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Liu L, Shi L, Su Y, Wang K, Wang H. Epidemiological features of spinal intradural tumors, a single-center clinical study in Beijing, China. BMC Musculoskelet Disord 2024; 25:613. [PMID: 39090624 PMCID: PMC11292946 DOI: 10.1186/s12891-024-07741-2] [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: 12/29/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Spinal intradural tumors are rare and heterogeneous in histological type, aggressiveness, and symptomatology, and there is a lack of data about them. This study investigated the epidemiological features of spinal intradural tumors. METHODS This retrospective analysis included patients with spinal intradural tumors who underwent surgical treatment at the Myelopathy and Spondylosis Ward Beijing Jishuitan Hospital between January 2012 and December 2022. RESULTS This study included 1321 patients [aged 47.19 ± 14.90 years, 603 (45.65%) males] with spinal intradural tumors. The most common histological subtype was schwannoma [n = 511 (38.68%)], followed by spinal meningioma [n = 184 (13.93%)] and ependymoma [n = 101 (7.65%)]. Fifteen (1.14%) patients were diagnosed with metastatic spinal intradural tumors as a presentation of another primary cancer type. The spinal intradural tumors were mostly found in the lumbar region [n = 436 (33.01%)], followed by the thoracic vertebrae [n = 390 (29.52%)], cervical vertebrae [n = 154 (11.66%)], and thoracolumbar region [n = 111 (8.40%)]. Schwannomas mostly affected the lumbar region [n = 256 (52.64%)], spinal meningiomas in the thoracic region [n = 153 (83.15)], and ependymomas in the lumbar region [56 (55.45%)]. The de novo metastases were mostly found in the lumbar region [n = 8 (53.33%)]. CONCLUSION According to the results of our single-center study, the most common spinal intradural tumor in Northern China is schwannoma, followed by spinal meningioma and ependymoma.
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Affiliation(s)
- Longqi Liu
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Liang Shi
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| | - Yibing Su
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Keda Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Hanbin Wang
- Department of Neurosurgery, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Xicheng District, Beijing, 100035, China
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Appasani S, Radhakrishnan N, Mathews A. Clinicopathological spectrum of central nervous system germ cell tumors: A single-institution retrospective study. INDIAN J PATHOL MICR 2024; 67:312-317. [PMID: 38394436 DOI: 10.4103/ijpm.ijpm_959_22] [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: 12/01/2022] [Accepted: 07/31/2023] [Indexed: 02/25/2024] Open
Abstract
CONTEXT Central nervous system germ cell tumors (CNSGCTs) though rare is the second most common extragonadal site for GCTs. AIMS To determine the clinicopathological features of CNSGCTs diagnosed at our center. SETTINGS AND DESIGN A retrospective study of all histologically diagnosed CNSGCTs, during 2006-2019. MATERIALS AND METHODS The patients' data were retrieved from the hospital information systems and analyzed. STATISTICAL ANALYSIS Data on categorical variables were analyzed as percentages, and data on continuous variables calculated as mean. Chi-square test or Fisher's exact test was used to study association between variables. RESULTS Of the total 34 cases with CNSGCT, age ranged from 1 to 27 years, majority in the second decade (19/34; 56%). Male: female (M: F) ratio was 1.6:1. Single site involvement was seen in 27 cases (27/34; 79%), whereas seven (7/34; 21%) showed bi/multifocal involvement. Among the unifocal cases, common sites involved were suprasellar (12/27; 44.4%), closely followed by the pineal (10/27; 37%). All multifocal tumors affected suprasellar compartment, being bifocal with pineal in four cases. A male gender predilection was noted among pineal region (9/10;90%) and multifocal tumors (5/7;71%). Germinoma was the commonest subtype (21/34; 61.8%) with male gender predilection (17/21; 81%) (M: F =4.3:1), with female predilection seen among mixed GCTs (MGCTs) (8/10; 80%) (M: F =1:4) and suprasellar location (M: F =1:2). Serum tumor markers (25 cases) and CSF markers (7 cases) were concordant with histology in all, except two cases. CONCLUSION Though histology and immunohistochemistry were diagnostic, correlation between serum and/or CSF marker was essential to rule out GCT component(s) that may be missed on biopsy due to sampling error.
