients who underwent microsurgery for intraspinal grade II ependymomas were retrospectively reviewed. Pre- and postoperative magnetic resonance imaging was performed in all patients. The diagnosis of grade II ependymomas was based on pathology. All the follow-up data were obtained during office visits. RESULTS There were ten males and five females, with a mean age of 13.7 ± 3.4 years. Four tumors were located in the cervical cord, six in the cervicothoracic cord, four in the thoracic cord, and one in the conus-cauda region, respectively. The most common symptom was motor deficits. Gross total resection (GTR) of the tumor was achieved in 12 cases, and subtotal resection (STR) was achieved in three cases. Regrowth of the residual tumor was observed in two STR cases during a mean follow-up period of 44.8 months. STR was performed again in one case due to clinical progression. At the last follow-up, 12 patients experienced an improvement in the neurological function and three patients maintained their preoperative status. CONCLUSIONS Pediatric intraspinal grade II ependymomas are amenable to surgical resection before neurological deficits deteriorate. GTR is the best treatment of choice, and the outcome is favorable. Due to uncertain therapeutic efficacy and possible radiation-induced toxicity, postoperative radiotherapy should be considered carefully for cases of STR.
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Affiliation(s)
- Tao Yang
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Dongcheng District, Beijing, 100050, China,
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Abstract
AbstractBackground: Ependymomas are rare tumors of the central nervous system whose management is controversial. This population-based study of adults and children with ependymoma aims to (1) identify clinical and treatment-related factors that impact survival and (2) determine if postoperative radiotherapy (RT) can improve survival of patients with subtotal resection (STR) to levels similar to patients who had gross total resection (GTR). Methods: This retrospective population-based study evaluated 158 patients with ependymoma diagnosed between 1975-2007 in Alberta, Canada. Results: Younger patients (<7 years of age) were more likely to be diagnosed with grade III tumors compared with adults in whom grade I tumors were more common (p=0.003). Adults were more likely to have spinally located tumors compared to young children whose tumors were typically found in the brain. Overall, young children with ependymoma were more likely to die than older children or adults (p=0.001). An equivalent number of patients underwent GTR as compared with STR (48% vs 45%, respectively). Overall, older age, spinal tumor location, lower grade, and GTR were associated with improved progression free survival but only GTR was associated with significant improvement in overall survival. Median survival after STR and RT was 82 months compared with 122 months in patients who had GTR (p=0.0022). Conclusions: This is the first Canadian population-based analysis of patients with ependymoma including adults and children. Extent of resection appears to be the most important factor determining overall survival. Importantly, the addition of RT to patients initially treated with STR does not improve survival to levels similar to patients receiving GTR.
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Sayegh ET, Aranda D, Kim JM, Oh T, Parsa AT, Oh MC. Prognosis by tumor location in adults with intracranial ependymomas. J Clin Neurosci 2014; 21:2096-101. [PMID: 25037313 DOI: 10.1016/j.jocn.2014.05.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 05/17/2014] [Indexed: 10/25/2022]
Abstract
Intracranial ependymomas are rare tumors in adults. Thus, factors affecting prognosis are poorly understood. We performed a study to investigate whether tumor location is an important prognostic factor in adults who undergo surgery for intracranial ependymomas. PubMed was searched to identify studies that reported clinical outcomes in adult patients with intracranial ependymoma. Data were extracted for patient and tumor characteristics, extent of resection, progression-free survival (PFS), and overall survival (OS). Tumors were categorized as supratentorial or infratentorial and extraventricular or intraventricular. Presenting clinical features and tumor characteristics were tabulated. Kaplan-Meier and multivariate Cox regression survival analyses were performed to determine PFS and OS by tumor location. Extent of resection was also analyzed by tumor location. A total of 183 patients were included in the meta-analysis. Patients presented at a mean of 8.2months with a myriad of clinical features. The mean tumor size was 3.38 cm, and 19.3% of tumors were cystic. Supratentorial tumors were most commonly located in the frontal and parietal lobes, and infratentorial tumors in the fourth ventricle. Supratentorial tumors demonstrated significantly poorer PFS (p<0.001) and OS (p=0.003) than infratentorial tumors, despite a higher rate of gross total resection (GTR) for the supratentorial tumors (72.6% versus 42.1%). Extraventricular ependymomas displayed significantly poorer PFS than intraventricular ependymomas (p=0.009). In summary, supratentorial ependymomas have significantly poorer PFS and OS than their infratentorial counterparts, despite being more conducive to GTR, suggesting increased clinical aggressiveness. Extraventricular location is also associated with significantly poorer PFS than intraventricular location.
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Affiliation(s)
- Eli T Sayegh
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Derick Aranda
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Joseph M Kim
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Taemin Oh
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Andrew T Parsa
- Department of Neurological Surgery, Northwestern University, Chicago, IL, USA
| | - Michael C Oh
- Methodist Brain and Spine Institute, 1411 N. Beckley Avenue, Pav. III, Ste. 152, Dallas, TX 75203, USA.
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Rogers HA, Mayne C, Chapman RJ, Kilday JP, Coyle B, Grundy RG. PI3K pathway activation provides a novel therapeutic target for pediatric ependymoma and is an independent marker of progression-free survival. Clin Cancer Res 2013; 19:6450-60. [PMID: 24077346 DOI: 10.1158/1078-0432.ccr-13-0222] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Currently, there are few effective adjuvant therapies for pediatric ependymoma outside confocal radiation, and prognosis remains poor. The phosphoinositide 3-kinase (PI3K) pathway is one of the most commonly activated pathways in cancer. PI3Ks transduce signals from growth factors and cytokines, resulting in the phosphorylation and activation of AKT, which in turn induces changes in cell growth, proliferation, and apoptosis. EXPERIMENTAL DESIGN PI3K pathway status was analyzed in ependymoma using gene expression data and immunohistochemical analysis of phosphorylated AKT (P-AKT). The effect of the PI3K pathway on cell proliferation was investigated by immunohistochemical analysis of cyclin D1 and Ki67, plus in vitro functional analysis. To identify a potential mechanism of PI3K pathway activation, PTEN protein expression and the mutation status of PI3K catalytic subunit α-isoform gene (PIK3CA) was investigated. RESULTS Genes in the pathway displayed significantly higher expression in supratentorial than in posterior fossa and spinal ependymomas. P-AKT protein expression, indicating pathway activation, was seen in 72% of tumors (n = 169) and P-AKT expression was found to be an independent marker of a poorer progression-free survival. A significant association between PI3K pathway activation and cell proliferation was identified, suggesting that pathway activation was influencing this process. PTEN protein loss was not associated with P-AKT staining and no mutations were identified in PIK3CA. CONCLUSIONS Our results suggest that the PI3K pathway could act as a biomarker, not only identifying patients with a worse prognosis but also those that could be treated with therapies targeted against the pathway, a strategy potentially effective in a high percentage of ependymoma patients.
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Affiliation(s)
- Hazel A Rogers
- Authors' Affiliation: Children's Brain Tumour Research Centre, D Floor Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, United Kingdom
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