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de Rojas T, Neven A, Towbin AJ, Carceller F, Bautista F, Riedl D, Sodergren S, Darlington AS, Fernandez-Teijeiro A, Moreno L. Clinical research tools in pediatric oncology: challenges and opportunities. Cancer Metastasis Rev 2020; 39:149-160. [DOI: 10.1007/s10555-020-09856-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Carceller F, Bautista FJ, Fowkes LA, Marshall LV, Sirvent SI, Chisholm JC, Pearson ADJ, Koh DM, Moreno L. Response Assessment in Paediatric Phase I Trials According to RECIST Guidelines: Survival Outcomes, Patterns of Progression and Relevance of Changes in Tumour Measurements. Pediatr Blood Cancer 2016; 63:1400-6. [PMID: 27149049 DOI: 10.1002/pbc.26039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/04/2016] [Indexed: 11/06/2022]
Abstract
INTRODUCTION RECIST guidelines constitute the reference for radiological response assessment in most paediatric trials of anticancer agents. However, these criteria have not been validated in children. We evaluated the outcomes and patterns of progression of children/adolescents enrolled in phase I trials in two paediatric drug development units. METHODS Patients aged ≤21 assessed with RECIST (v1.0 or v1.1) were eligible. Clinico-radiological data were analysed using Mann-Whitney U and log-rank tests to correlate response categories and sum of longest diameters (SLD) with time-to-event variables and overall survival (OS). RESULTS Sixty-one patients (71 enrolments) were evaluated; median age: 12.7 years (range, 3.1-20.9). Overall, 7% achieved complete/partial response (n = 5) and 31% disease stabilisation (n = 22). Median (95% CI) OS (in months) was 29.1 (27.6-30.6) with complete/partial response, 8.9 (2.0-15.8) with stable disease and 2.8 (2.3-3.3) with disease progression (P < 0.001); 32.6% patients with measurable disease presented exclusive progression of existing non-target lesions and/or new lesions. The change in SLD at best response showed a linear correlation with duration of response (r = -0.605; P = 0.004) and time on trial (r = -0.61; P = 0.003), but the change in SLD at progression did not correlate with time to progression (r = -0.219; P = 0.206). CONCLUSIONS Response assessment according to RECIST correlated with OS in children/adolescents treated on phase I trials. The reduction in SLD at best response correlated with more prolonged responses. Tumour size did not constitute an optimal method to assess disease progression in one third of patients with measurable disease. Further refinement of current response assessment guidelines will enable the development of paediatric-specific radiological criteria.
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Affiliation(s)
- Fernando Carceller
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Francisco J Bautista
- Paediatric Oncology Department, Clinical Trials Unit, Hospital Niño Jesús, Madrid, Spain
| | - Lucy A Fowkes
- Radiology Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lynley V Marshall
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Sara I Sirvent
- Paediatric Radiology Department, Hospital Niño Jesús, Madrid, Spain
| | - Julia C Chisholm
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Andrew D J Pearson
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Dow-Mu Koh
- Radiology Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lucas Moreno
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
- Paediatric Oncology Department, Clinical Trials Unit, Hospital Niño Jesús, Madrid, Spain
- Clinical Research Programme, CNIO (Spanish National Cancer Research Centre), Madrid, Spain
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Hu D, Yu T, Duan X, Peng Y, Zhai R. Determination of the optimal energy level in spectral CT imaging for displaying abdominal vessels in pediatric patients. Eur J Radiol 2014; 83:589-94. [DOI: 10.1016/j.ejrad.2013.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 10/07/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
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Mueller WP, Coppenrath E, Pfluger T. Nuclear medicine and multimodality imaging of pediatric neuroblastoma. Pediatr Radiol 2013; 43:418-27. [PMID: 23151727 DOI: 10.1007/s00247-012-2512-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/22/2012] [Accepted: 06/23/2012] [Indexed: 12/20/2022]
Abstract
Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system and is metastatic or high risk for relapse in nearly 50% of cases. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for defining the adequate therapeutic choice. Tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor specific agent for imaging. MIBG imaging has several disadvantages, such as limited spatial resolution, limited sensitivity in small lesions and the need for two or even more acquisition sessions. Most of these limitations can be overcome with positron emission tomography (PET) using [F-18]2-fluoro-2-deoxyglucose [FDG]. Furthermore, new tracers, such as fluorodopa or somatostatin receptor agonists, have been tested for imaging neuroblastoma recently. However, MIBG scintigraphy and PET alone are not sufficient for operative or biopsy planning. In this regard, a combination with morphological imaging is indispensable. This article will discuss strategies for primary and follow-up diagnosis in neuroblastoma using different nuclear medicine and radiological imaging methods as well as multimodality imaging.
