1
|
Nguyen A, Nguyen A, Fleeting C, Patel A, Bazett N, Hey G, Mandavali A, Brown NJ, Woolridge M, Foreman M, Lucke-Wold B. An Evaluation of Risk Factors for Intracranial Metastases of Sarcomas: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 187:e683-e699. [PMID: 38704144 DOI: 10.1016/j.wneu.2024.04.146] [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: 04/14/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Sarcomas, a group of neoplasms comprising both tissue and bone soft tissue tumors, has an increasing prevalence in recent years. Prognosis significantly hinges on early detection, and if not detected early, may consequently metastasize. This review will be the first systematic review and meta-analysis characterizing the presentation and progression of brain metastases from bone and soft tissue cancers. METHODS The PubMed, Scopus, and Web of Science databases were queried to identify studies reporting the incidence of intracranial brain metastases from primary sarcoma to the present. Abstract and full-text screening of 1822 initial articles returned by preliminary search yielded 28 studies for inclusion and data extraction. Qualitative assessment of the studies was conducted in accordance with the Newcastle-Ottawa Scale criteria. Meta-analyses were applied to assess risk factors on outcomes. RESULTS The average age within the cohort was 27.9 years with a male and female prevalence of 59.1% and 40.9%, respectively. The odds ratio for living status (dead/alive) was calculated for several risk factors - male/female [OR 1.14, 95% CI 0.62, 2.07], single/multiple metastases [OR 0.67, 95% CI 0.35, 1.28], lung metastases/not [OR 1.63, 95% CI 0.85, 3.13], surgery/no surgery [OR 0.49, 95% CI 0.20, 1.21]. The standardized mean differences for duration from diagnoses to metastases were likewise analyzed - male/female [SMD 0.13, 95% CI -0.15, 0.42], single/multiple metastases [SMD 0.11, 95% CI -0.20, 0.42], lung metastases/not [SMD -0.03, 95% CI -0.38, 0.32], surgery/no surgery [SMD 0.45, 95% CI -0.18, 1.09]. The standardized mean differences for duration from metastases to death were analyzed - lung metastases/not [SMD 0.43, 95% CI -0.08, 0.95]. CONCLUSIONS Our study observed no statistically significant differences in mortality rate among several patient risk factors. Consequentially, there lacks a clear answer as to whether or not an association between mortality rates exists with these patient factors. As such, it is important to continue research in brain-metastasizing sarcomas despite their relative rarity.
Collapse
Affiliation(s)
| | - Andrew Nguyen
- College of Medicine, University of Florida, Gainesville, Florida, USA.
| | - Chance Fleeting
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Aashay Patel
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Nicholas Bazett
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Grace Hey
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Akhil Mandavali
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California-Irvine, Orange, California, USA
| | - Maxwell Woolridge
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Marco Foreman
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
2
|
Newman J, Leelatian N, Liang J. Characterization of pediatric non-hematopoietic tumor metastases to the central nervous system: A single institution review. J Neuropathol Exp Neurol 2024; 83:268-275. [PMID: 38350468 DOI: 10.1093/jnen/nlae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Central nervous system (CNS) metastases represent a small portion of pediatric CNS neoplasms and data surrounding this condition with high morbidity is scarce. Single institutional archival institutional pathology records between 1999 and 2022 were searched for patients over 21 years old and younger with CNS, dura, cranial nerve, CSF, or leptomeningeal metastases; 41 cases were identified. We documented primary tumor types and locations, metastasis locations, types of invasion (direct extension vs distant metastasis), times from imaging or pathologic diagnosis to CNS involvement, and outcomes. Distant metastasis was the most common mechanism of metastasis (n = 32, 78%). Interval times to CNS metastasis varied by both tumor type and primary tumor location. In this cohort, osteosarcoma portended the shortest survival following CNS metastasis. This study highlights the diverse mechanisms and locations of CNS involvement in pediatric CNS metastases and illuminates a need for varied monitoring strategies when considering primary tumor type and anatomic location.
