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Zarfati A, Martucci C, Persano G, Cassanelli G, Crocoli A, Madafferi S, Natali GL, De Ioris MA, Inserra A. Preoperative Spinal Angiography for Thoracic Neuroblastoma: Impact of Identification of the Adamkiewicz Artery on Gross Total Resection and Neurological Sequelae. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1116. [PMID: 37508612 PMCID: PMC10378327 DOI: 10.3390/children10071116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Patients with thoracic neuroblastoma (TNB) are at high risk of postoperative neurologic complications due to iatrogenic lesions of the artery of Adamkiewicz (AKA). The role of performing a preoperative spinal angiography (POSA) in these patients must be clarified. The present study sought to further understand the relationship between POSA and TNB, as well as the effects of identifying the AKA on surgical excision and neurological consequences. METHODS Data from patients with TNB who underwent POSA between November 2015 and February 2022 at our tertiary pediatric center were retrospectively analyzed. RESULTS Six patients were identified, five of whom (83%) were considered eligible for surgical excision. Gross total resection (GTR) was achieved in three patients (60%), which included two patients with an AKA contralateral to the tumor, and one with an homolateral AKAl. After a median follow-up of 4.1 years from diagnosis, no patients developed neurological complications; five (83%) were alive and well, and one died from refractory recurrence. CONCLUSIONS Among patients with TNB, POSA was useful for identifying the AKA and defining the optimal surgical strategy. POSA should be considered in the preoperative evaluation of TNB to increase the likelihood of GTR and reduce the threats of iatrogenic neurologic sequelae.
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Affiliation(s)
- Angelo Zarfati
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Cristina Martucci
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Giorgio Persano
- Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Giulia Cassanelli
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Silvia Madafferi
- Surgical Oncology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Gian Luigi Natali
- Interventional Radiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Hematology/Oncology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandro Inserra
- General and Thoracic Pediatric Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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Neuroblastoma GD2 Expression and Computational Analysis of Aptamer-Based Bioaffinity Targeting. Int J Mol Sci 2021; 22:ijms22169101. [PMID: 34445807 PMCID: PMC8396649 DOI: 10.3390/ijms22169101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 02/08/2023] Open
Abstract
Neuroblastoma (NB) is a neuroectodermal embryonic cancer that originates from primordial neural crest cells, and amongst pediatric cancers with high mortality rates. NB is categorized into high-, intermediate-, and low-risk cases. A significant proportion of high-risk patients who achieve remission have a minimal residual disease (MRD) that causes relapse. Whilst there exists a myriad of advanced treatment options for NB, it is still characterized by a high relapse rate, resulting in a reduced chance of survival. Disialoganglioside (GD2) is a lipo-ganglioside containing a fatty acid derivative of sphingosine that is coupled to a monosaccharide and a sialic acid. Amongst pediatric solid tumors, NB tumor cells are known to express GD2; hence, it represents a unique antigen for subclinical NB MRD detection and analysis with implications in determining a response for treatment. This article discusses NB MRD expression and analytical assays for GD2 detection and quantification as well as computational approaches for GD2 characterization based on high-throughput image processing and genomic data analysis.
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3
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Chung C, Boterberg T, Lucas J, Panoff J, Valteau-Couanet D, Hero B, Bagatell R, Hill-Kayser CE. Neuroblastoma. Pediatr Blood Cancer 2021; 68 Suppl 2:e28473. [PMID: 33818884 PMCID: PMC8785544 DOI: 10.1002/pbc.28473] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 01/01/2023]
Abstract
The survival of patients with high-risk neuroblastoma has improved significantly with the use of intensive multimodality treatment regimens, including chemotherapy, surgery, radiation therapy, myeloablative chemotherapy followed by stem cell rescue, and immunotherapy. This report summarizes the current treatment strategies used in the COG and SIOP for children with neuroblastoma. The improved global collaboration and the adoption of a uniform International Neuroblastoma Risk Group Staging System will help facilitate comparison of homogeneous pretreatment cohorts across clinical trials. Future research strategies regarding the indications for and dosages of radiation therapy to the primary and metastatic sites, and the integration of meta-iodobenzyl guanidine therapy into the multimodal treatment program, are discussed.
