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Khalatbari H, Shulkin BL, Parisi MT. PET/CT and PET/MR in Soft Tissue Sarcoma: An Update. Semin Nucl Med 2024; 54:313-331. [PMID: 38423851 DOI: 10.1053/j.semnuclmed.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
Soft tissue sarcomas account for 6%-8% of pediatric cancers. The rhabdomyosarcoma family is the most frequent soft tissue sarcoma in this age group accounting for 3% of pediatric cancers. Rhabdomyosarcomas are high-grade tumors with a high propensity to metastasize. The risk-adapted, multimodal therapeutic approach for rhabdomyosarcomas incorporates a combination of surgery, radiotherapy, and multi-agent cytotoxic chemotherapy. Soft tissue sarcomas other than rhabdomyosarcoma account for 3%-4% of pediatric cancers. The nonrhabdomyosarcoma soft tissue sarcomas include both low-grade and high-grade tumors. While surgery is the mainstay of therapy in most non-rhabdomyosarcoma soft tissue sarcomas, many cases require a multimodal therapeutic approach including radiotherapy and chemotherapy. In North America, most pediatric patients with soft tissue sarcomas are treated in Children's Oncology Group clinical trials. In this article, we will primarily focus on the staging, risk stratification, imaging recommendations, and interpretations in accordance with the Children's Oncology Group trials. We will review the results and recommendations of International Soft Tissue Sarcoma Database Consortium and European trials in relevant sections where they provide complementary guidelines.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Marguerite T Parisi
- University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
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2
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Chen X, Shou J, Li S, Fan Y, Zhang J. 18F-FDG PET/CT findings of paratesticular alveolar rhabdomyosarcoma. CANCER INNOVATION 2024; 3:e121. [PMID: 38946934 PMCID: PMC11212322 DOI: 10.1002/cai2.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 11/22/2023] [Accepted: 02/07/2024] [Indexed: 07/02/2024]
Abstract
Rhabdomyosarcoma (RMS) originates from primitive mesenchymal cells and is the most common soft tissue tumor in childhood. 18F-fluoro-deoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) has been reported to be valuable in RMS staging and risk stratification. Paratesticular RMS is a relatively uncommon form of RMS, most of which are of the embryonal histologic type. Paratesticular alveolar RMS is associated with aggressive behavior, high metastatic potential, and poor outcomes. To the best of our knowledge, 18F-FDG PET/CT imaging findings of paratesticular alveolar RMS have never been described. Here, we report on a 16-year-old boy's rare paratesticular alveolar RMS with multiple metastases and its findings on 18F-FDG PET/CT. This case also demonstrates the potential value of 18F-FDG PET/CT in RMS staging and treatment decisions, and may aid in the differential diagnosis.
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Affiliation(s)
- Xueqi Chen
- Department of Nuclear MedicinePeking University First HospitalBeijingChina
| | - Jiayin Shou
- Department of Nuclear MedicinePeking University First HospitalBeijingChina
| | - Shanshi Li
- Department of Radiation OncologyPeking University First HospitalBeijingChina
| | - Yan Fan
- Department of Nuclear MedicinePeking University First HospitalBeijingChina
| | - Jianhua Zhang
- Department of Nuclear MedicinePeking University First HospitalBeijingChina
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3
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Chisholm J, Mandeville H, Adams M, Minard-Collin V, Rogers T, Kelsey A, Shipley J, van Rijn RR, de Vries I, van Ewijk R, de Keizer B, Gatz SA, Casanova M, Hjalgrim LL, Firth C, Wheatley K, Kearns P, Liu W, Kirkham A, Rees H, Bisogno G, Wasti A, Wakeling S, Heenen D, Tweddle DA, Merks JHM, Jenney M. Frontline and Relapsed Rhabdomyosarcoma (FAR-RMS) Clinical Trial: A Report from the European Paediatric Soft Tissue Sarcoma Study Group (EpSSG). Cancers (Basel) 2024; 16:998. [PMID: 38473359 DOI: 10.3390/cancers16050998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
The Frontline and Relapsed Rhabdomyosarcoma (FaR-RMS) clinical trial is an overarching, multinational study for children and adults with rhabdomyosarcoma (RMS). The trial, developed by the European Soft Tissue Sarcoma Study Group (EpSSG), incorporates multiple different research questions within a multistage design with a focus on (i) novel regimens for poor prognostic subgroups, (ii) optimal duration of maintenance chemotherapy, and (iii) optimal use of radiotherapy for local control and widespread metastatic disease. Additional sub-studies focusing on biological risk stratification, use of imaging modalities, including [18F]FDG PET-CT and diffusion-weighted MRI imaging (DWI) as prognostic markers, and impact of therapy on quality of life are described. This paper forms part of a Special Issue on rhabdomyosarcoma and outlines the study background, rationale for randomisations and sub-studies, design, and plans for utilisation and dissemination of results.
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Affiliation(s)
- Julia Chisholm
- Children and Young People's Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton SM2 5PT, UK
| | - Henry Mandeville
- Children and Young People's Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton SM2 5PT, UK
| | | | | | - Timothy Rogers
- Department of Paediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Anna Kelsey
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Janet Shipley
- The Institute of Cancer Research, London SW7 3RP, UK
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam UMC, 1081 HV Amsterdam, The Netherlands
| | - Isabelle de Vries
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Bart de Keizer
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Susanne A Gatz
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham B15 2TG, UK
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | | | | | - Charlotte Firth
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Wenyu Liu
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Amanda Kirkham
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Helen Rees
- Department of Paediatric Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS1 3NU, UK
| | - Gianni Bisogno
- Department of Women and Children's Health, University of Padova, 35122 Padua, Italy
| | - Ajla Wasti
- The Institute of Cancer Research, London SW7 3RP, UK
| | | | | | - Deborah A Tweddle
- Vivo Biobank, Translational & Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
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4
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Totadri S, Bansal D, Donaldson SS, Binitie O, Teot L, Gupta AA, Oberoi S. Common queries in managing rhabdomyosarcoma in low- and middle-income countries: An Indo-North American collaboration. Pediatr Blood Cancer 2023; 70:e30616. [PMID: 37574816 DOI: 10.1002/pbc.30616] [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: 04/09/2023] [Revised: 07/01/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma among children and adolescents. The management of RMS involves risk stratification of the patients based on various clinicopathological characteristics. The multimodality treatment approach requires chemotherapy, surgery, and/or radiation. The treatment of RMS necessitates the involvement of multiple disciplines, such as pathology, pediatric oncology, surgery, and radiation oncology. The disease heterogeneity, molecular testing, evolving treatment regimens, and limited resources are some of the challenges faced by clinicians while treating a patient with RMS in low- and middle-income countries (LMICs). In this review, we endeavor to bring experts from varying fields to address clinicians' common questions while managing a child or adolescent with RMS in LMICs. This review is most applicable to level 2 centers in LMICs as per the levels of services described by the Adapted Treatment Regimens Working Group of the Pediatric Oncology in Developing Countries committee of the International Society of Pediatric Oncology.
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Affiliation(s)
- Sidharth Totadri
- Department of Paediatrics, Paediatric Haematology-Oncology Unit, Christian Medical College, Vellore, India
| | - Deepak Bansal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Pediatric Hematology-Oncology Unit, Advanced Pediatrics Center, Chandigarh, India
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Odion Binitie
- Department of Sarcoma, Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Lisa Teot
- Department of Pathology, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Abha A Gupta
- Division of Pediatric Hematology-Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sapna Oberoi
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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5
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Schoot RA, van Ewijk R, von Witzleben AA, Kao SC, Merks JHMH, Morosi C, Pace E, Shulkin BL, Ferrari A, von Kalle T, van Rijn RR, Weiss AR, Sparber-Sauer M, Ter Horst SAJ, McCarville MB. INternational Soft Tissue saRcoma ConsorTium (INSTRuCT) consensus statement: Imaging recommendations for the management of rhabdomyosarcoma. Eur J Radiol 2023; 166:111012. [PMID: 37541182 DOI: 10.1016/j.ejrad.2023.111012] [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: 05/19/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
Rhabdomyosarcoma is the most common soft-tissue neoplasm in the pediatric population. The survival of children with rhabdomyosarcoma has only marginally improved over the past 25 years and remains poor for those with metastatic disease. A significant challenge to advances in treatment of rhabdomyosarcoma is the relative rarity of this disease, necessitating years to complete clinical trials. Progress can be accelerated by international cooperation and sharing national experiences. This necessitates agreement on a common language to describe patient cohorts and consensus standards to guide diagnosis, treatment, and response assessment. These goals formed the premise for creating the INternational Soft Tissue saRcoma ConsorTium (INSTRuCT) in 2017. Multidisciplinary members of this consortium have since developed international consensus statements on the diagnosis, treatment, and management of pediatric soft-tissue sarcomas. Herein, members of the INSTRuCT Diagnostic Imaging Working Group present international consensus recommendations for imaging of patients with rhabdomyosarcoma at diagnosis, at staging, and during and after completion of therapy. The intent is to promote a standardized imaging approach to pediatric patients with this malignancy to create more-reliable comparisons of results of clinical trials internationally, thereby accelerating progress in managing rhabdomyosarcoma and improving survival.
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Affiliation(s)
- Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Anna-Anais von Witzleben
- Institute of Radiology Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany.
| | - Simon C Kao
- Department of Radiology, The University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - J H M Hans Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Carlo Morosi
- Department of Radiology, Istituto Nazionale Tumori, Milan, Italy.
| | - Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, England, United Kingdom.
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Istituto Nazionale Tumori, Milan, Italy.
| | - Thekla von Kalle
- Institute of Radiology Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany.