Collapse
Affiliation(s)
- John Newman
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nalin Leelatian
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jiancong Liang
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
3
|
Central Nervous System Metastasis in Neuroblastoma: From Three Decades Clinical Experience to New Considerations in the Immunotherapy Era. Cancers (Basel) 2022; 14:cancers14246249. [PMID: 36551734 PMCID: PMC9777007 DOI: 10.3390/cancers14246249] [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: 11/03/2022] [Revised: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Central nervous system (CNS) metastatic spread in neuroblastoma (NB) is rare and occurs more often at relapse/progression. We report on CNS involvement in high risk (HR) NB over 25 years. For this retrospective study, we reviewed the CNS imaging of all the patients treated at Bambino Gesù Children Hospital from 1 July 1996 to 30 June 2022. A total of 128 patients with HR NB were diagnosed over 26 years. Out of 128 patients, CNS metastatic spread occurred in 6 patients: 3 patients presented a metastatic spread at diagnosis, while in 3 patients, CNS was involved at relapse. Overall, the rate of occurrence of CNS spread is 4.7% with the same distribution at diagnosis and at relapse, namely 2.3%. Interestingly, CNS spread at diagnosis was observed only before 2012, whereas CNS was observed at relapse only after 2012, in the immunotherapy era. CNS metastases presented similar imaging features at diagnosis and at relapse, with a peculiar hemorrhagic aspect and mainly hemispheric localization in patients with bone skull involvement at the time of diagnosis. The outcome is dismal, and 3 out of 6 patients died for progressive disease.
Collapse
|
4
|
Liu Y, Huo L, Zhang J, Liu Y. Intracranial Metastases Tend to Be Overt and Predict Poor Prognosis in Children With Neuroblastoma. Front Pediatr 2021; 9:716880. [PMID: 34805033 PMCID: PMC8596640 DOI: 10.3389/fped.2021.716880] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Neuroblastoma (NB) is the most common pediatric extracranial solid neoplasm after leukemia. Intracranial metastases (IM) rarely occur in patients with NB. The present study aimed to review the clinical characteristics of NB patients from a single center presenting with IM. Methods: Two hundred children (aged 3-91 months) with NB admitted to the Fourth Affiliated Hospital of China Medical University between January 2009 and December 2015 were enrolled, and their clinical characteristics were recorded. The patients were divided into two groups based on the presence of IM. Their clinical characteristics, including demographics, clinical features, and laboratory and imaging studies, were retrospectively analyzed. Results: IM occurred in 22 of 200 (11%) neuroblastoma patients, with a median age of 42.5 months (range, 3-91 months), with a male-to-female ratio of 1.4:1. Seven patients had IM at the initial diagnosis. Among the 15 children who did not have IM at initial presentation, the median interval from presentation to the diagnosis of IM was 17.3 months (range, 1-55 months). Compared with the control group, NB patients with IM tended to be asymptomatic at the time of NB diagnosis, which was made incidentally during routine physical examination (5 of 22, 22.7%, p < 0.05). In addition, this group had more primary intra-abdominal sites (18 of 22, 81.8%, p < 0.001) and worse prognosis (5 of 22, 22.7%, p < 0.05). Conclusions: NB patients with IM have insidious onset in the early stage and a lower survival rate, especially patients with primary intra-abdominal lesions. Regular neurological monitoring could improve the rate of early diagnosis and prognosis of NB children with IM. Familiarity with the characteristic findings of NB with IM is necessary to avoid misdiagnosis and initiate necessary interventions.
Collapse
Affiliation(s)
- Ying Liu
- Department of Pediatrics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Liang Huo
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jinhua Zhang
- Department of Pediatrics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Ying Liu
- Department of Pediatrics, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| |
Collapse
|
5
|
Odone-Filho V, Cristofani LM, Maluf PT, Almeida MTA, Halley N, Vince CSC, de Azambuja AMP, Brumatti M, Lubraico P, da Camara Lopes LHA, Leite KRM, Silva JLF, Plese JPP, Weltman E. Involvement of the central nervous system in neuroblastomas: A potential direct pathway. Med Hypotheses 2019; 136:109479. [PMID: 31778890 DOI: 10.1016/j.mehy.2019.109479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/25/2019] [Accepted: 11/08/2019] [Indexed: 11/24/2022]
Abstract
Although frequently disseminated to other anatomical sites, neuroblastoma (NB) is rarely reported as involving the central nervous system (CNS), which may reflect insufficient research in poorly controlled systemic disease. Here we demonstrate the involvement of the CNS in patients with NB over 18 months of age at diagnosis of extensive systemic disease. Meningeal metastases were observed even in the presence of complete systemic control. Although no improvement in patient's survival was observed, radiotherapy was effective in preventing CNS recurrence after observation of actual or previous dural disease. In conclusion, this study uncovered the uncommon pathologic involvement of the CNS in children with advanced NB and underscores the meningeal surface as a potential pathway for this to occur.