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Affiliation(s)
- Christine Chung
- Department of Radiation Oncology, Diablo Valley Oncology and Hematology, Pleasant Hill, California
| | - Tom Boterberg
- Department of Radiation Oncology Ghent University Hospital, Gent, Belgium
| | - John Lucas
- Department of Radiation Oncology St Jude Children's Research Hospital, Memphis, Tennessee
| | - Joseph Panoff
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health, South Florida, Florida
| | - Dominique Valteau-Couanet
- Department of Childhood and Adolescent Cancer Gustave Roussy Cancer Campus, Villejuif-Grand, Paris, France
| | - Barbara Hero
- Department of Pediatric Hematology and Oncology, University Children's Hospital, Cologne, Germany
| | - Rochelle Bagatell
- Department of Pediatrics, Division of Oncology, Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine E Hill-Kayser
- Department of Radiation Oncology University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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4
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Pancaldi A, Peng L, Rhee DS, Dunn E, Forcucci JA, Belchis D, Pratilas CA. DICER1-associated metastatic abdominopelvic primitive neuroectodermal tumor with an EWSR1 rearrangement in a 16-yr-old female. Cold Spring Harb Mol Case Stud 2020; 6:mcs.a005603. [PMID: 33028642 PMCID: PMC7552927 DOI: 10.1101/mcs.a005603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/31/2020] [Indexed: 12/30/2022] Open
Abstract
We report a case of a DICER1-associated EWSR1-rearranged malignant primitive neuroectodermal tumor (PNET) arising in a patient with DICER1 tumor predisposition syndrome. A 16-yr-old female with a history of multinodular goiter presented with a widely metastatic abdominal small round blue cell tumor with neuroectodermal differentiation. EWSR1 gene rearrangement was identified in the tumor by fluorescence in situ hybridization (FISH). Genetic analysis revealed biallelic pathogenic DICER1 variation. The patient was treated with an aggressive course of chemotherapy, surgery, and radiation with complete pathologic response. We believe this case to represent a new expression of the DICER1 tumor predisposition syndrome, an entity caused by deleterious germline mutations in the DICER1 gene, encoding a ribonuclease active in the processing of miRNA. Patients with germline mutations in DICER1 develop a diverse group of benign and malignant tumors. Some of these tumors have been noted to have immature neuroepithelium as a component, including the ciliary body medulloepithelioma and the recently described DICER1-associated presacral malignant teratoid neoplasm. To our knowledge, abdominal sarcomas that resemble PNET histology with an EWSR1 rearrangement have not previously been described as a classical expression of the DICER1 syndrome phenotype.
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Affiliation(s)
- Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Lei Peng
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
| | - Daniel S Rhee
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA.,Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Emily Dunn
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Jessica A Forcucci
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
| | - Deborah Belchis
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.,Doctor's Community Hospital, Lanham, Maryland 20706, USA
| | - Christine A Pratilas
- Division of Pediatric Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland 21231, USA
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5
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Kruger E, Obasaju P, Dunn E, Lukish J, Goicochea L, Pratilas CA, Rhee DS. Desmoplastic small round cell tumor presenting as an inguinal mass in a 2-year old boy. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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6
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Sindhi R, Rohan V, Bukowinski A, Tadros S, de Ville de Goyet J, Rapkin L, Ranganathan S. Liver Transplantation for Pediatric Liver Cancer. Cancers (Basel) 2020; 12:cancers12030720. [PMID: 32204368 PMCID: PMC7140094 DOI: 10.3390/cancers12030720] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
Unresectable hepatocellular carcinoma (HCC) was first removed successfully with total hepatectomy and liver transplantation (LT) in a child over five decades ago. Since then, children with unresectable liver cancer have benefitted greatly from LT and a confluence of several equally important endeavors. Regional and trans-continental collaborations have accelerated the development and standardization of chemotherapy regimens, which provide disease control to enable LT, and also serve as a test of unresectability. In the process, tumor histology, imaging protocols, and tumor staging have also matured to better assess response and LT candidacy. Significant trends include a steady increase in the incidence of and use of LT for hepatoblastoma, and a significant improvement in survival after LT for HCC with each decade. Although LT is curative for most unresectable primary liver sarcomas, such as embryonal sarcoma, the malignant rhabdoid tumor appears relapse-prone despite chemotherapy and LT. Pediatric liver tumors remain rare, and diagnostic uncertainty in some settings can potentially delay treatment or lead to the selection of less effective chemotherapy. We review the current knowledge relevant to diagnosis, LT candidacy, and post-transplant outcomes for these tumors, emphasizing recent observations made from large registries or larger series.