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Affiliation(s)
- Sreelekha Appasani
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | | | - Anitha Mathews
- Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala, India
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Hoveyan J, Asatryan E, Grigoryan H, Hovsepyan S, Avagyan A, Hakobyan L, Sargsyan L, Iskanyan S, Avagyan M, Hovhannisyan S, Melnichenko I, Minasyan M, Papyan R, Manukyan N, Lazaryan A, Danelyan S, Muradyan A, Arakelyan J, Qaddoumi I, Boop F, Mkhitharyan A, Harutyunyan M, Tamamyan G, Bardakhchyan S. Trends in pediatric CNS tumors in Armenia: a multicenter retrospective study. Childs Nerv Syst 2024; 40:435-444. [PMID: 37837453 DOI: 10.1007/s00381-023-06179-6] [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: 08/14/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Central nervous system (CNS) tumors are the most common solid malignancies in children worldwide, including in Armenia. The current study aims to analyze epidemiological data, treatment, and outcomes of children and young adults (≤25 years) with CNS tumors in Armenia during the last 26 years. METHODS We collected data from pediatric and young adult patients treated in selected sites in Armenia from 1st January 1995 to 31st December 2020. Incidence by sex, age at diagnosis, time from first complaints to diagnosis, histopathology results, treatment strategies, complications, and overall survival (OS) rates were calculated. RESULTS The multicenter data analysis revealed 149 patients with diagnosed primary CNS tumors over 26 years. Among them, 84 (56.4%) were male. The median age at diagnosis was 7 years (range, 3 months to 25 years), and the median time from the first complaints to diagnosis was 2 months (range, 1 week to 70 months). Medulloblastomas and other embryonal tumors (47), low-grade gliomas (32), and high-grade gliomas (22) were the most commonly diagnosed malignancies. Ependymomas, craniopharyngiomas, germ cell tumors, and other malignancies were observed in 22 patients. For 26 patients, no histopathological or radiological diagnosis was available. Follow-up information was available for 98 (65.8%) patients. The 5-year OS rate for the whole study group was 67.7%. CONCLUSION Consistent with international data, embryonal tumors, and gliomas were the most commonly diagnosed CNS malignancies in Armenia. Multimodal treatment was often not available in Armenia during the study period, especially for early cases.
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Affiliation(s)
- Julieta Hoveyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia.
- Immune Oncology Research Institute, Yerevan, Armenia.
| | - Eduard Asatryan
- Division of Neurosurgery, Department of Surgery, Wigmore Hospital for Children, Yerevan, Armenia
| | - Henrik Grigoryan
- Department of Pediatric Hematology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Shushan Hovsepyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Immune Oncology Research Institute, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Anna Avagyan
- Department of Pediatric Hematology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Lusine Hakobyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Lilit Sargsyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Samvel Iskanyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Manushak Avagyan
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Saten Hovhannisyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Irina Melnichenko
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Mariam Minasyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Ruzanna Papyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Immune Oncology Research Institute, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Narek Manukyan
- National Center of Oncology named after V. A. Fanarjyan, Yerevan, Armenia
| | - Armine Lazaryan
- Department of Radiation Oncology, National Center of Oncology named after V. A. Fanarjyan, Yerevan, Armenia
| | - Samvel Danelyan
- Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Armen Muradyan
- Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | | | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Frederick Boop
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Armen Mkhitharyan
- HistoGen Pathology Center, Yerevan, Armenia
- Department of Pathology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Martin Harutyunyan
- Adult's Solid Tumor Chemotherapy Department, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Gevorg Tamamyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Immune Oncology Research Institute, Yerevan, Armenia
- Department of Pediatric Hematology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Samvel Bardakhchyan
- Immune Oncology Research Institute, Yerevan, Armenia
- Adult's Solid Tumor Chemotherapy Department, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
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Yao B, Wang H, Wu X, Wang C, Tang T, An W, Zhu B. A system review of central nervous system tumors on children in China: epidemiology and clinical characteristics. BMC Cancer 2024; 24:138. [PMID: 38281032 PMCID: PMC10821253 DOI: 10.1186/s12885-024-11883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/15/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND Central nervous system (CNS) tumors are the most common solid tumors in children and the leading cause of cancer-related death in the latter. Currently, the incidence rate exceeds that of leukemia and ranks first in the incidence of malignant tumors in children. METHODS The epidemiological data on childhood CNS tumors were collected from the Chinese Cancer Registry Annual Report. The annual percent change (APC) of incidence and mortality-rate changes were estimated via Joinpoint regression. Due to a lack of pertinent data, we performed a system review on the clinical-pathological characteristics in Chinese publications. RESULTS There was no significant increase in the incidence rate (APC: -0.1, 95% CI: -1.5 to 1.3), but there was a significant increase in the mortality rate (APC: 1.8, 95% CI: 0.3 to 3.4) for childhood CNS tumors. In the subgroup analysis, there were significant increases in both the incidence and mortality rates in rural areas (APC in the incidence: 6.2, 95% CI: 2.4 to 10.2; APC in mortality: 4.4, 95% CI: 0.4 to 8.4). The most common location and type of childhood CNS were, respectively, the cerebral hemisphere (25.5%, 95% CI: 21.7% to 29.4%) and astrocytomas (26.8%, 95% CI: 23.9% to 29.6%). CONCLUSIONS The epidemiological trends, and the relevant prediction, highlighted the need to pay continual attention to childhood CNS tumors, and the clinicopathology evinced its own distinctive characteristics. Timely detection and effective treatment must be further promoted regarding childhood CNS tumors with a view to decreasing the disease burden, especially in rural areas.