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Aaron R Weiss
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Maine Medical Center, Portland, ME, USA.
| | - Monika Sparber-Sauer
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany; University of Medicine Tübingen, Tübingen, Germany.
| | - Simone A J Ter Horst
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
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6
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Rodina AD, Polyakov VG, Gorbunova TV, Merkulov OA, Kashanina AL, Odzharova AA, Stroganova AM. Distant metastasis of alveolar rhabdomyosarcoma with pancreatic parameningeal localization in children: clinical case series. HEAD AND NECK TUMORS (HNT) 2023. [DOI: 10.17650/2222-1468-2022-12-4-91-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Rhabdomyosarcoma is a malignant neoplasm that develops from embryonic mesenchymal cells, with an annual incidence of 4.3 cases per 1,000,000 children. The prevalence of the tumor process is estimated on the basis of data from a comprehensive examination, including magnetic resonance imaging with intravenous contrast, ultrasound examination of the primary focus of regional and distant metastasis zones, computed tomography and radioisotope studies. The overall 5-year survival rate for localized rhabdomyosarcoma reaches 70 %. During the initial diagnosis, distant metastasis to the lungs, bones, and bone marrow is detected, which significantly worsens the prognosis in 20–25 % of patients. The factors of an extremely unfavorable prognosis for the course of alveolar rhabdomyosarcoma are the occurrence of regional and distant metastases before the start of specific treatment, dissemination of the tumor lesion during treatment, and the presence of translocation of the 13q14 sector. Publications contain data on a high (11.2 %) prevalence of metastases of alveolar rhabdomyosarcoma in the pancreas. In the presence of metastatic lesions of the pancreas, surgical treatment is effective only in combination with chemoradiotherapy. Long-term results of treatment of this cohort of children are unsatisfactory due to the high risk of recurrence and dissemination of the tumor.Aim. To study risk factors, evaluate methods and prospects for the treatment of children with metastatic pancreatic lesions in parameningeal alveolar rhabdomyosarcoma. The article considers three clinical cases of such a lesion. We would like to draw the attention of pediatric oncologists and radiologists to the possible association of metastases in the pancreas in children with localization of rhabdomyosarcoma in the head and neck region, which requires improvement of examination protocols in this group of patients.
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Affiliation(s)
- A. D. Rodina
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - V. G. Polyakov
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
| | - T. V. Gorbunova
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
| | - O. A. Merkulov
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - A. L. Kashanina
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - A. A. Odzharova
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
| | - A. M. Stroganova
- N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia
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7
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Morris CD, Tunn PU, Rodeberg DA, Terwisscha van Scheltinga S, Binitie O, Godzinski J, Dall'Igna P, Million L, Hawkins DS, Koscielniak E, Bisogno G, Rogers TN. Surgical management of extremity rhabdomyosarcoma: A consensus opinion from the Children's Oncology Group, the European Pediatric Soft-Tissue Sarcoma Study Group, and the Cooperative Weichteilsarkom Studiengruppe. Pediatr Blood Cancer 2023; 70:e28608. [PMID: 32776456 DOI: 10.1002/pbc.28608] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 02/06/2023]
Abstract
The treatment of extremity rhabdomyosarcoma remains a challenge due to several adverse prognostic factors frequently associated with this tumor site. The International Soft-Tissue Sarcoma Database Consortium (INSTRuCT) is a collaboration of the Children's Oncology Group Soft-Tissue Sarcoma Committee, the European Pediatric Soft-Tissue Sarcoma Study Group, and the Cooperative Weichteilsarkom Studiengruppe. The INSTRuCT surgical committee developed an internationally applicable consensus opinion document for the surgical treatment of extremity rhabdomyosarcoma. This document addresses surgical management, including biopsy, nodal staging, timing of therapy, resection and reexcision, reconstruction, and surgical approach at relapse.
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Affiliation(s)
- Carol D Morris
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Per-Ulf Tunn
- Department of Orthopedic Oncology, Helios Klinikum Berlin-Buch, Sarcoma Center Berlin-Brandenburg, Berlin, Germany
| | - David A Rodeberg
- Division Pediatric Surgery, East Carolina University, Greenville, North Carolina
| | | | - Odion Binitie
- Sarcoma Department, Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jan Godzinski
- Department of Pediatric Surgery, Marciniak Hospital, Wroclaw, Poland and Department of Pediatric Traumatology and Emergency Medicine, Medical University, Wroclaw, Poland
| | - Patrizia Dall'Igna
- Pediatric Surgery Division, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Lynn Million
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California
| | - Douglas S Hawkins
- Division of Hematology/Oncology, Seattle Children's Hospital, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - Ewa Koscielniak
- Klinikum Stuttgart, Zentrum für Kinder, Jugendund Frauenmedizin, Olga Hospital, Pediatrics 5 (Pediatric Oncology Hematology and Immunology), Stuttgart, Germany
| | - Gianni Bisogno
- Hematology and Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padova, Italy
| | - Timothy N Rogers
- Department of Pediatric Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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8
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Mendoza H, Nosov A, Pandit-Taskar N. Molecular imaging of sarcomas with FDG PET. Skeletal Radiol 2023; 52:461-475. [PMID: 36173459 DOI: 10.1007/s00256-022-04182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 02/02/2023]
Abstract
Sarcoma comprises a heterogenous entity of musculoskeletal malignancies arising from a mesenchymal origin. The diagnosis and management of pediatric sarcoma requires a multidisciplinary approach and the use of various imaging modalities including CT, MRI and FDG PET scans. FDG PET/CT (FDG PET), as a metabolic imaging, complements and provides superior diagnostic information as against other imaging modalities alone. Advantages of FDG PET in differentiating malignant sarcomatous lesions from benign lesions, and value in staging and restaging have been noted in several studies. The use of FDG PET in clinical management has increased over the years. The data on prognostication of outcomes or predicting responders to therapy with FDG PET in patients with sarcoma is somewhat limited. This review will focus on the pearls and pitfalls of FDG PET and role of FDG PET in initial extent of disease assessment, treatment response, and surveillance imaging pertaining to osteosarcoma, chondrosarcoma, Ewing's sarcoma, and rhabdomyosarcoma. We also discuss the limitations and unmet needs of FDG PET in the management of patients with sarcoma.
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Affiliation(s)
- Humberto Mendoza
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Anton Nosov
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
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9
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Phillips RS, Vaarwerk B, Morgan JE. Using Evidence-Based Medicine to Support Clinical Decision-Making in RMS. Cancers (Basel) 2022; 15:cancers15010066. [PMID: 36612064 PMCID: PMC9817945 DOI: 10.3390/cancers15010066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
The foundations of evidence-based practice are the triad of patient values and preferences, healthcare professional experience, and best available evidence, used together to inform clinical decision-making. Within the field of rhabdomyosarcoma, collaborative groups such as the European Paediatric Soft Tissue Sarcoma Group (EpSSG) have worked to develop evidence to support this process. We have explored many of the key research developments within this review, including patient and public involvement, decision-making research, research into areas other than drug development, core outcome sets, reporting and dissemination of research, evidence synthesis, guideline development and clinical decision rules, research of research methodologies, and supporting research in RMS.
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Affiliation(s)
- Robert S. Phillips
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
- Department of Paediatric Haematology and Oncology, Leeds Children’s Hospital, Leeds LS1 3EX, UK
| | - Bas Vaarwerk
- Department of Paediatrics, Amsterdam UMC—Emma Children’s Hospital, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jessica E. Morgan
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
- Department of Paediatric Haematology and Oncology, Leeds Children’s Hospital, Leeds LS1 3EX, UK
- Correspondence:
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10
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Noriega-Álvarez E, Orduña Díez M, Sanz Viedma S, Peiró Valgañón V, Velasco Nuño M, Orcajo Rincón J, Rodríguez Alfonso B, Domínguez Gadea L. Aportaciones de la medicina nuclear en la enfermedad musculoesquelética tumoral maligna en niños. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Contributions of nuclear medicine to malignant musculoskeletal tumor disease in children. Rev Esp Med Nucl Imagen Mol 2022; 41:395-407. [DOI: 10.1016/j.remnie.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
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12
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Crane JN, Xue W, Qumseya A, Gao Z, Arndt CA, Donaldson SS, Harrison DJ, Hawkins DS, Linardic CM, Mascarenhas L, Meyer WH, Rodeberg DA, Rudzinski ER, Shulkin BL, Walterhouse DO, Venkatramani R, Weiss AR. Clinical group and modified TNM stage for rhabdomyosarcoma: A review from the Children's Oncology Group. Pediatr Blood Cancer 2022; 69:e29644. [PMID: 35253352 PMCID: PMC9233945 DOI: 10.1002/pbc.29644] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/14/2022]
Abstract
The Children's Oncology Group (COG) uses Clinical Group (CG) and modified Tumor Node Metastasis (TNM) stage to classify rhabdomyosarcoma (RMS). CG is based on surgicopathologic findings and is determined after the completion of initial surgical procedure(s) but prior to chemotherapy and/or radiation therapy. The modified TNM stage is based on clinical and radiographic findings and is assigned prior to any treatment. These systems have evolved over several decades. We review the history, evolution, and rationale behind the current CG and modified TNM classification systems used by COG for RMS. Data from the seven most recently completed and reported frontline COG trials (D9602, D9802, D9803, ARST0331, ARST0431, ARST0531, ARST08P1) were analyzed, and confirm that CG and modified TNM stage remain relevant and useful for predicting prognosis in RMS. We propose updates based on recent data and discuss factors warranting future study to further optimize these classification systems.
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Affiliation(s)
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Amira Qumseya
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Zhengya Gao
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Carola A.S. Arndt
- Department of Pediatric and Adolescent Medicine, Mayo Clinic and Foundation, Rochester, MN
| | | | - Douglas J. Harrison
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX
| | - Douglas S. Hawkins
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | | | - Leo Mascarenhas
- Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, CA
| | - William H. Meyer
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - David A. Rodeberg
- Division of Pediatric Surgery, Department of Surgery, East Carolina University, Greenville, NC
| | - Erin R. Rudzinski
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
| | - David O. Walterhouse
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Aaron R. Weiss
- Department of Pediatrics, Maine Medical Center, Portland, ME
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D’Arco F, Ugga L. Pearls, Pitfalls, and Mimics in Pediatric Head and Neck Imaging. Neuroimaging Clin N Am 2022; 32:433-445. [DOI: 10.1016/j.nic.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Clinical Perspectives for 18F-FDG PET Imaging in Pediatric Oncology: Μetabolic Tumor Volume and Radiomics. Metabolites 2022; 12:metabo12030217. [PMID: 35323660 PMCID: PMC8956064 DOI: 10.3390/metabo12030217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Pediatric cancer, although rare, requires the most optimized treatment approach to obtain high survival rates and minimize serious long-term side effects in early adulthood. 18F-FDG PET/CT is most helpful and widely used in staging, recurrence detection, and response assessment in pediatric oncology. The well-known 18F-FDG PET metabolic indices of metabolic tumor volume (MTV) and tumor lesion glycolysis (TLG) have already revealed an independent significant prognostic value for survival in oncologic patients, although the corresponding cut-off values remain study-dependent and not validated for use in clinical practice. Advanced tumor “radiomic” analysis sheds new light into these indices. Numerous patterns of texture 18F-FDG uptake features can be extracted from segmented PET tumor images due to new powerful computational systems supporting complex “deep learning” algorithms. This high number of “quantitative” tumor imaging data, although not decrypted in their majority and once standardized for the different imaging systems and segmentation methods, could be used for the development of new “clinical” models for specific cancer types and, more interestingly, for specific age groups. In addition, data from novel techniques of tumor genome analysis could reveal new genes as biomarkers for prognosis and/or targeted therapies in childhood malignancies. Therefore, this ever-growing information of “radiogenomics”, in which the underlying tumor “genetic profile” could be expressed in the tumor-imaging signature of “radiomics”, possibly represents the next model for precision medicine in pediatric cancer management. This paper reviews 18F-FDG PET image segmentation methods as applied to pediatric sarcomas and lymphomas and summarizes reported findings on the values of metabolic and radiomic features in the assessment of these pediatric tumors.