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Affiliation(s)
- Rakesh Sindhi
- Hillman Center for Pediatric Transplantation, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (A.B.); (S.T.)
- Correspondence: ; Tel.: +1-412-692-7123
| | - Vinayak Rohan
- Medical University of South Carolina, Charleston, SC 29403, USA;
| | - Andrew Bukowinski
- Hillman Center for Pediatric Transplantation, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (A.B.); (S.T.)
| | - Sameh Tadros
- Hillman Center for Pediatric Transplantation, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (A.B.); (S.T.)
| | - Jean de Ville de Goyet
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy;
| | - Louis Rapkin
- Department of Hematology/Oncology, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA;
| | - Sarangarajan Ranganathan
- Department of Pathology, Children’s Hospital Medical Center of Cincinnati, Cincinnati, OH 45229, USA;
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7
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El-Gendi A, Fadel S, El-Shafei M, Shawky A. Avoiding liver transplantation in post-treatment extent of disease III and IV hepatoblastoma. Pediatr Int 2018; 60:862-868. [PMID: 29906299 DOI: 10.1111/ped.13634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/30/2018] [Accepted: 06/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Primary liver transplantation is recommended for central post-treatment extent of disease (POST-TEXT) III and IV hepatoblastoma. The aim of this study was to prospectively assess the safety and oncological efficacy of aggressive non-transplant extended hepatic resection in these patients. METHODS A prospective study involved 18 children with central pretreatment extent of disease (PRETEXT) III and IV: three had primary liver transplantation whereas 15 underwent hepatic resection after neoadjuvant chemotherapy. RESULTS Median tumor volume was 317 mL (range, 135-546 mL). After four cycles of chemotherapy, POST-TEXT stage was III in 12 patients and IV in three patients. There was no perioperative mortality. Postoperative complications consisted of two bile leaks, one temporary decompensation and one sub-phrenic collection requiring drainage. One and 3 year disease-free survival was 93.3% and 73.3% respectively. The 3 year overall survival was 86.6%. Four patients developed recurrence, of whom two died. Early recurrence in 1 year occurred in one patient. All recurrences were distant metastases. CONCLUSIONS Extended major hepatic resection for selected cases of POST-TEXT III and IV hepatoblastoma is a technically challenging but feasible approach with acceptable morbidity and mortality rates. Oncological outcomes are similar to liver transplantation without the long-term commitment of immunosuppression or donor risk and morbidity, but a potential donor should always be organized on standby.