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Affiliation(s)
- Bing Yao
- Department of Neurosurgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Hongying Wang
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110001, Liaoning Province, China
| | - Xiaomei Wu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Chenyu Wang
- Department of Library, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Tao Tang
- Department of Neurosurgery, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Wenxiu An
- Department of Medical Management, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China
| | - Bo Zhu
- Department of Cancer Prevention and Treatment, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, No. 44 Xiaoheyan Road, Dadong District, Shenyang, 110001, Liaoning Province, China.
- Department of Medical Management, Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, Liaoning Province, China.
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Nair R, Nayal B, Beedkar S, Menon G. "A tumour registry initiative". World Neurosurg X 2023; 20:100227. [PMID: 37456693 PMCID: PMC10344826 DOI: 10.1016/j.wnsx.2023.100227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Published literature on epidemiological profile of paediatric brain tumours in India is limited. Aim: To present a retrospective analysis of the histological spectrum of 158 paediatric age group central nervous system tumours operated in a single tertiary care hospital in Coastal South India between January 2015 and December 2021. Material and methods Retrospective analysis of the data regarding frequencies of various primary brain tumours among 158 paediatric patients (<18 years of age). The tumours were categorised according to the revised 4th edition of World Health Organization (WHO) classification of tumours of the Central Nervous system. Results Paediatric CNS constituted 8.5% of total intracranial tumours (158/1860) operated in the study period. The mean age of the patients was 10.2 years and a definite male predominance was noted (1.54:1) Astrocytomas, glioneuronal tumours, and neuronal tumours constituted the majority (72/158; 45.6%) followed by embryonal tumours (31/158; 19.6%) and craniopharyngiomas(24/158; 15.4%).Of the glial neoplasms majority were pilocytic and other astrocytic tumours(41.6%), followed by mixed neuroglial tumours (19.4%), diffuse high grade astrocytomas (Grade III/IV) (11.1%), diffuse low -grade astrocytomas (Grade II) (9.7%) and ependymomas (13.8%). Our series also included six meningiomas (3.8%), five germ cell tumours (3.16%), four nerve sheath tumours (2.53%), two choroid plexus tumours (1.26%), two pineal parenchymal tumours (1.26%) and one metastasis from a soft tissue sarcoma from the thigh. Supratentorial tumours (58.2%) were more common than posterior fossa (34.6%) and spinal tumours (7.6%) and visual pathway gliomas accounted for 5.6% of all our tumours. Conclusions Paediatric central nervous system tumours are more common in boys and in the second decade of life. Astrocytomas are the most common paediatric brain tumours followed by medulloblastomas and craniopharyngiomas. Pediatric tumours affect the supratentorial compartment more often than the infratentorial compartment. The profile of paediatric brain tumours in our series is similar to that reported from other Indian centres as well as most western literature.