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Shah S, Purandare N, Kembhavi S, Puranik A, Agrawal A, Bedmutha A, Qureshi S, Chinnaswamy G, Vora T, Prasad M, Parambil B, Rangarajan V. FDG PETCT for assessing marrow involvement at staging pediatric nonhematological round cell malignancies. Nucl Med Commun 2022; 43:56-63. [PMID: 34618718 DOI: 10.1097/mnm.0000000000001491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND HYPOTHESIS Bone and lung are the common sites of metastasis in pediatric round cell tumors and its presence indicates poor outcomes. Staging workup for these malignancies thus includes bone marrow biopsy (BMB) along with evaluation of thorax, and tissue analysis for N MYCN status in neuroblastoma. BMB is an invasive procedure requiring general anesthesia with known disadvantages.With an aim of avoiding an invasive BMB a study was taken up to evaluate efficacy of FDG PET CT in detecting marrow involvement in neuroblastoma and rhabdomyosarcoma at staging. MATERIALS AND METHOD Prospective observational study evaluated 83 newly diagnosed treatment naïve patients of neuroblastoma (n = 43) and rhabdomyosarcoma (n = 42) who underwent conventional imaging of PETCT with CECT of local region along with a CT thorax and BMB (both iliac crest) done within 1 week. Findings of FDG PETCT were compared with bone marrow histology and accuracy parameters were calculated. RESULT The overall sensitivity, specificity, accuracy, positive-predictive value (PPV), negative-predictive value (NPV) of FDG PETCT for detection of marrow disease was 100%, 86.1%, 89.4%. 68.9% and 100%, respectively. Subset analysis showed sensitivity, specificity, PPV and NPV of 100%, 66%, 71.4% and 100%, respectively, for neuroblastoma, with rhabdomyosarcoma patients having few events NPV of 100% accuracy of 97.6%. CONCLUSION FDG PETCT with sensitivity and NPV of 100% can be considered as a first stop imaging and biopsy can be avoided in patients with a negative scan.
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Affiliation(s)
- Sneha Shah
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Hospital, Parel
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Nilendu Purandare
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Hospital, Parel
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Ameya Puranik
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Hospital, Parel
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Archi Agrawal
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Hospital, Parel
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Akshay Bedmutha
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Hospital, Parel
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sajid Qureshi
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Surgery
| | - Girish Chinnaswamy
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Pediatric Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Tushar Vora
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Pediatric Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Maya Prasad
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Pediatric Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Badira Parambil
- Homi Bhabha National Institute (HBNI), Mumbai, India
- Department of Pediatric Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear medicine and Molecular Imaging, Tata Memorial Hospital, Parel
- Homi Bhabha National Institute (HBNI), Mumbai, India
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16
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Purandare NC, Shah S, Agrawal A, Puranik A, Rangarajan V. Spectrum of Flurodeoxyglucose Positron Emission Tomography/Computerized Tomography Findings in Tumors and Tumor-Like Conditions of the Musculoskeletal System. Indian J Nucl Med 2021; 36:327-339. [PMID: 34658562 PMCID: PMC8481850 DOI: 10.4103/ijnm.ijnm_242_20] [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: 12/24/2020] [Revised: 02/12/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
Bone and soft-tissue tumors display a wide range of metabolic activity on flurodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) imaging due to their varying histopathological features. Several benign tumors show high FDG uptake similar to that seen in malignant lesions and their metabolic characteristics can overlap. Certain benign tumors can potentially undergo malignant transformation and FDG PET/CT can play an important role in detecting malignant change. The intensity of metabolic activity on FDG PET/CT correlates with histological grade of malignant tumors and also acts as a valuable prognostic factor. FDG PET/CT plays an important role in the staging work up of bone and soft-tissue malignancies. It has been found to be superior to conventional imaging techniques primarily for detecting distant metastatic disease. Because of its ability to detect metabolic changes, FDG PET/CT is a very useful in assessing response to treatment. Metabolic response seen on FDG PET is a powerful surrogate marker of histopathological response to chemotherapy. The purpose of this article is to study the variable patterns of FDG uptake in tumors of the musculoskeletal system, describe the clinical utility of FDG PET/CT in predicting malignant change in benign tumors and discuss its role in staging, response assessment, and prognostication of malignant lesions.
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Affiliation(s)
- Nilendu C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National University (HBNI), Mumbai, Maharashtra, India
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Mercolini F, Zucchetta P, Jehanno N, Corradini N, Van Rijn RR, Rogers T, Cameron A, Scarzello G, Coppadoro B, Minard-Colin V, Gallego S, Chisholm J, Merks JH, Bisogno G. Role of 18F-FDG-PET/CT in the staging of metastatic rhabdomyosarcoma: a report from the European paediatric Soft tissue sarcoma Study Group. Eur J Cancer 2021; 155:155-162. [PMID: 34385068 DOI: 10.1016/j.ejca.2021.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Initial staging of rhabdomyosarcoma is crucial for prognosis and to tailor the treatment. The standard radiology workup (SRW) includes magnetic resonance imaging, chest computed tomography (CT) and bone scintigraphy, but 18 Fluorine-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) (18F-FDG-PET/CT (PET-CT)) use is increasing. The aim of this study was to evaluate the impact of PET-CT in the initial staging of patients with metastatic rhabdomyosarcoma enrolled in the European protocol MTS2008. METHODS Two authors retrospectively reviewed the SRW and PET-CT reports comparing the number and sites of metastases detected. For bone marrow involvement, PET-CT and bone marrow aspirates/biopsies were compared. RESULTS Among 263 metastatic patients enrolled from October 2008 to December 2016, 121 had PET-CT performed at diagnosis, and for 118 of 121 patients, both PET-CT and radiological reports were available for review. PET-CT showed higher sensitivity than SRW in the ability to detect locoregional (96.2% versus 78.5%, P value = 0.0013) and distant lymph node involvement (94.8% versus 79.3%, P value = 0.0242), but sensitivity was lower for intrathoracic sites (lung 79.6% versus 100%, P value = 0.0025). For bone metastasis, PET-CT was more sensitive than bone scintigraphy (96.4% versus 67.9%, P value = 0.0116). The PET-CT sensitivity and specificity to detect marrow involvement were 91.8% and 93.8%, respectively. The mean number of metastatic sites was 1.94 (range 0-5) with PET-CT and 1.72 (range 0-5) with SRW. In four patients (3.4%), PET-CT changed the staging from localised to metastatic disease. CONCLUSION PET can identify metastatic disease not evident on SRW in a small number of patients. This is because of its higher ability to recognise lymph node and bone involvement. Chest CT remains essential to detect lesions in intrathoracic sites, which can be performed in a one stop-shot routine examination or on a dedicated chest CT scan. PET-CT could replace bone scintigraphy to study bone involvement.
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Affiliation(s)
- Federico Mercolini
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Bolzano Hospital, Bolzano, Italy.
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padova, Italy
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie, PSL Research University, Paris, France
| | - Nadege Corradini
- Department of Pediatric Hematology and Oncology-IHOPe, Centre Léon Bérard, Lyon, France
| | - Rick R Van Rijn
- Department of Radiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Timothy Rogers
- Department of Paediatric Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Alison Cameron
- Bristol Haematology and Oncology Hospital, University Hospitals Bristol and Weston, Bristol, UK
| | - Giovanni Scarzello
- Radiotherapy Division, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Veronique Minard-Colin
- Département de cancérologie de l'enfant et l'adolescent, INSERM U1015, Gustave Roussy, Université Paris-Saclay, 94805, Villejuif, France
| | - Soledad Gallego
- Servicio de Oncología y Hematología Pediatrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Julia Chisholm
- Children and Young Peoples Unit, Royal Marsden Hospital, Down's Road, Sutton, Surrey, UK
| | - J Hans Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
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Radiation Therapy in the Treatment of Head and Neck Rhabdomyosarcoma. Cancers (Basel) 2021; 13:cancers13143567. [PMID: 34298780 PMCID: PMC8305800 DOI: 10.3390/cancers13143567] [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] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/11/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022] Open
Abstract
The use of radiation therapy is an important part of multimodality treatment for rhabdomyosarcoma. The specific doses, treatment volumes, and techniques used in radiation therapy can vary dramatically based upon a number of factors including location, tumor size, and molecular characteristics, resulting in complex decisions in treatment planning. This article reviews the principles of evaluation and management for head and neck rhabdomyosarcoma including a summary of the historical studies upon which current management is based.
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GEIS-SEHOP clinical practice guidelines for the treatment of rhabdomyosarcoma. Clin Transl Oncol 2021; 23:2460-2473. [PMID: 34212338 DOI: 10.1007/s12094-021-02654-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Rhabdomyosarcoma (RMS) is the most frequent soft tissue sarcoma (STS) in children and adolescents. In Spain the annual incidence is 4.4 cases per million children < 14 years. It is an uncommon neoplasm in adults, but 40% of RMS are diagnosed in patients over 20 years of age, representing 1% of all STS in this age group. RMS can appear anywhere in the body, with some sites more frequently affected including head and neck, genitourinary system and limbs. Assessment of a patient with suspicion of RMS includes imaging studies (MRI, CT, PET-CT) and biopsy. All patients with RMS should receive chemotherapy, either at diagnosis in advanced or metastatic stages, or after initial resection in early local stages. Local control includes surgery and/or radiotherapy depending on site, stage, histology and response to chemotherapy. This guide provides recommendations for diagnosis, staging and treatment of this neoplasm.