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Affiliation(s)
- Ahmed El-Gendi
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Shady Fadel
- Department of Medical and Radiation Oncology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed El-Shafei
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Shawky
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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8
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Xiong X, Li Y, Liu L, Qi K, Zhang C, Chen Y, Fang J. Arsenic trioxide induces cell cycle arrest and affects Trk receptor expression in human neuroblastoma SK-N-SH cells. Biol Res 2018; 51:18. [PMID: 29898774 PMCID: PMC5998579 DOI: 10.1186/s40659-018-0167-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 06/06/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Arsenic trioxide (As2O3), a drug that has been used in China for approximately two thousand years, induces cell death in a variety of cancer cell types, including neuroblastoma (NB). The tyrosine kinase receptor (Trk) family comprises three members, namely TrkA, TrkB and TrkC. Various studies have confirmed that TrkA and TrkC expression is associated with a good prognosis in NB, while TrkB overexpression can lead to tumor cell growth and invasive metastasis. Previous studies have shown that As2O3 can inhibit the growth and proliferation of a human NB cell line and can also affect the N-Myc mRNA expression. It remains unclear whether As2O3 regulates Trks for the purposes of treating NB. METHODS The aim of the present study was to investigate the effect of As2O3 on Trk expression in NB cell lines and its potential therapeutic efficacy. SK-N-SH cells were grown with increasing doses of As2O3 at different time points. We cultured SK-N-SH cells, which were treated with increasing doses of As2O3 at different time points. Trk expression in the NB samples was quantified by immunohistochemistry, and the cell cycle was analyzed by flow cytometry. TrkA, TrkB and TrkC mRNA expression was evaluated by real-time PCR analysis. RESULTS Immunohistochemical and real-time PCR analyses indicated that TrkA and TrkC were over-expressed in NB, and specifically during stages 1, 2 and 4S of the disease progression. TrkB expression was increased in stage 3 and 4 NB. As2O3 significantly arrested SK-N-SH cells in the G2/M phase. In addition, TrkA, TrkB and TrkC expression levels were significantly upregulated by higher concentrations of As2O3 treatment, notably in the 48-h treatment period. Our findings suggested that to achieve the maximum effect and appropriate regulation of Trk expression in NB stages 1, 2 and 4S, As2O3 treatment should be at relatively higher concentrations for longer delivery times;however, for NB stages 3 and 4, an appropriate concentration and infusion time for As2O3 must be carefully determined. CONCLUSION The present findings suggested that As2O3 induced Trk expression in SK-N-SH cells to varying degrees and may be a promising adjuvant to current treatments for NB due to its apoptotic effects.
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Affiliation(s)
- Xilin Xiong
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
- Pediatric Hematology/Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Yang Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
- Pediatric Hematology/Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Ling Liu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
- Department of Pediatric Hematology/Oncology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, 524000 Guangdong China
| | - Kai Qi
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
- Pediatric Hematology/Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Chi Zhang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
- Pediatric Hematology/Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
| | - Yueqin Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
- Department of Life Sciences, Sun Yat-Sen University, Guangzhou, 510120 Guangdong China
| | - Jianpei Fang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
- Pediatric Hematology/Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120 China
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9
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Lungren MP, Towbin AJ, Roebuck DJ, Monroe EJ, Gill AE, Thakor A, Towbin RB, Cahill AM, Matthew Hawkins C. Role of interventional radiology in managing pediatric liver tumors : Part 1: Endovascular interventions. Pediatr Radiol 2018; 48:555-564. [PMID: 29362840 DOI: 10.1007/s00247-018-4068-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/02/2017] [Accepted: 01/03/2018] [Indexed: 12/14/2022]
Abstract
Primary liver malignancies are rare in children. Hepatoblastoma and hepatocellular carcinoma (HCC) together represent the overwhelming majority of cases. Overall survival of hepatoblastoma approaches 80% with multimodal treatment approaches that include chemotherapy, surgery and transplantation. However, there remains a subset of children with hepatoblastoma in whom resection or transplantation is not possible. The 5-year survival for children diagnosed with HCC is less than 30% and remains a significant therapeutic challenge. The poor outcomes for children with primary liver tumors motivate investigation of new therapeutic alternatives. Interventional oncology offers a broad scope of percutaneous and transcatheter endovascular cancer therapies that might provide clinical benefits. Minimally invasive approaches are distinct from medical, surgical and radiation oncologic treatments, and in adults these approaches have been established as the fourth pillar of cancer care. Transarterial chemoembolization is a minimally invasive locoregional treatment option performed by interventional radiologists with level-I evidence as standard of care in adults with advanced liver malignancy; transarterial chemoembolization in adults has served to prolong disease-free progression, downstage and bridge patients for surgical and transplant interventions, and improve overall survival. However, while several groups have reported that transarterial chemoembolization is feasible in children, the published experience is limited primarily to small retrospective case series. The lack of prospective trial evidence has in part limited the utilization of transarterial chemoembolization in the pediatric patient population. The purpose of this article is to provide an overview of the role of interventional radiology in the diagnosis and endovascular management of hepatic malignancies in children.