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Affiliation(s)
- Wolfgang Peter Mueller
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.
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Gande A, Tormenti MJ, Koutourousiou M, Paluzzi A, Fernendez-Miranda JC, Snydermnan CH, Gardner PA. Intraoperative computed tomography guidance to confirm decompression following endoscopic endonasal approach for cervicomedullary compression. J Neurol Surg B Skull Base 2013; 74:44-9. [PMID: 24436887 PMCID: PMC3699170 DOI: 10.1055/s-0032-1329627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 08/16/2012] [Indexed: 02/07/2023] Open
Abstract
Introduction Cervicomedullary compression often requires an anterior approach to address the compressive vector. In certain cases an endoscopic endonasal approach (EEA) is ideal for decompression. It is essential that an adequate decompression be achieved and verified before the patient leaves the operating room. The purpose of this study was to evaluate the use intraoperative computed tomography (IO-CT) in assessing the adequacy of decompression. Methods A retrospective chart review revealed 11 cases of EEA odontoid resection IO-CT verification of decompression. Operative reports and review of imaging was used to determine if further decompression was performed following the intraoperative scan. Results Out of 11 EEA cases, 4 (36%) patients showed evidence of residual compression following an initial IO-CT. Further operative decompression was undertaken following the first scan in all cases. A second intraoperative scan was then used to confirm complete decompression. No patient left the operating room with residual compression. Discussion IO-CT provided valuable utility in 36% of the cases after the initial resection was incomplete. The standard fluoroscopic guidance may not provide adequate resolution and enhanced utility like IO-CT.
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Affiliation(s)
- Abhiram Gande
- School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Matthew J. Tormenti
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Maria Koutourousiou
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Alessandro Paluzzi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Juan C. Fernendez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl H. Snydermnan
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Paul A. Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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Ueda T, Naka N, Araki N, Ishii T, Tsuchiya H, Yoshikawa H, Mochizuki K, Tsuboyama T, Toguchida J, Ozaki T, Murata H, Kudawara I, Tanaka K, Iwamoto Y, Yazawa Y, Kushida K, Otsuka T, Sato K. Validation of radiographic response evaluation criteria of preoperative chemotherapy for bone and soft tissue sarcomas: Japanese Orthopaedic Association Committee on Musculoskeletal Tumors Cooperative Study. J Orthop Sci 2008; 13:304-12. [PMID: 18696187 PMCID: PMC2779413 DOI: 10.1007/s00776-008-1235-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 03/18/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND The radiographic evaluation of the response to preoperative chemotherapy for bone and soft tissue sarcomas is based mostly on the change in primary tumor size before and after chemotherapy, as is done for many solid cancers. Its prognostic correlation, however, has hardly been validated. METHODS We conducted a retrospective validation study of the Japanese Orthopaedic Association (JOA) radiographic response evaluation criteria of preoperative chemotherapy for bone and soft tissue sarcomas as a JOA Committee on Musculoskeletal Tumors cooperative study. A total of 125 consecutive patients with high-grade bone (n = 77) and soft tissue (n = 48) sarcomas treated with neoadjuvant chemotherapy and definitive surgery in 25 tertiary referral hospitals were selected for the study. We investigated the correlation between the tumor size-based radiographic response evaluation criteria of preoperative chemotherapy for bone and soft tissue sarcomas provided by the JOA Committee on Musculoskeletal Tumors (hereafter called the JOA criteria) and the patients' overall survival using the Kaplan-Meier method and the log-rank test. RESULTS The JOA criteria correlated relatively well with survival for malignant bone tumors (mostly comprising osteosarcoma and Ewing's sarcoma) but not for soft tissue sarcomas, suggesting that the tumor size-based radiographic evaluation criteria for the response to preoperative chemotherapy in patients with soft tissue sarcomas is invalid. CONCLUSIONS The JOA criteria, based on the change in primary tumor size, is valid for malignant bone tumors but invalid for soft tissue sarcomas. Other new evaluation modalities of the response to preoperative chemotherapy using innovative functional imaging techniques are needed for soft tissue sarcomas.