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20
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Harrison DJ, Parisi MT, Khalatbari H, Shulkin BL. PET with 18F-Fluorodeoxyglucose/Computed Tomography in the Management of Pediatric Sarcoma. PET Clin 2021; 15:333-347. [PMID: 32498989 DOI: 10.1016/j.cpet.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The role for PET with fludeoxyglucose F 18 (18F-FDG PET)/computed tomography (CT) in the management of pediatric sarcomas continues to be controversial. The literature supports a role for PET/CT in the staging and surveillance of certain specific pediatric sarcoma subtypes; however, the data are less clear regarding whether PET/CT can be used as a biomarker for prognostication. Despite the interest in using this imaging modality in the management of pediatric sarcomas, most studies are limited by retrospective design and small sample size. Additional data are necessary to fully understand how best to use 18F-FDG PET/CT in pediatric sarcoma management.
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Affiliation(s)
- Douglas J Harrison
- Division of Pediatrics, MD Anderson Cancer Center, Unit 87, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA; Department of Pediatrics, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Barry L Shulkin
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
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Machavoine R, Helfre S, Bernier V, Bolle S, Leseur J, Corradini N, Rome A, Defachelles AS, Deneuve S, Bernard S, Fayoux P, Nicollas R, Mondain M, Luscan R, Denoyelle F, Simon F, Kadlub N, Kolb F, Honart JF, Orbach D, Minard-Colin V, Moya-Plana A, Couloigner V. Locoregional Control and Survival in Children, Adolescents, and Young Adults With Localized Head and Neck Alveolar Rhabdomyosarcoma-The French Experience. Front Pediatr 2021; 9:783754. [PMID: 35186818 PMCID: PMC8855824 DOI: 10.3389/fped.2021.783754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The head and neck (HN) are the most frequent sites of pediatric rhabdomyosarcoma (RMS). Alveolar RMS (ARMS) represents ~20% of all RMS cases and frequently spread to lymph nodes (LNs). The aim was to report locoregional control, event-free survival (EFS), and overall survival (OS), according to clinical and pathological features, LN staging, and treatment modalities. METHODS The study included all patients prospectively enrolled in EpSSG RMS 2005 study under 21 years of age with localized HN ARMS and diagnosed between 2005 and 2016 in France. Medical data including imaging, surgical report, and radiation therapy planes were analyzed. RESULTS Forty-eight patients (median age 6 years; range 4 months-21 years), corresponding to 30 parameningeal and 18 non-parameningeal ARMS, were included. There were 33 boys (69%). Tumor locations included the following: orbit (n = 7) among which four cases had bone erosion, paranasal sinuses and nasal cavity (n = 16), deep facial spaces (n = 10), nasolabial fold (n = 8), and other non-parameningeal HN sites (n = 7). A fusion transcript of PAX3-FOXO1 or PAX7-FOXO1 was expressed in 33 of the 45 cases (73%) with molecular analysis. At diagnosis, 10 patients had primary resection of the primary tumor (PRPT) (none with microscopic complete resection) and 9 had LN staging. After induction chemotherapy, 26 patients (54%) had secondary resection of the primary tumor (SRPT) and 13 patients (27%) had cervical LN dissection. A total of 43 patients (90%) were treated with radiation therapy.With a median follow-up of 7 years (range 2-13 years), 5-year OS and EFS were 78% (95% CI, 63-88%) and 66% (95% CI, 51-78%), respectively. We observed 16 events (10 deaths): 4 local, 4 regional, 1 local and regional, and 7 metastatic. In univariate analysis, OS was only superior for patients under 10 years of age (p = 0.002), while FOXO1-negative ARMS, SRPT for parameningeal ARMS, and LN surgery were associated with significantly better EFS. CONCLUSION Our study confirms a better outcome for fusion-negative ARMS and ARMS in children under 10 years. Moreover, LN surgery and SRPT of parameningeal tumor may improve EFS of ARMS. Larger studies are needed to confirm our findings.
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Affiliation(s)
- Roxane Machavoine
- Department of Pediatric Oto-Rhino-Laryngology, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Sylvie Helfre
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Valérie Bernier
- Département Universitaire de Radiothérapie-Curiethérapie, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Stéphanie Bolle
- Department of Radiation Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Julie Leseur
- Service de Radiothérapie, Centre Eugène Marquis, Rennes, France
| | - Nadège Corradini
- Service d'Oncologie Pédiatrique, Institut d'Hématologie et d'Oncologie Pédiatrique, Hospices Civils de Lyon, Lyon, France
| | - Angélique Rome
- Pediatric Oncology Department, Hôpitaux Universitaires de Marseille Timone, AP-HM, Marseille, France
| | | | - Sophie Deneuve
- Service d'Oto-Rhino-Laryngologie, Centre Léon Bérard, Lyon, France
| | - Sophie Bernard
- Department of Pediatric Oto-Rhino-Laryngology, Hôpital Robert Debré, APHP, Paris, France
| | - Pierre Fayoux
- Department of Pediatric Oto-Rhino-Laryngology, Hôpital Jeanne de Flandre, CHRU Lille, Lille, France
| | - Richard Nicollas
- Department of Pediatric Oto-Rhino-Laryngology, Hôpitaux Universitaires de Marseille Timone, AP-HM, Marseille, France
| | - Michel Mondain
- Service d'Oto-Rhino-Laryngologie, CHU Montpellier, Montpellier, France
| | - Romain Luscan
- Department of Pediatric Oto-Rhino-Laryngology, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Françoise Denoyelle
- Department of Pediatric Oto-Rhino-Laryngology, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - François Simon
- Department of Pediatric Oto-Rhino-Laryngology, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Natacha Kadlub
- Department of Pediatric Maxillo-Facial and Plastic Surgery, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Fréderic Kolb
- Plastic Surgery Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-François Honart
- Plastic Surgery Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), PSL Research University, Institut Curie, Paris, France
| | - Véronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, INSERM 1015, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Antoine Moya-Plana
- Department of Oto-Rhino-Laryngology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Vincent Couloigner
- Department of Pediatric Oto-Rhino-Laryngology, Hôpital Necker-Enfants Malades, APHP, Paris, France
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European guideline for imaging in paediatric and adolescent rhabdomyosarcoma - joint statement by the European Paediatric Soft Tissue Sarcoma Study Group, the Cooperative Weichteilsarkom Studiengruppe and the Oncology Task Force of the European Society of Paediatric Radiology. Pediatr Radiol 2021; 51:1940-1951. [PMID: 34137936 PMCID: PMC8426307 DOI: 10.1007/s00247-021-05081-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 01/25/2021] [Accepted: 04/14/2021] [Indexed: 02/08/2023]
Abstract
Appropriate imaging is essential in the treatment of children and adolescents with rhabdomyosarcoma. For adequate stratification and optimal individualised local treatment utilising surgery and radiotherapy, high-quality imaging is crucial. The paediatric radiologist, therefore, is an essential member of the multi-disciplinary team providing clinical care and research. This manuscript presents the European rhabdomyosarcoma imaging guideline, based on the recently developed guideline of the European Paediatric Soft Tissue Sarcoma Study Group (EpSSG) Imaging Committee. This guideline was developed in collaboration between the EpSSG Imaging Committee, the Cooperative Weichteilsarkom Studiengruppe (CWS) Imaging Group, and the Oncology Task Force of the European Society of Paediatric Radiology (ESPR). MRI is recommended, at diagnosis and follow-up, for the evaluation of the primary tumour and its relationship to surrounding tissues, including assessment of neurovascular structures and loco-regional lymphadenopathy. Chest CT along with [F-18]2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/CT or PET/MRI are recommended for the detection and evaluation of loco-regional and distant metastatic disease. Guidance on the estimation of treatment response, optimal long-term follow-up, technical imaging settings and standardised reporting are described. This European imaging guideline outlines the recommendations for imaging in children and adolescents with rhabdomyosarcoma, with the aim to harmonise imaging and to advance patient care.
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Usefulness of 18f-FDG PET-CT in Staging, Restaging, and Response Assessment in Pediatric Rhabdomyosarcoma. Diagnostics (Basel) 2020; 10:diagnostics10121112. [PMID: 33371506 PMCID: PMC7767528 DOI: 10.3390/diagnostics10121112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/23/2020] [Accepted: 12/11/2020] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyosarcoma is the most common soft-tissue sarcoma of childhood. Despite clinical advances, subsets of these patients continue to suffer high morbidity and mortality rates associated with their disease. Following the European guidelines for 18F-FDG PET and PET-CT imaging in pediatric oncology, the routine use of 18F-FDG PET-CT may be useful for patients affected by rhabdomyosarcoma, in staging, in the evaluation of response to therapy, and for restaging/detection of relapse. The European Pediatric Protocols are very old, and for staging and restaging, they recommend only radionuclide bone scan. The 18F-FDG PET-CT exam is listed as an optional investigation prescribed according to local availability and local protocols in the investigations panel required at the end of the treatment. We present two cases highlighting the usefulness of 18F-FDG PET-CT in managing pediatric patients affected by rhabdomyosarcoma, providing some bibliographic references.