Collapse
Affiliation(s)
- Vicente Odone-Filho
- Sao Paulo University Medical School, Pediatric Department, Hematology-Oncology Division, Brazil.
| | - Lilian Maria Cristofani
- Sao Paulo University Medical School, Pediatric Department, Hematology-Oncology Division, Brazil
| | - Paulo Taufi Maluf
- Sao Paulo University Medical School, Pediatric Department, Hematology-Oncology Division, Brazil
| | | | - Nathalia Halley
- Hematology-Oncology Division, Pediatric Department, Sao Paulo University Medical School, Brazil
| | | | | | - Melina Brumatti
- Hematology-Oncology Division, Pediatric Department, Sao Paulo University Medical School, Brazil
| | - Priscilla Lubraico
- Hematology-Oncology Division, Pediatric Department, Sao Paulo University Medical School, Brazil
| | | | | | | | | | - Eduardo Weltman
- Hospital Israelita Albert Einstein, Department of Radiotherapy, Brazil
| |
Collapse
|
6
|
Moreira DC, Macy ME, Cost CR, Greffe BS, Garrington TP. Central Nervous System Involvement of Rhabdomyosarcoma: A Single Institution Experience. J Pediatr Hematol Oncol 2019; 41:152-154. [PMID: 29668538 PMCID: PMC6192856 DOI: 10.1097/mph.0000000000001166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The incidence of central nervous system (CNS) involvement in patients with rhabdomyosarcoma (RMS) is low, and the outcome is dismal. We present a single institution analysis of CNS involvement of pediatric RMS. In 59 patients, the prevalence of CNS involvement was 11.9% (7 patients), higher than prior reports. Of the 6 deaths from disease, all had rapid progression, with a median survival of 14 days. The higher incidence could be secondary to treatment modifications or more sensitive detection. These findings are useful for decisions at the time of CNS involvement and could lead to modifications for future RMS clinical trials.
Collapse
Affiliation(s)
- Daniel C. Moreira
- Department of Pediatric Oncology, University of Colorado Denver School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Margaret E. Macy
- Department of Pediatric Oncology, University of Colorado Denver School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Carrye R. Cost
- Department of Pediatric Oncology, University of Colorado Denver School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Brian S. Greffe
- Department of Pediatric Oncology, University of Colorado Denver School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| | - Timothy P. Garrington
- Department of Pediatric Oncology, University of Colorado Denver School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
| |
Collapse
|
7
|
Abstract
OBJECT Collectively, metastatic tumors are the most common malignancy encountered in the adult central nervous system (CNS), arising most often from lung, breast, skin, and gastrointestinal tract carcinomas. Limited information is available in the literature regarding solid nonhematopoietic CNS metastases in children. The authors carried out a retrospective study of pediatric metastatic neoplasms to the CNS treated in a 30-year period to characterize their frequency, common histological subtypes, and sites of origin. METHODS The archival pathology files were searched (1981-2011) for metastatic tumors to the CNS in patients 21 years of age and younger. Pathology material was reviewed, tumors were classified by site of origin and histological subtype, and survival was evaluated. RESULTS The authors identified 26 patients with solid nonhematopoietic CNS metastases out of 1135 pediatric CNS tumors diagnosed from 1981 to 2011. Patients ranged in age from 1.5 to 20.3 years and were equally divided between sexes. Most CNS metastases were supratentorial (85%) and solitary (65%). The mean interval from primary malignant diagnosis to CNS metastasis was 27 months. Sites of origin included kidney/adrenal, bone/soft tissue, gonads, head and neck, lung, and liver. Mean survival after CNS involvement was 36.6 months. Overall 1-year and 5-year survival rates were 52% and 16%, respectively. CONCLUSIONS In neuropathology practice, nonhematopoietic pediatric CNS metastases are far less common than are nonhematopoietic adult CNS metastases, accounting for approximately 2% of all pediatric CNS tumors. The most common tumors to exhibit CNS metastasis are of kidney/adrenal origin, followed by those from bone/soft tissue. As expected, prognosis is dismal, despite aggressive therapy.