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Affiliation(s)
- Matthew P Lungren
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road Room 1862, Stanford, CA, 94305-5913, USA.
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Eric J Monroe
- Department of Radiology, Division of Interventional Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Anne E Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Avnesh Thakor
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road Room 1862, Stanford, CA, 94305-5913, USA
| | - Richard B Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
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10
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Dübbers M, Simon T, Berthold F, Fischer J, Volland R, Hero B, Cernaianu G. Retrospective analysis of relapsed abdominal high-risk neuroblastoma. J Pediatr Surg 2018; 53:558-566. [PMID: 29021103 DOI: 10.1016/j.jpedsurg.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND/PURPOSE The impact of abdominal topography and surgical technique on resectability and local relapse pattern of relapsed abdominal high-risk neuroblastoma (R-HR-NB) is not clearly defined. METHODS A sample of thirty-nine patients with R-HR-NB enrolled in the German neuroblastoma trials between 2001 and 2010 was analyzed retrospectively using surgical and imaging reports. We evaluated resectability and local relapse pattern within 6 standardized abdominal regions, impact of extent of the first resective surgery on overall survival (OS), and of number of operations and a higher cumulative surgical assessment score (C-SAS) on OS after the first event. RESULTS In the left upper abdomen, rates for tumor persistence and relapse were 45.9% and 13.5% and in the left lower abdomen 27.7% and 8.3%, respectively. OS in months did not differ between complete and incomplete first resections (median (interquartile range): 35 (45.6) vs. 40 (65.4), P=.649). Better OS after the first event was associated with repeated as compared to single surgery (47.7 (64.7) vs. 4.3 (12.5), P=.000), and with higher as compared to lower C-SAS (47.7 (64.3) vs. 7.6 (14.7), P=.002). CONCLUSIONS OS after relapse/progression was not dependent on the extent of first resection. The number of operations was associated with better outcome after event. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE LEVEL III Retrospective comparative study.
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Affiliation(s)
- Martin Dübbers
- Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Frank Berthold
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Janina Fischer
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Ruth Volland
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Barbara Hero
- Department of Pediatric Oncology and Hematology, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
| | - Grigore Cernaianu
- Division of Pediatric Surgery, University Hospital Cologne, Kerpenerstr. 62, 50937, Köln, Germany.
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11
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POST-TEXT III and IV Hepatoblastoma: Extended Hepatic Resection Avoids Liver Transplantation in Selected Cases. Ann Surg 2017; 266:318-323. [PMID: 27501172 DOI: 10.1097/sla.0000000000001936] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To analyze the outcome of hepatoblastoma (HB) patients presenting with post treatment extent of disease (POST-TEXT) stages III and IV after neoadjuvant chemotherapy. BACKGROUND Primary liver transplantation has been advocated as surgical treatment for children with HB involving 3 or 4 sectors at diagnosis. However, in some cases, tumors seem resectable after chemotherapy through aggressive use of nontransplant surgical procedures. METHODS Data of 27 HB patients were reviewed, undergoing extended liver resection for POST-TEXT III or IV tumors after chemotherapy between 1992 and 2015. Median follow-up was 58 months (range 9-188). RESULTS Median age at surgery was 18.2 months (interquartile range 10.8-32.5). Staging of the children after chemotherapy revealed POST-TEXT III in 21 and POST-TEXT IV in 6 cases. In 2 children, the hepatic resection was performed under cardiopulmonary bypass because of extended vena cava thrombosis; in 2 patients, a simultaneous sternotomy was performed for resection of bilateral lung metastases. The 5-year overall survival rate was 80.7%. CONCLUSIONS Aggressive surgical resection is a successful approach in some patients with POST-TEXT III and IV HB who otherwise would be candidates for liver transplantation. These children should undergo central review and should be surgically managed at centers of excellence for pediatric liver surgery. Despite challenging surgical procedures and complex clinical courses, the patients benefit from avoidance of morbidities of organ transplant. However, preparation of backup liver transplantation should be considered in selected cases.