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Harrison DJ, Chi YY, Tian J, Hingorani P, Mascarenhas L, McCowage GB, Weigel BJ, Venkatramani R, Wolden SL, Yock TI, Rodeberg DA, Hayes-Jordan AA, Teot LA, Spunt SL, Meyer WH, Hawkins DS, Shulkin BL, Parisi MT. Metabolic response as assessed by 18 F-fluorodeoxyglucose positron emission tomography-computed tomography does not predict outcome in patients with intermediate- or high-risk rhabdomyosarcoma: A report from the Children's Oncology Group Soft Tissue Sarcoma Committee. Cancer Med 2020; 10:857-866. [PMID: 33340280 PMCID: PMC7897958 DOI: 10.1002/cam4.3667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Strategies to optimize management in rhabdomyosarcoma (RMS) include risk stratification to assign therapy aiming to minimize treatment morbidity yet improve outcomes. This analysis evaluated the relationship between complete metabolic response (CMR) as assessed by 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET) imaging and event-free survival (EFS) in intermediate-risk (IR) and high-risk (HR) RMS patients. METHODS FDG-PET imaging characteristics, including assessment of CMR and maximum standard uptake values (SUVmax) of the primary tumor, were evaluated by central review. Institutional reports of SUVmax were used when SUVmax values could not be determined by central review. One hundred and thirty IR and 105 HR patients had FDG-PET scans submitted for central review or had SUVmax data available from institutional report at any time point. A Cox proportional hazards regression model was used to evaluate the relationship between these parameters and EFS. RESULTS SUVmax at study entry did not correlate with EFS for IR (p = 0.32) or HR (p = 0.86) patients. Compared to patients who did not achieve a CMR, EFS was not superior for IR patients who achieved a CMR at weeks 4 (p = 0.66) or 15 (p = 0.46), nor for HR patients who achieved CMR at week 6 (p = 0.75) or 19 (p = 0.28). Change in SUVmax at week 4 (p = 0.21) or 15 (p = 0.91) for IR patients or at week 6 (p = 0.75) or 19 (p = 0.61) for HR patients did not correlate with EFS. CONCLUSION Based on these data, FDG-PET does not appear to predict EFS in IR or HR-RMS. It remains to be determined whether FDG-PET has a role in predicting survival outcomes in other RMS subpopulations.
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Affiliation(s)
| | | | - Jing Tian
- University of Florida, Gainesville, FL, USA
| | - Pooja Hingorani
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leo Mascarenhas
- Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - Brenda J Weigel
- University of Minnesota/Masonic Cancer Center, Minneapolis, MN, USA
| | - Rajkumar Venkatramani
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center, Houston, TX, USA
| | | | - Torunn I Yock
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | | | | | - Sheri L Spunt
- Lucile Packard Children's Hospital Stanford University, Palo Alto, CA, USA
| | - William H Meyer
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Rhee DS, Rodeberg DA, Baertschiger RM, Aldrink JH, Lautz TB, Grant C, Meyers RL, Tracy ET, Christison-Lagay ER, Glick RD, Mattei P, Dasgupta R. Update on pediatric rhabdomyosarcoma: A report from the APSA Cancer Committee. J Pediatr Surg 2020; 55:1987-1995. [PMID: 32674846 DOI: 10.1016/j.jpedsurg.2020.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/31/2020] [Accepted: 06/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE Rhabdomyosarcoma is the most common soft tissue sarcoma in children and young adults and requires multimodality treatment. The purpose of this review is to present an update on risk stratification as well as surgical and medical management strategies in pediatric rhabdomyosarcoma. METHODS A comprehensive review of the current literature on pediatric rhabdomyosarcoma, including the most recent Children's Oncology Group studies and several international collaboratives, was performed by the authors and key findings were summarized in the manuscript. RESULTS FOXO1 fusion status is a stronger prognostic factor than histology and is now used for risk stratification in treatment protocols. For assessment of regional nodal involvement, FDG-PET-CT shows poor sensitivity and specificity to detect histologically confirmed nodal metastasis. Thus, surgical assessment of regional lymph nodes is required for rhabdomyosarcoma of the extremities or trunk as well as paratesticular rhabdomyosarcoma in patients ≥10 years of age, although adherence to surgical guidelines remains poor. Hemiscrotectomy performed for scrotal violation in paratesticular rhabdomyosarcoma has not shown an improvement in event free survival and is not recommended. CONCLUSIONS Surgical and medical treatment strategies for rhabdomyosarcoma in children continue to evolve. This review provides current evidence-based treatment standards with an emphasis on surgical care. TYPE OF STUDY Review. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Daniel S Rhee
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - David A Rodeberg
- Division of Pediatric Surgery, Department of Surgery, East Carolina University, Greenville, NC
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, ON
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL
| | - Christa Grant
- Division of Pediatric Surgery, Penn State Children's Hospital, Hershey, PA
| | - Rebecka L Meyers
- Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, UT
| | - Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Emily R Christison-Lagay
- Division of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, Yale New Haven Children's Hospital, New Haven, CT
| | - Richard D Glick
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, NY
| | - Peter Mattei
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Rogers TN, De Corti F, Burrieza GG, Guérin F, Terwisscha van Scheltinga S, Smeulders N, Craigie R, Jenney M, Kelsey A, Zanetti I, Coppadoro B, De Salvo GL, Bisogno G, Martelli H. Paratesticular rhabdomyosarcoma-Impact of locoregional approach on patient outcome: A report from the European paediatric Soft tissue sarcoma Study Group (EpSSG). Pediatr Blood Cancer 2020; 67:e28479. [PMID: 32573979 DOI: 10.1002/pbc.28479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Paratesticular rhabdomyosarcoma (PT RMS) is rare compared to benign scrotal pathology. Inappropriate first surgery (InFS) required supplementary treatment to maintain excellent outcomes. Initial staging of regional lymph nodes is important. The aim of this study was to determine to what extent the quality of locoregional approach impacted on patient morbidity and survival. DESIGN/METHODS Analysis was performed on all nonmetastatic PT RMS patients enrolled in the European paediatric Soft tissue sarcoma Study Group (EpSSG) RMS 2005 protocol. Aspects assessed were adherence to surgical guidelines and impact of protocol violations, relapse analysis, and survival outcomes. RESULTS Analysis was performed on 237 patients, with median follow up of 67.1 months. Median age was 9.0 years. InFS occurred in 75 of 237 (32%) patients. InFS required intensified chemotherapy (10) and local therapy. After InFS, 61 required primary reexcision and five delayed surgery. Of 26 recurrences, the risk of relapse was higher in patients ≥10 years (21/26) and was mainly locoregional in 16 of 26 recurrences (± metastatic). Sixteen of 26 died with 14 of 16 patients ≥10 years. Nodal relapse neither occurred when N1 nodes were identified at diagnosis, nor after surgical staging. Five-year overall survival (OS) at age <10 years versus ≥10 years was 98.1 and 86.7%, respectively (P = .0013). Event-free survival (EFS) at age <10 years versus ≥10 years was 95.8 and 79.6%, respectively (P = .0004). OS and EFS did not highlight a significant difference in patients undergoing appropriate versus InFS (P = .8479, P = .2780, respectively). CONCLUSIONS InFS required intensified therapy to maintain excellent OS and EFS, so better anticipation of malignancy is required. Surgical staging of the retroperitoneal lymph nodes should be performed in patients ≥10 years old.
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Affiliation(s)
- Timothy N Rogers
- Department of Paediatric Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Federica De Corti
- Pediatric Surgery Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | | | - Florent Guérin
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | | | - Naima Smeulders
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ross Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Meriel Jenney
- Department of Pediatric Oncology, Children's Hospital for Wales Heath Park, Cardiff, UK
| | - Anna Kelsey
- Department of Pediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ilaria Zanetti
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Hélène Martelli
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
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Sa R, Liu D, Zhao H, Hou S, Lin Q, Guan F. Utility of [ 18F] Fluoro-Deoxyglucose Positron Emission Tomography/Computed Tomography for Staging and Therapy Response Evaluation in Pediatric Rhabdomyosarcoma: A Case Series and Literature Review. Front Med (Lausanne) 2020; 7:281. [PMID: 32766257 PMCID: PMC7381203 DOI: 10.3389/fmed.2020.00281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background: The role of [18F] fluoro-deoxyglucose [[18F] FDG] positron emission tomography (PET)/computed tomography (CT) in pediatric rhabdomyosarcoma (RMS) is not well-established. This manuscript explores the role of staging and therapy response evaluation of PET/CT in a series of patients with RMS. Methods: Thirteen consecutive patients with pathologically proven RMS underwent baseline PET/CT scan and a second PET/CT for evaluation of therapy response. Maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), highest standardized uptake peak value (SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were obtained from baseline PET/CT and were used as potential predictors for evaluation of metabolic treatment response. Results: On baseline PET/CT, most RMSs are located in the pelvic cavity, and upper arms ranked second. The primary lesions were large and showed invasion to the surrounding tissues. Lymph node metastases were seen in eight patients, and eight patients showed distant metastasis to the lung, liver, and bone. The median SUVmax, SUVmean, and SUVpeak of primary sites were 7.1, 4.0, and 5.9, respectively. The median MTV and TLG were 196.6 cm3 and 780.2, respectively. After therapy, six patients received complete metabolic response (CMR) and non-CMR occurred in seven patients on the second PET/CT. SUVmax, SUVpeak, MTV, and TLG in patients with CMR were significantly lower than those in patients with non-CMR. Conclusions: Primary sites and metastatic lesions of RMS demonstrate increased glycolytic activity, which may allow them to be imaged using [18F] FDG PET/CT. Metabolic parameters derived from the baseline PET/CT have potential value for predicting CMR to therapy in pediatric RMS.
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Affiliation(s)
- Ri Sa
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun, China
| | - Danyan Liu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Hongguang Zhao
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun, China
| | - Sen Hou
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun, China
| | - Qiuyu Lin
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun, China
| | - Feng Guan
- Department of Nuclear Medicine, The First Hospital of Jilin University, Changchun, China
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Rodríguez-Alfonso B, Simó-Perdigó M, Orcajo Rincón J. Functional imaging in soft tissue sarcomas: Update of the indications for 18F-FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Rodríguez-Alfonso B, Simó-Perdigó M, Orcajo Rincón J. Functional image in soft tissue sarcomas: An update of the indications of 18F-FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2020; 39:233-243. [PMID: 32616457 DOI: 10.1016/j.remn.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 11/29/2022]
Abstract
Soft tissue sarcomas (STS) are a rare and heterogeneous group of tumors. They account for 1% of solid malignant tumors in adults and 7% in children and are responsible for 2% of cancer mortality. They require a multidisciplinary approach in centers with experience. This collaboration aims to update the scientific evidence to strengthen, together with clinical experience, the bases for the use and limitations of 18F-FDG-PET/CT in STSs. The general recommendations for the use of PET/CT in STS at present are summarized as the initial evaluation of soft tissue tumours when conventional image does not establish benignity with certainty and this determines the approach; in biopsy guiding in selected cases; in the initial staging, as additional tool, for rhabdomyosarcoma and STS of extremities or superficial trunk and head and neck tumours; in the suspicion of local recurrence when the CT or MRI are inconclusive and in the presence of osteosynthesis or prosthetic material and in assessment of therapy response to local/systemic therapy in stages ii/iii. In addition, PET/CT has the added value of being a surrogate marker of the histopathological response and it provides prognostic information, both in the baseline study and after treatment.