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Affiliation(s)
- Takafumi Ueda
- Department of Orthopaedic Surgery, Osaka National Hospital, Kinki-Block Comprehensive Cancer Center, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006 Japan
| | - Norifumi Naka
- Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Nobuhito Araki
- Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Takeshi Ishii
- Department of Orthopaedic Surgery, Chiba Cancer Center, Chiba, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Ishikawa, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuo Mochizuki
- Department of Orthopaedic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Tadao Tsuboyama
- Development and Rehabilitation of Motor Function, Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junya Toguchida
- Department of Tissue Regeneration, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroaki Murata
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ikuo Kudawara
- Department of Orthopaedic Surgery, Osaka National Hospital, Kinki-Block Comprehensive Cancer Center, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006 Japan
| | - Kazuhiro Tanaka
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yasuo Yazawa
- Department of Orthopaedic Oncology, Tochigi Cancer Center, Tochigi, Japan
| | - Kazuyoshi Kushida
- Department of Bone and Soft Tissue Tumor Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Takanobu Otsuka
- Department of Musculoskeletal Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Keiji Sato
- Department of Orthopaedic Surgery, Aichi Medical University School of Medicine, Aichi, Japan
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Abstract
Paediatric soft tissue sarcomas (STS) are a group of malignant tumours that originate from primitive mesenchymal tissue and account for 7% of all childhood tumours. Rhabdomyosarcomas (RMS) and undifferentiated sarcomas account for approximately 50% of soft tissue sarcomas in children and non-rhabdomyomatous soft tissue sarcomas (NRSTS) the remainder. The prognosis and biology of STS tumours vary greatly depending on the age of the patient, the primary site, tumour size, tumour invasiveness, histologic grade, depth of invasion, and extent of disease at diagnosis. Over recent years, there has been a marked improvement in survival rates in children and adolescents with soft tissue sarcoma and ongoing international studies continue to aim to improve these survival rates whilst attempting to reduce the morbidity associated with treatment. Radiology plays a crucial role in the initial diagnosis and staging of STS, in the long term follow-up and in the assessment of many treatment related complications. We review the epidemiology, histology, clinical presentation, staging and prognosis of soft tissue sarcomas and discuss the role of radiology in their management.
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Affiliation(s)
- K Park
- Radiology Department, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK.
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Eliminating Unenhanced CT When Evaluating Abdominal Neoplasms in Children. AJR Am J Roentgenol 2007; 189:1211-4. [DOI: 10.2214/ajr.07.2154] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
18F-fluorodeoxyglucose positron emission tomography (FDG-PET) and FDG-PET/computed tomography (CT) are becoming increasingly important imaging tools in the noninvasive evaluation and monitoring of children with known or suspected malignant diseases. In this review, we discuss the preparation of children undergoing PET studies and review radiation dosimetry and its implications for family and caregivers. We review the normal distribution of 18F-fluorodeoxyglucose (FDG) in children, common variations of the normal distribution, and various artifacts that may arise. We show that most tumors in children accumulate and retain FDG, allowing high-quality images of their distribution and pathophysiology. We explore the use of FDG-PET in the study of children with the more common malignancies, such as brain neoplasms and lymphomas, and the less-common tumors, including neuroblastomas, bone and soft-tissue sarcomas, Wilms' tumors, and hepatoblastomas. For comparison, other PET tracers are included because they have been applied in pediatric oncology. Multiple multicenter trials are underway that use FDG-PET in the management of children with neoplastic disease; these studies should give us greater insight into the impact FDG-PET can make in their care. PET is emerging as an important diagnostic imaging tool in the evaluation of pediatric cancers. The recent advent of dual-modality PET-computed tomography (PET/CT) imaging systems has added unprecedented diagnostic capability by revealing the precise anatomical localization of metabolic information and metabolic characterization of normal and abnormal structures. The use of CT transmission scanning for attenuation correction has shortened the total acquisition time, which is an especially desirable attribute in pediatric imaging. Moreover, expansion of the regional distribution of the most common PET radiotracer, FDG, and the introduction of mobile PET units have greatly increased access to this powerful diagnostic imaging technology. Here, we review the clinical applications of PET and PET/CT in pediatric oncology. General considerations in patient preparation and radiation dosimetry will be discussed.