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12
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Fischer J, Pohl A, Volland R, Hero B, Dübbers M, Cernaianu G, Berthold F, von Schweinitz D, Simon T. Complete surgical resection improves outcome in INRG high-risk patients with localized neuroblastoma older than 18 months. BMC Cancer 2017; 17:520. [PMID: 28778185 PMCID: PMC5543757 DOI: 10.1186/s12885-017-3493-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/20/2017] [Indexed: 12/24/2022] Open
Abstract
Background Although several studies have been conducted on the role of surgery in localized neuroblastoma, the impact of surgical timing and extent of primary tumor resection on outcome in high-risk patients remains controversial. Methods Patients from the German neuroblastoma trial NB97 with localized neuroblastoma INSS stage 1–3 age > 18 months were included for retrospective analysis. Imaging reports were reviewed by two independent physicians for Image Defined Risk Factors (IDRF). Operation notes and corresponding imaging reports were analyzed for surgical radicality. The extent of tumor resection was classified as complete resection (95–100%), gross total resection (90–95%), incomplete resection (50–90%), and biopsy (<50%) and correlated with local control rate and outcome. Patients were stratified according to the International Neuroblastoma Risk Group (INRG) staging system. Survival curves were estimated according to the method of Kaplan and Meier and compared by the log-rank test. Results A total of 179 patients were included in this study. 77 patients underwent more than one primary tumor operation. After best surgery, 68.7% of patients achieved complete resection of the primary tumor, 16.8% gross total resection, 14.0% incomplete surgery, and 0.5% biopsy only. The cumulative complication rate was 20.3% and the surgery associated mortality rate was 1.1%. Image defined risk factors (IDRF) predicted the extent of resection. Patients with complete resection had a better local-progression-free survival (LPFS), event-free survival (EFS) and OS (overall survival) than the other groups. Subgroup analyses showed better EFS, LPFS and OS for patients with complete resection in INRG high-risk patients. Multivariable analyses revealed resection (complete vs. other), and MYCN (non-amplified vs. amplified) as independent prognostic factors for EFS, LPFS and OS. Conclusions In patients with localized neuroblastoma age 18 months or older, especially in INRG high-risk patients harboring MYCN amplification, extended surgery of the primary tumor site improved local control rate and survival with an acceptable risk of complications.
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Affiliation(s)
- Janina Fischer
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.