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Affiliation(s)
- B Rodríguez-Alfonso
- Servicio de Medicina Nuclear, Hospital Universitario Puerta de Hierro de Majadahonda, Majadahonda, Madrid, España.
| | - M Simó-Perdigó
- Servicio de Medicina Nuclear, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - J Orcajo Rincón
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España; Miembro del Grupo Español de Investigación en Sarcomas (GEIS)
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Bailey KA, Wexler LH. Pediatric rhabdomyosarcoma with bone marrow metastasis. Pediatr Blood Cancer 2020; 67:e28219. [PMID: 32100935 PMCID: PMC7643423 DOI: 10.1002/pbc.28219] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of adolescence and childhood. Although most patients with localized RMS are cured, outcome of those with metastatic disease remains unsatisfactory. RMS with bone marrow (BM) metastasis accounts for approximately 6% of all cases with RMS and has a 3-year event-free survival of 14%. Our study aims to describe our institution's experience of patients with metastatic RMS with BM involvement. METHODS This was a single-institution retrospective study from Memorial Sloan Kettering Kids, a tertiary pediatric oncology center. Patients with RMS who were diagnosed with BM metastasis between 1998 and 2018 were identified from pathology reports. RESULTS For patients with RMS and BM positivity at diagnosis (N = 27), the median survival was 1.5 years. The 1-, 2-, and 3-year overall survival (OS) were 81%, 32%, and 20%, respectively. There is one long-term (defined as >4 year) survivor who is still alive 14.9 years after diagnosis despite two metastatic recurrences. An Oberlin status of 4 that included BM metastasis portended a 3-year OS of 0%. CONCLUSIONS Although most patients will respond to initial therapy, BM metastasis at the time of diagnosis lends a near-fatal diagnosis in pediatric patients with RMS. Novel therapies are desperately needed to consolidate their initial remission.
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The impact of 18F-FDG PET on initial staging and therapy planning of pediatric soft-tissue sarcoma patients. Pediatr Radiol 2020; 50:252-260. [PMID: 31628508 DOI: 10.1007/s00247-019-04530-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Soft-tissue sarcomas in children are a histologically heterogenous group of malignant tumors accounting for approximately 7% of childhood cancers. There is a paucity of data on the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for initial staging and whether PET influenced management of these patients. OBJECTIVE The aim of this analysis is to assess the use of 18F-FDG PET exclusively, and as a supplement to cross-sectional imaging in comparison to typical imaging protocols (CT and magnetic resonance imaging [MRI]) for initial staging as well as therapy planning in pediatric soft-tissue sarcoma patients. MATERIALS AND METHODS The list of 18F-FDG PET/CT performed for soft-tissue sarcoma between March 2007 and October 2017 was obtained from the Hospital Information System database. Twenty-six patients who had received 18F-FDG PET, MRI and/or CT at initial diagnosis were included in the study. 18F-FDG PET and concurrent diagnostic CT and MRI at initial staging were independently reviewed to note the number of primary and metastatic lesions detected by each modality. A chart review was conducted to collect information on final diagnosis, staging and treatment plan. RESULTS During the study period, 26 patients (15 females) ages 1.3-17.9 years (median age: 6 years) had received 18F-FDG PET/CT at initial diagnosis of soft-tissue sarcoma. Diagnostic CT was available for comparison in all 26 patients and MRI was available in 18 patients. The mean interval between cross-sectional imaging and 18F-FDG PET was 5.9 days (range: 0-30 days). All 26 primary lesions were equally detected by 18F-FDG PET compared to CT and MRI. From 84 metastatic lesions, 16 were detected by PET as well as CT and MRI, 12 by 18F-FDG PET only (included mainly lymph node metastases) and 56 by CT and MRI only (included mainly lung metastases). 18F-FDG PET changed therapy planning in 5 patients out of 26 (19%) by showing additional lesions not detected by CT and MRI. CONCLUSION 18F-FDG PET proved to be a valuable tool for precise initial staging of pediatric soft-tissue sarcoma patients, especially in detecting lymph node metastasis, and could be included in their initial work-up. Given the relative rarity and heterogeneity of this group of tumors, additional investigations are required to definitely establish a role for 18F-FDG PET in the initial staging and therapy planning of soft-tissue sarcoma in the pediatric population.
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32
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Kalemaki MS, Karantanas AH, Exarchos D, Detorakis ET, Zoras O, Marias K, Millo C, Bagci U, Pallikaris I, Stratis A, Karatzanis I, Perisinakis K, Koutentakis P, Kontadakis GA, Spandidos DA, Tsatsakis A, Papadakis GZ. PET/CT and PET/MRI in ophthalmic oncology (Review). Int J Oncol 2020; 56:417-429. [PMID: 31939615 PMCID: PMC6959466 DOI: 10.3892/ijo.2020.4955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022] Open
Abstract
Orbital and ocular anatomy is quite complex, consisting of several tissues, which can give rise to both benign and malignant tumors, while several primary neoplasms can metastasize to the orbital and ocular space. Early detection, accurate staging and re-staging, efficient monitoring of treatment response, non-invasive differentiation between benign and malignant lesions, and accurate planning of external radiation treatment, are of utmost importance for the optimal and individualized management of ophthalmic oncology patients. Addressing these challenges requires the employment of several diagnostic imaging techniques, such as high-definition digital fundus photography, ultrasound imaging, optical coherence tomography, optical coherence tomography (OCT)-angiography, computed tomography (CT) and magnetic resonance imaging (MRI). In recent years, technological advances have enabled the development of hybrid positron emission tomography (PET)/CT and PET/MRI systems, setting new standards in cancer diagnosis and treatment. The capability of simultaneously targeting several cancer-related biochemical procedures using positron emitting-radiopharmaceuticals, while morphologically characterizing lesions by CT or MRI, together with the intrinsic quantitative capabilities of PET-imaging, provide incremental diagnostic information, enabling accurate, highly efficient and personalized treatment strategies. Aim of the current review is to discuss the current applications of hybrid PET/CT and PET/MRI imaging in the management of patients presenting with the most commonly encountered orbital and ocular tumors.
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Affiliation(s)
- Maria S Kalemaki
- Department of Ophthalmology, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece
| | | | - Dimitris Exarchos
- Department of CT‑MRI and PET/CT, Evangelismos Hospital, 10676 Athens, Greece
| | - Efstathios T Detorakis
- Department of Ophthalmology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Odysseas Zoras
- Department of Surgical Oncology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Kostas Marias
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), 70013 Heraklion, Greece
| | - Corina Millo
- Positron Emission Tomography Department, Clinical Center (CC), National Institutes of Health (NIH), Bethesda, MD 20814, USA
| | - Ulas Bagci
- Center for Research in Computer Vision (CRCV), University of Central Florida (UCF), Orlando, FL 32816, USA
| | - Ioannis Pallikaris
- Department of Ophthalmology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Andreas Stratis
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), 70013 Heraklion, Greece
| | - Ioannis Karatzanis
- Foundation for Research and Technology Hellas (FORTH), Computational Biomedicine Laboratory (CBML), 70013 Heraklion, Greece
| | - Kostas Perisinakis
- Department of Medical Physics, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Pavlos Koutentakis
- Department of Ophthalmology, Venizeleio General Hospital of Heraklion, 71409 Heraklion, Greece
| | - Georgios A Kontadakis
- Department of Ophthalmology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Aristidis Tsatsakis
- Laboratory of Forensic Sciences and Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Georgios Z Papadakis
- Department of Radiology, Medical School, University of Crete, 71003 Heraklion, Greece
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Halstead NV, Cost NG, Hecht SL, Walker JP. Neurofibromatosis-1 and Rhabdomyosarcoma: An Unusual Recurrence. Urology 2019; 137:168-172. [PMID: 31794814 DOI: 10.1016/j.urology.2019.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 11/19/2022]
Abstract
Neurofibromatosis-1 has a known increased risk of malignancy with rhabdomyosarcoma occurring in up to 6% of patients. Here we report on an 8-year-old male with a history of Neurofibromatosis-1 and previously treated stage 3, group III bladder/prostate embryonal rhabdomyosarcoma (diagnosed at 18 months old) who presented with penile swelling concerning for priapism. Imaging and subsequent biopsy confirmed embryonal rhabdomyosarcoma of the penile corporal bodies. Penile rhabdomyosarcoma is exceedingly rare, with less than 15 case reports in the literature. Our patient received chemoradiation per D9803 with organ preserving local control and is doing well 3 months after treatment.
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Affiliation(s)
- Nadia V Halstead
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO.
| | - Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Sarah L Hecht
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Jonathan P Walker
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
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Lim HJ, Johnny Ong CA, Tan JWS, Ching Teo MC. Utility of positron emission tomography/computed tomography (PET/CT) imaging in the evaluation of sarcomas: A systematic review. Crit Rev Oncol Hematol 2019; 143:1-13. [DOI: 10.1016/j.critrevonc.2019.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 07/02/2019] [Indexed: 12/14/2022] Open
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35
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The clinical and radiologic features of paediatric rhabdomyosarcoma. Pediatr Radiol 2019; 49:1516-1523. [PMID: 31620851 DOI: 10.1007/s00247-019-04386-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/01/2019] [Accepted: 03/08/2019] [Indexed: 02/01/2023]
Abstract
Rhabdomyosarcoma is the most common soft-tissue sarcoma in children. The most common sites are head and neck, genitourinary tract and extremities. In this review we outline the clinical and radiologic features of paediatric rhabdomyosarcoma, as well as imaging considerations and imaging of relapse.