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Affiliation(s)
- Hossein Jadvar
- Division of Nuclear Medicine, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, and Children's Hospital Boston, MA, USA
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Pirro V, Skanjeti A, Pelosi E. 18F-fluorodeoxyglucose-positron emission tomography in the characterization of suspected rhabdoid renal tumor recurrence: a case report. J Pediatr Hematol Oncol 2007; 29:69-71. [PMID: 17230072 DOI: 10.1097/mph.0b013e318030abd5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Rhabdoid tumor is a rare, aggressive, and undifferentiated cancer, that can be localized in the central nervous system, in the thorax or in the kidney. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is a noninvasive technique in cancer patients' management. Its role in the diagnosis and staging of rhabdoid renal tumor is not known at all. We report the case of a child with suspected recurrence of rhabdoid renal tumor studied with FDG-PET/computed tomography. A 4-year-old male previously treated for a rhabdoid tumor of the left kidney, underwent PET scan to differentiate local recurrence from postsurgical fibrosis. FDG-PET study showed the presence of intense, multiple, and inhomogeneous tracer uptakes in the left renal fossa (ie, the site of suspected computed tomography recurrence), with the involvement of the adjacent abdominal wall. Further pathologic uptakes were evidenced in the para-aortic, celiac, mesenteric areas, and at the hepatic hilum. Therefore, PET scan allowed a complete disease staging, evidencing unexpected local and distant disease extension. Thus, FDG-PET study could be considered in the evaluation of patients with renal rhabdoid tumor, at least when disease recurrence is suspected.
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Affiliation(s)
- Valeria Pirro
- IRMET PET Center, Via Onorato Vigliani 89/A, 10135 Turin, Italy
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Affiliation(s)
- K Hahn
- Department of Nuclear Medicine, University of Munich, Ziemssenstrasse 1, 80336, Munich, Germany
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Therasse P, Eisenhauer EA, Verweij J. RECIST revisited: a review of validation studies on tumour assessment. Eur J Cancer 2006; 42:1031-9. [PMID: 16616487 DOI: 10.1016/j.ejca.2006.01.026] [Citation(s) in RCA: 326] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 01/24/2006] [Indexed: 12/16/2022]
Abstract
The response evaluation criteria in solid tumours (RECIST) was developed in the late 1990s to replace the WHO criteria for response evaluation. The new criteria included important changes such as unidimensional tumour measurement, selection of target lesions with a minimum size, details concerning imaging modalities and a new threshold for assignment of objective progression. RECIST was published in February 2000 and very quickly came into operation first in clinical trials performed under the auspices of EORTC, US NCI or NCI Canada Clinical Trials Group but was adopted quickly thereafter by the entire cancer clinical research community. As several key features of RECIST were based on analysis of retrospective clinical data, it was felt important to carefully monitor the implementation of the guidelines and stimulate prospective validation studies. This paper reviews the literature that has been published on RECIST from 2000 up to November 2005. In total 60 papers and ASCO, abstracts directly refer to research studies or reviews related to RECIST and its implementation. Amongst the 60 references identified for this review, 11 papers refer to validation studies (seven prospective and four retrospective), six papers refer to the comparison of unidimensional measurements versus bi or tri-dimensional measurements, 12 papers address issues raised with the implementation of RECIST in Mesothelioma and Gastro-Intestinal Stromal Tumours and four papers report on an adaptation of RECIST for specific tumour types. In general, RECIST has been well received by the scientific community and most validation studies fully support the implementation of the new criteria. As expected, however, some issues have been identified. In keeping with the mathematical differences in definition of progression, RECIST delays the identification of progression as compared to WHO criteria in some instances. RECIST criteria are not easily applicable in some types of trials such as those in paediatric tumours and in mesothelioma. Furthermore, anatomical changes in the tumour as described by RECIST may be detected later than functional changes in some circumstances, as for example in Gastro-Intestinal Stromal Tumours treated with Imatinib. However, there is no other universal method of tumour assessment as yet and functional imaging methods have not been validated and will not be widely available for some time. The findings of this review, together with experience acquired thus far and the results of some ongoing research projects, have paved the way for RECIST 2.0 to be hopefully announced later this year.
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Affiliation(s)
- P Therasse
- EORTC Data center, Avenue E. Mounier, 83 Box 11, 1200 Brussels, Belgium.
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