| | - Alexandra Pohl
- Department of Pediatric Surgery, Dr. von Haunersches Children's Hospital, Munich, Germany
| | - Ruth Volland
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - Barbara Hero
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | - Martin Dübbers
- Division of Pediatric Surgery, University Children's Hospital of Cologne, Cologne, Germany
| | - Grigore Cernaianu
- Division of Pediatric Surgery, University Children's Hospital of Cologne, Cologne, Germany
| | - Frank Berthold
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
| | | | - Thorsten Simon
- Department of Pediatric Oncology and Hematology, University Children's Hospital of Cologne, Kerpener Str. 62, 50924, Cologne, Germany
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Džinić T, Hartwig S, Lehr S, Dencher NA. Oxygen and differentiation status modulate the effect of X-ray irradiation on physiology and mitochondrial proteome of human neuroblastoma cells. Arch Physiol Biochem 2016; 122:257-265. [PMID: 27615280 DOI: 10.1080/13813455.2016.1218518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cytotoxic effects, including oxidative stress, of low linear energy transfer (LET)-ionizing radiation are often underestimated and studies of their mechanisms using cell culture models are widely conducted with cells cultivated at atmospheric oxygen that does not match its physiological levels in body tissues. Also, cell differentiation status plays a role in the outcome of experiments. We compared effects of 2 Gy X-ray irradiation on the physiology and mitochondrial proteome of nondifferentiated and human neuroblastoma (SH-SY5Y) cells treated with retinoic acid cultivated at 21% and 5% O2. Irradiation did not affect the amount of subunits of OxPhos complexes and other non-OxPhos mitochondrial proteins, except for heat shock protein 70, which was increased depending on oxygen level and differentiation status. These two factors were proven to modulate mitochondrial membrane potential and the bioenergetic status of cells. We suggest, moreover, that oxygen plays a role in the differentiation of human SH-SY5Y cells.
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Affiliation(s)
- Tamara Džinić
- a Physical Biochemistry, Department of Chemistry , Technische Universität Darmstadt , Darmstadt , Germany
| | - Sonja Hartwig
- b Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center at the Heinrich-Heine-University Düsseldorf, Leibniz Center for Diabetes Research , Düsseldorf , Germany , and
- c German Center for Diabetes Research (DZD) , München , Neuherberg , Germany
| | - Stefan Lehr
- b Institute of Clinical Biochemistry and Pathobiochemistry, German Diabetes Center at the Heinrich-Heine-University Düsseldorf, Leibniz Center for Diabetes Research , Düsseldorf , Germany , and
- c German Center for Diabetes Research (DZD) , München , Neuherberg , Germany
| | - Norbert A Dencher
- a Physical Biochemistry, Department of Chemistry , Technische Universität Darmstadt , Darmstadt , Germany
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14
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Englum BR, Rialon KL, Speicher PJ, Gulack B, Driscoll TA, Kreissman SG, Rice HE. Value of surgical resection in children with high-risk neuroblastoma. Pediatr Blood Cancer 2015; 62:1529-35. [PMID: 25810376 DOI: 10.1002/pbc.25504] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/30/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The value of gross total resection (GTR) for children with high-risk neuroblastoma (NB) is controversial. We hypothesized that patients undergoing GTR would demonstrate improved overall survival (OS) compared those having <GTR. METHODS Using a single institutional database, we reviewed the medical records of all children with high-risk NB undergoing hematopoietic stem cell transplantation (HSCT) as part of multimodality therapy from 1990 to 2012. Children had received surgical care at multiple institutions (n = 14) prior to HSCT and were divided into two groups based on extent of surgical resection: GTR (no visible or palpable disease at end of operation) and <GTR (no surgery, biopsy only, or subtotal resection). Kaplan-Meier curves and Cox hazards models evaluated differences in overall survival (OS). RESULTS One hundred four children underwent HSCT, and 87 (83.6%) had adequate data for analysis. Thirty eight percent had GTR while 62% had <GTR prior to HSCT. There was no significant difference in OS in patients undergoing GTR compared to <GTR (Log rank test: P = 0.49). Post-hoc analysis demonstrated a survival advantage for patients undergoing >90% resection compared to <90% resection (P = 0.008). Multivariable Cox models confirmed these findings with improved survival in children undergoing >90% vs. <90% resection but no difference in GTR vs. <GTR. CONCLUSION Gross total resection prior to HSCT in high-risk NB patients is not associated with improved OS compared to <GTR; however, these results suggest that >90% resection is associated with improved OS compared to less than 90% resection.
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Affiliation(s)
- Brian R Englum
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Kristy L Rialon
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Paul J Speicher
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Brian Gulack
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Timothy A Driscoll
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Susan G Kreissman
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Henry E Rice
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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