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Garritty C, Stevens A, Hamel C, Golfam M, Hutton B, Wolfe D. Knowledge Synthesis in Evidence-Based Medicine. Semin Nucl Med 2019; 49:136-144. [PMID: 30819393 DOI: 10.1053/j.semnuclmed.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Systematic reviews are the most common form of knowledge synthesis and remain a cornerstone of the practice of evidence-based medicine. They offer enhanced rigor and validity relative to traditional narrative review articles by reducing bias and increasing objectivity. In answering focused research questions, systematic reviews are directly applicable to clinical practice as well as the development of clinical guidelines and the identification of knowledge gaps, which may drive future primary research directions. Typically, such a rigorous process necessarily requires substantive time to carefully and systematically identify, screen, and synthesize all relevant available primary research on a topic. Further, other knowledge synthesis methods have emerged to address the varying needs of decision makers with respect to condensed timelines and more diverse research questions, as well as to allow incorporation of already synthesized evidence into reviews. These alternative methods include rapid reviews, scoping reviews, and overviews of systematic reviews, which are being used with increasing frequency by clinicians, decision-makers, and researchers. We encourage clinicians and researchers in nuclear medicine and other imaging sciences to acquire a greater familiarity with these methods and to consider them in clinical decision making, the development of clinical guidelines, and the planning of future research activities.
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Affiliation(s)
- C Garritty
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa Methods Centre, Ottawa, Canada
| | - A Stevens
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa Methods Centre, Ottawa, Canada
| | - C Hamel
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa Methods Centre, Ottawa, Canada
| | - M Golfam
- Edmundston Regional Hospital, Vitalite Health Network, New Brunswick, Canada
| | - B Hutton
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa Methods Centre, Ottawa, Canada; Ottawa University School of Epidemiology, Public Health and Preventive Medicine, Ottawa, Canada
| | - D Wolfe
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa Methods Centre, Ottawa, Canada.
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Chambers G, Frood R, Patel C, Scarsbrook A. 18F-FDG PET-CT in paediatric oncology: established and emerging applications. Br J Radiol 2019; 92:20180584. [PMID: 30383441 PMCID: PMC6404840 DOI: 10.1259/bjr.20180584] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/01/2018] [Accepted: 10/27/2018] [Indexed: 12/11/2022] Open
Abstract
Accurate staging and response assessment is vital in the management of childhood malignancies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG PET-CT) provides complimentary anatomical and functional information. Oncological applications of FDG PET-CT are not as well-established within the paediatric population compared to adults. This article will comprehensively review established oncological PET-CT applications in paediatric oncology and provide an overview of emerging and future developments in this domain.
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Affiliation(s)
- Greg Chambers
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Russell Frood
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chirag Patel
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Angelini A, Castellucci P, Ceci F. Future Perspective of the Application of Positron Emission Tomography-Computed Tomography-MR Imaging in Musculoskeletal Disorders. PET Clin 2018; 14:183-191. [PMID: 30420219 DOI: 10.1016/j.cpet.2018.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is the imaging method of choice in sarcoma patients. PET may help in diagnosis, grading, staging, biopsy guidance, monitoring response to therapy, restaging for recurrence, and prognosis. 18F-FDG-PET/MRI combines the higher tissue contrast of MRI in the study of soft-tissue lesions and the peculiarities of PET imaging that allow the characterization of tissues. The use of 18F-FDG-PET/MRI in these patients has reduces the radiation dose, which is of great importance, particularly in children. Data support the routine use of 18F-FDG-PET either using CT or MRI in patients with sarcoma.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padova, Via 8 Febbraio 1848, 2, 35122 Padova, Italy
| | - Paolo Castellucci
- Nuclear Medicine, Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Via massarenti 9, 40138, Bologna, Italy
| | - Francesco Ceci
- Department of Molecular and Medical Pharmacology, Ahmanson Translational Imaging Division, University of California at Los Angeles (UCLA), 200 Medical Plaza, Suite B114, Los Angeles CA 90095, USA; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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Khalatbari H, Parisi MT, Kwatra N, Harrison DJ, Shulkin BL. Pediatric Musculoskeletal Imaging: The Indications for and Applications of PET/Computed Tomography. PET Clin 2018; 14:145-174. [PMID: 30420216 DOI: 10.1016/j.cpet.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of PET/computed tomography (CT) for the evaluation and management of children, adolescents, and young adults continues to expand. The principal tracer used is 18F-fluorodeoxyglucose and the principal indication is oncology, particularly musculoskeletal neoplasms. The purpose of this article is to review the common applications of PET/CT for imaging of musculoskeletal issues in pediatrics and to introduce the use of PET/CT for nononcologic issues, such as infectious/inflammatory disorders, and review the use of 18F-sodium fluoride in trauma and sports-related injuries.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas J Harrison
- Department of Pediatrics, MD Anderson Cancer Center, 7600 Beechnut Street, Houston, TX 77074, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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40
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Walterhouse DO, Barkauskas DA, Hall D, Ferrari A, De Salvo GL, Koscielniak E, Stevens MCG, Martelli H, Seitz G, Rodeberg DA, Shnorhavorian M, Dasgupta R, Breneman JC, Anderson JR, Bergeron C, Bisogno G, Meyer WH, Hawkins DS, Minard-Colin V. Demographic and Treatment Variables Influencing Outcome for Localized Paratesticular Rhabdomyosarcoma: Results From a Pooled Analysis of North American and European Cooperative Groups. J Clin Oncol 2018; 36:JCO2018789388. [PMID: 30351998 PMCID: PMC6286163 DOI: 10.1200/jco.2018.78.9388] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Treatment recommendations for localized paratesticular rhabdomyosarcoma (PT RMS) differ in North America and Europe. We conducted a pooled analysis to identify demographic features and treatment choices that affect outcome. PATIENTS AND METHODS We retrospectively analyzed the effect of nine demographic variables and four treatment choices on event-free survival (EFS) and overall survival (OS) from 12 studies conducted by five cooperative groups. RESULTS Eight hundred forty-two patients with localized PT RMS who enrolled from 1988 to 2013 were included. Patients age ≥ 10 years were more likely than younger patients to have tumors that were > 5 cm, enlarged nodes (N1), or pathologically involved nodes ( P ≤ .05 each). With a median follow-up of 7.5 years, Kaplan-Meier estimates for 5-year EFS and OS were 87.7% and 94.8%, respectively. Of demographic variables, cooperative group, era of enrollment, age category, tumor size, Intergroup Rhabdomyosarcoma Study group, and T stage affected EFS ( P ≤ .05 each). Surgical assessment of regional nodes, which was performed in 23.5% of patients-usually in those age ≥ 10 years or with suspicious or N1 nodes-was the only treatment variable associated with EFS by univariable and multivariable analyses ( P ≤ .05 each) in patients age ≥ 1 year. A variable selection procedure on a proportional hazards regression model selected era of enrollment, age, tumor size, and surgical assessment of regional nodes as significant ( P ≤ .05 each) in the EFS model, and era of enrollment, age, tumor size, and histology ( P ≤ .05 each) in the OS model. CONCLUSION Localized PT RMS has a favorable prognosis. Age ≥ 10 years at diagnosis and tumor size larger than 5 cm are unfavorable prognostic features. Surgical assessment of regional nodes is important in patients age ≥ 10 years and in those with N1 nodes as it affects EFS.
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Affiliation(s)
- David O Walterhouse
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Donald A Barkauskas
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - David Hall
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Andrea Ferrari
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Gian Luca De Salvo
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Ewa Koscielniak
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Michael C G Stevens
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Hélène Martelli
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Guido Seitz
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - David A Rodeberg
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Margarett Shnorhavorian
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Roshni Dasgupta
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - John C Breneman
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - James R Anderson
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Christophe Bergeron
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Gianni Bisogno
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - William H Meyer
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Douglas S Hawkins
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
| | - Veronique Minard-Colin
- David O. Walterhouse, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Donald A. Barkauskas, University of Southern California, Los Angeles; David Hall, Children's Oncology Group, Monrovia, CA; Andrea Ferrari, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale Tumori, Milan; Gian Luca De Salvo, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico, Padua; Gianni Bisogno, University of Padua, Padova, Italy; Ewa Koscielniak, Olgahospital, Stuttgart; Guido Seitz, University Hospital, Marburg, Germany; Michael C.G. Stevens, Royal Hospital for Children, Bristol, United Kingdom; Hélène Martelli, Assistance Publique-Hôpitaux de Paris, Hopital Bicetre, Le Kremlin-Bicetre; Christophe Bergeron, Centre Léon Bérard, Lyon; Veronique Minard-Colin, Gustave Roussy, Villejuif, France; David A. Rodeberg, East Carolina University, Greenville, NC; Margarett Shnorhavorian and Douglas S. Hawkins, Seattle Children's Hospital, University of Washington; Douglas S. Hawkins, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Roshni Dasgupta and John C. Breneman, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; James R. Anderson, Merck Research Laboratories, North Wales, PA; and William H. Meyer, University of Oklahoma School of Medicine, Oklahoma City, OK
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Ovarian conservation in management of pediatric gynecology malignancies. Curr Opin Obstet Gynecol 2018; 30:316-325. [DOI: 10.1097/gco.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW Three primary categories of gynecologic cancer are found in pediatric and adolescent patients: stromal carcinomas including juvenile granulosa cell tumors and Sertoli-Leydig cell tumors, rhabdomyosarcomas arising from the vagina and cervix (sarcoma botryoides), and ovarian germ cell tumors which comprise a wide range of histologies. These entities are rare and treatment approaches have focused on decreasing late effects of chemotherapy treatment. Here, we review presentation, histologic classifications, diagnosis, and treatment recommendations for pediatric gynecologic cancers. RECENT FINDINGS Event-free and overall survival for these cancers is high, and the goals of treatment are minimization of morbidity and preservation of fertility with unilateral salpingo-oophorectomies and limited staging. Surveillance of tumor markers after surgery is helpful in monitoring for disease progression and adjuvant chemotherapy is often reserved for patients at recurrence. Recent literature supports avoiding chemotherapy even in high-grade germ cell tumors in the pediatric population.
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Borinstein SC, Steppan D, Hayashi M, Loeb DM, Isakoff MS, Binitie O, Brohl AS, Bridge JA, Stavas M, Shinohara ET, Meyer WH, Reed DR, Wagner LM. Consensus and controversies regarding the treatment of rhabdomyosarcoma. Pediatr Blood Cancer 2018; 65. [PMID: 28905489 DOI: 10.1002/pbc.26809] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/28/2017] [Accepted: 08/10/2017] [Indexed: 12/20/2022]
Abstract
Optimal treatment of rhabdomyosarcoma (RMS) requires multidisciplinary approach, incorporating chemotherapy with local control. Although current therapies are built on cooperative group trials, a comprehensive standard of care to guide clinical decision making has been lacking, especially for relapsed patients. Therefore, we assembled a panel of pediatric and adolescent and young adult sarcoma experts to develop treatment guidelines for managing RMS and to identify areas in which further research is needed. We created algorithms incorporating evidence-based care for patients with RMS, emphasizing the importance of clinical trials and close integration of all specialties involved in the care of these patients.