Collapse
Affiliation(s)
- Andrea L Wiens
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | | |
Collapse
|
8
|
Osawa SI, Kumabe T, Saito R, Sonoda Y, Niizuma H, Watanabe M, Tominaga T. Infratentorial brain metastases of pediatric non-epithelial malignant tumors: three case reports. Brain Tumor Pathol 2011; 28:167-74. [DOI: 10.1007/s10014-010-0014-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
|
9
|
Campagna J, Crete R, Rooks V, Kratovil T. An 18-month-old with progressive vomiting and leg pain. Clin Pediatr (Phila) 2010; 49:897-900. [PMID: 19380882 DOI: 10.1177/0009922809334353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- John Campagna
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii, USA.
| | | | | | | |
Collapse
|
10
|
Abstract
Medulloblastoma is one of the most frequent brain tumors in childhood. The mortality of medulloblastoma decreased significantly during the last few decades, which was the result of the better surgical and radiotherapeutic methods and of the development of chemotherapy. The aim of this publication is the critical review of the present chemotherapeutic treatment. The new therapeutic trials based on the molecular genetic mechanism of these tumors are also mentioned.
Collapse
Affiliation(s)
- Dezsô Schuler
- Semmelweis Egyetem AOK II. sz. Gyermekgyógyászati Klinika 1094 Budapest Tuzoltó utca 7-9.
| |
Collapse
|
11
|
Arush MWB, Kollender Y, Issakov J, Shalom RB, Arieh YB, Malkin L, Postovsky S. Unusual leptomeningeal dissemination in a child with extracranial metastatic alveolar rhabdomyosarcoma. Pediatr Hematol Oncol 2009; 26:473-8. [PMID: 19657999 DOI: 10.3109/08880010902993218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The authors describe a 6-year-old boy diagnosed with alveolar rhabdomyosarcoma located in the thigh, with distal metastases to lungs, bones, and bone marrow. A very good partial response to first-line chemotherapy was obtained, but the child developed fatal leptomeningeal dissemination immediately after complete resection of the primary tumor. This case demonstrates the rapidity with which leptomeningeal spread of extracranial metastatic alveolar rhabdomyosarcoma can occur and underscores the importance of diagnostic lumbar puncture and brain radiological investigations at diagnosis, even when the tumors are not in the parameningeal location.
Collapse
Affiliation(s)
- Myriam Weyl Ben Arush
- Department of Pediatric Hematology Oncology, Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel. m
| | | | | | | | | | | | | |
Collapse
|
12
|
Priest JR, Magnuson J, Williams GM, Abromowitch M, Byrd R, Sprinz P, Finkelstein M, Moertel CL, Hill DA. Cerebral metastasis and other central nervous system complications of pleuropulmonary blastoma. Pediatr Blood Cancer 2007; 49:266-73. [PMID: 16807914 DOI: 10.1002/pbc.20937] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pleuropulmonary blastoma (PPB) is a rare tumor of pleura and lung in young children. Central nervous system (CNS) complications, particularly cerebral parenchymal metastases, occur in aggressive forms of PPB: Types II and III PPB. This article evaluates cerebral and meningeal metastases, cerebrovascular events (CVA) caused by tumor emboli, spinal cord complications, and intracranial second malignancies in PPB. PROCEDURE International PPB Registry and literature cases were evaluated for CNS events. Cerebral metastasis patients were evaluated for gender, side of origin of PPB, PPB Type, interval from diagnosis to metastasis, status of chest disease, treatment, and outcome. Standard statistical methods were used to calculate the cumulative probability of cerebral metastasis and survival following metastasis. RESULTS Thirty-nine cases of cerebral metastasis were identified in 5/53 Registry Type II cases, 15/44 Registry Type III cases, and 19/143 literature Type II/III cases. Metastases occurred 1-60, median 11.5 months after diagnosis. Chest disease was controlled in 50% of children at time of metastasis. The cumulative probability of cerebral metastasis by 5 years from diagnosis was 11% for Type II patients (95%CI (confidence interval): 2-20%) and 54% for Type III patients (95%CI: 31-76%). Seven children survive cerebral metastasis. Other CNS complications were post-operative CVA (five cases), spinal cord invasion or compression (six), leptomeningeal disease (three), and second intracranial malignancies (two). CONCLUSIONS Cerebral metastasis is more frequent in PPB than in other childhood sarcomas. Clinicians should screen for this complication. Diverse other CNS complications are less common and require careful diagnosis.
Collapse
Affiliation(s)
- John R Priest
- International Pleuropulmonary Blastoma Registry, Children's Hospitals and Clinics of Minnesota, St. Paul, Minnesota 55102, and Washington University Medical Center, Division of Anatomic Pathology, St. Louis, MO, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|