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Affiliation(s)
- Scott C Borinstein
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Diana Steppan
- Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Masanori Hayashi
- Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - David M Loeb
- Division of Pediatric Oncology, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Michael S Isakoff
- Center for Cancer and Blood Disorders, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Odion Binitie
- Sarcoma Department, Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andrew S Brohl
- Sarcoma Department, Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julia A Bridge
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Mark Stavas
- Division of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric T Shinohara
- Division of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William H Meyer
- Jimmy Everest Section of Pediatric Hematology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Damon R Reed
- Sarcoma Department, Adolescent and Young Adult Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Lars M Wagner
- Division of Pediatric Hematology/Oncology, University of Kentucky, Lexington, Kentucky
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Häußler SM, Stromberger C, Olze H, Seifert G, Knopke S, Böttcher A. Head and neck rhabdomyosarcoma in children: a 20-year retrospective study at a tertiary referral center. J Cancer Res Clin Oncol 2017; 144:371-379. [PMID: 29143871 DOI: 10.1007/s00432-017-2544-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/07/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to assess rhabdomyosarcomas (RMS) of the head and neck in pediatric patients with regard to clinical presentation, treatment, and survival. METHODS Data were retrospectively obtained from patient charts with regard to RMS of the head and neck diagnosed between 1996 and 2016 at a tertiary referral center. Clinical course, treatment modalities, and side effects were analyzed. Survival analysis was carried out using the Kaplan-Meier method. RESULTS Twenty-eight patients (17 male, 11 female) with a mean age at diagnosis of 6.8 ± 5.0 years have been included. Fourteen patients (50%) presented with painless swelling in the head and neck region and nine patients (32.1%) presented with cranial nerve deficit at initial diagnosis. The location of the majority of rhabdomyosarcomas was orbital (N = 9; 32.1%), followed by parapharyngeal (n = 4; 14.2%) and sinonasal (n = 3; 10.7%). All patients (n = 28; 100%) received polychemotherapy, additional adjuvant radiation therapy was carried out in 24 patients (85.7%), and surgery was performed in 12 cases (42.9%). The 5-year overall survival was 91.3%, and median progression-free survival was 46 ± 67.4 months. Common side effects resulting from chemotherapy and radiation therapy included neutropenia, mucositis, nausea and vomiting, and radiodermatitis, long-term side effects included microsomia and facial mutilation. CONCLUSION Multimodality treatment of rhabdomyosarcomas of the head and neck in pediatric patients may lead to a 5-year overall survival of up to 91.3%.
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Affiliation(s)
- Sophia Marie Häußler
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenbuger Platz 1, 13353, Berlin, Germany.
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenbuger Platz 1, 13353, Berlin, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Charité Mitte, Berlin, Germany
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany
| | - Steffen Knopke
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow-Klinikum, Augustenbuger Platz 1, 13353, Berlin, Germany
| | - Arne Böttcher
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Shelmerdine SC, Lorenzo AJ, Gupta AA, Chavhan GB. Pearls and Pitfalls in Diagnosing Pediatric Urinary Bladder Masses. Radiographics 2017; 37:1872-1891. [DOI: 10.1148/rg.2017170031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Susan C. Shelmerdine
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
| | - Armando J. Lorenzo
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
| | - Abha A. Gupta
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
| | - Govind B. Chavhan
- From the Department of Clinical Radiology, Great Ormond Street Hospital, London, England (S.C.S.); Departments of Urology (A.J.L.), Oncology (A.A.G.), and Diagnostic Imaging (G.B.C.), The Hospital for Sick Children, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Department of Medical Imaging, University of Toronto, Toronto, Ont, Canada (G.B.C.)
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Natarajan A, Puranik A, Purandare N, Agrawal A, Shah S, Rangarajan V. An Infrequent Case of Adult Alveolar Rhabdomyosarcoma with Pancreatic Metastases Detected in F-18 FDG PET/CT. Indian J Nucl Med 2017; 32:227-229. [PMID: 28680211 PMCID: PMC5482023 DOI: 10.4103/ijnm.ijnm_28_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rhabdomyosarcoma (RMS) is a rare cancer in adults, comprising about 1% of all forms of adult cancer. Common sites of metastases are lungs, skeletal system, lymph nodes, and brain. Metastases of RMS to pancreas are infrequent. We report a case of adult orbital alveolar RMS with pancreatic metastases detected in F-18-fluorodeoxyglucose-positron emission tomography/computed tomography.
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Affiliation(s)
- Aravintho Natarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Diagnosis and Management of Rhabdomyosarcoma in Children and Adolescents: ICMR Consensus Document. Indian J Pediatr 2017; 84:393-402. [PMID: 28378141 DOI: 10.1007/s12098-017-2315-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
Rhabdomyosarcoma (RMS) is a highly malignant tumor which is thought to originate from the pluripotent mesenchyme. It is the most common soft-tissue sarcoma of childhood. This review article summarizes the recent and older published literature and gives an overview of management of RMS in children. RMS can arise in a wide variety of primary sites, some of which are associated with specific patterns of local invasion, regional lymph nodal spread, therapeutic response and long term outcome, hence requiring physicians to be familiar with site-specific staging and treatment details. Most common primary sites include the head and neck region, genitourinary tract, and extremities. Prognosis for children and adolescents with RMS has recently improved substantially, especially for patients with local or locally extensive disease because of the development of multi-modal therapy incorporating surgery, dose-intensive combination chemotherapy, and radiation therapy. Despite aggressive approaches the outcome for patients who present with metastatic disease remains unsatisfactory. Clinical trials are ongoing to reduce toxicity and improve outcomes of such patients; newer agents in combination are being investigated.
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49
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Sari N, Okur N, Uçmak G, Ilhan IE. Paratesticular Rhabdomyosarcoma Associated with Tuberculosis. J Trop Pediatr 2017; 63:160-162. [PMID: 27686557 DOI: 10.1093/tropej/fmw065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We report a 16-year-old male patient diagnosed with paratesticular rhabdomyosarcoma and mediastinal tuberculous lymphadenitis. The differential diagnosis between high or early stage of rhabdomyosarcoma and tuberculosis (TB) was critical in this patient without a history of TB. Unexpected lymphadenopathies detected during the staging of patients with malignancy should be carefully evaluated, and TB should be taken into consideration in the differential diagnosis especially in underdeveloped and developing countries. Unnecessary additional treatments increase the rate of mortality and morbidity because of upstaging of cancer. Further, TB reactivation can be seen during chemotherapy because of immunosuppression.
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Affiliation(s)
- Neriman Sari
- Department of Pediatric Hematology and Oncology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Nurettin Okur
- Department of Pediatric Hematology and Oncology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Gulin Uçmak
- Department of Nuclear Medicine, Hitit University, Faculty of Medicine, Çorum Training and Research Hospital and Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Inci Ergürhan Ilhan
- Department of Pediatric Hematology and Oncology, Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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50
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Iatrou I, Theologie-Lygidakis N, Schoinohoriti O, Tzermpos F, Vessala AM. Rhabdomyosarcoma of the maxillofacial region in children and adolescents: Report of 9 cases and literature review. J Craniomaxillofac Surg 2017; 45:831-838. [PMID: 28431807 DOI: 10.1016/j.jcms.2017.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 02/10/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To review clinical presentation, histology, treatment and survival for pediatric maxillofacial rhabdomyosarcoma (RMS) and evaluate the role of surgical treatment. STUDY DESIGN Retrospective analysis of medical charts. METHODS Files of patients, treated for primary maxillofacial RMS from 1997 to 2016, were examined for clinical presentation, staging, histology, treatment protocol and complications, recurrence and final outcome. RESULTS Our cohort included 4 male and 5 female patients (mean age 8.47 years). One tumor, occupying the infratemporal space, was parameningeal; the other 8, located at the mandible (4) or the maxilla/zygomatic bone (4) were non-parameningeal. All patients received chemotherapy preoperatively. Surgery was performed in 7 patients, of whom 4 received postoperative radiotherapy. The histological type was alveolar (5) or embryonal (4). Overall survival hitherto was 66,6%, depending on histology (40% and 100% for the alveolar and embryonal type respectively). CONCLUSIONS Pediatric maxillofacial RMS originated mostly from the facial skeleton and most tumors were non-parameningeal. The alveolar type was slightly more common. An individualized multidisciplinary approach combining chemotherapy and local control mostly with surgery and selectively with radiotherapy has proven successful for the treatment of non-orbital, non-parameningeal maxillofacial RMS. Histology was a major treatment determinant and the most important prognostic factor.
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Affiliation(s)
- Ioannis Iatrou
- University Department of Oral and Maxillofacial Surgery at 'A. & P. Kyriakou' Children's Hospital of Athens, Dental School, University of Athens, Thivon and Levadias Str, 11527, Ampelokipi, Athens, Greece
| | - Nadia Theologie-Lygidakis
- University Department of Oral and Maxillofacial Surgery at 'A. & P. Kyriakou' Children's Hospital of Athens, Dental School, University of Athens, Thivon and Levadias Str, 11527, Ampelokipi, Athens, Greece
| | - Ourania Schoinohoriti
- University Department of Oral and Maxillofacial Surgery at 'A. & P. Kyriakou' Children's Hospital of Athens, Dental School, University of Athens, Thivon and Levadias Str, 11527, Ampelokipi, Athens, Greece.
| | - Fotis Tzermpos
- University Department of Oral and Maxillofacial Surgery at 'A. & P. Kyriakou' Children's Hospital of Athens, Dental School, University of Athens, Thivon and Levadias Str, 11527, Ampelokipi, Athens, Greece
| | - Anna-Maria Vessala
- University Department of Oral and Maxillofacial Surgery at 'A. & P. Kyriakou' Children's Hospital of Athens, Dental School, University of Athens, Thivon and Levadias Str, 11527, Ampelokipi, Athens, Greece
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