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Affiliation(s)
- Rajesh Nair
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Bhavna Nayal
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Saurabh Beedkar
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Barua N, Borah N, Haque I, Borah AL, Saikia BK, Barman A, Ahmed SA. A retrospective epidemiological study of the World Health Organization (WHO)-classified primary brain and other Central Nervous System (CNS) tumors from a tertiary health care center in Northeast India. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Abstract
Background
Brain and other central nervous systems (CNS) tumors are a heterogeneous group of neoplasms that are prevalent in all age groups and gender. The study aimed to investigate the pattern of distribution of World Health Organization (WHO) classified primary brain and other CNS tumors among different age groups and gender at a tertiary care center in Northeast India. This is the first study of CNS tumors from this region of the country. The data obtained can be useful for correct diagnosis, timely treatment, and management of CNS tumors in this area. It can also provide relevant information concerning research and funding for this disease. Data collection was done retrospectively from January 1996 to March 2022. Distribution frequency as per age, gender, histopathology type, and tumor location was estimated. Data analysis was performed using the SPSS software.
Results
A total of 1441 primary brain and other CNS tumors were examined in the study. There were 232 pediatric cases (16.1%) and 1209 adult cases (83.9%). The ratio of males to females was 1.4. The majority of the cases in the overall cohort were meningiomas (n = 346; 24%). Among the pediatric cohort, the maximum occurrence of gliomas, glioneuronal, and neuronal tumors (n = 68; 29.3%) was seen while meningiomas (n = 336; 27.8%) showed the highest prevalence in the adult cohort. There were 248 other distinct cases of CNS (17.2%) of which 62 (26.7%) were identified within the pediatric cohort and the remaining 186 (15.4%) were detected among the adult population. Most of the tumor sites was supratentorial areas (n = 759; 52.7%) with the next being spinal cord (n = 258; 18%).
Conclusion
This is the first study from Northeast India that highlights the prevalence of WHO-classified CNS tumors. With newer and advanced health care and diagnostic facilities, there is an increased incidence of CNS tumors in developing countries. Our study may help in understanding the epidemiological aspects and highlight the need for research, funding, and maintenance of a hospital-based tumor registry for this particular ailment.
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Yang W, Cai Y, Chen J, Yang P, Ying Z, Liang Y, Ling M, Zhu K, Sun H, Ji Y, Peng X, Zhang N, Ma W, Ge M. Epidemiological characteristics, clinical presentations, and prognoses of pediatric brain tumors: Experiences of national center for children's health. Front Oncol 2023; 13:1067858. [PMID: 36776329 PMCID: PMC9915562 DOI: 10.3389/fonc.2023.1067858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
Background We aimed to describe the epidemiological characteristics, clinical presentations, and prognoses in a national health center for children. Methods From January 2015 to December 2020, 484 patients aged 0-16 years, who were diagnosed with brain tumors and received neurosurgery treatment, were enrolled in the study. Pathology was based on the World Health Organization 2021 nervous system tumor classification, and tumor behaviors were classified according to the International Classification of Diseases for Oncology, third edition. Results Among the 484 patients with brain tumors, the median age at diagnosis was 4.62 [2.19, 8.17] years (benign tumors 4.07 [1.64, 7.13] vs. malignant tumors 5.36 [2.78, 8.84], p=0.008). The overall male-to-female ratio was 1.33:1(benign 1.09:1 vs. malignant 1.62:1, p=0.029). Nausea, vomiting, and headache were the most frequent initial symptoms. The three most frequent tumor types were embryonal tumors (ET, 22.8%), circumscribed astrocytic gliomas (20.0%), and pediatric-type diffuse gliomas (11.0%). The most common tumor locations were the cerebellum and fourth ventricle (38.67%), the sellar region (22.9%) and ventricles (10.6%). Males took up a higher proportion than females in choroid plexus tumors (63.6%), ET (61.1%), ependymal tumors (68.6%), and germ cell tumors (GCTs, 78.1%). Patients were followed for 1 to 82 months. The overall 5-year survival rate was 77.5%, with survival rates of 91.0% for benign tumors and 64.6% for malignant tumors. Conclusion Brain tumors presented particularly sex-, age-, and regional-dependent epidemiological characteristics. Our results were consistent with previous reports and might reflect the real epidemiological status in China.
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Affiliation(s)
- Wei Yang
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yingjie Cai
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jiashu Chen
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ping Yang
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Zesheng Ying
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuting Liang
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Miao Ling
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Kaiyi Zhu
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Hailang Sun
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Yuanqi Ji
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Xiaojiao Peng
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Nan Zhang
- Department of Pathology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Wenping Ma
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Ming Ge
- Department of Neurosurgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China,*Correspondence: Ming Ge,
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Harris MK, Graham RT, Cappellano AM, Margol AS, Michaiel G, Crawford JR, Ioakeim-Ioannidou M, Stanek JR, Liu KX, MacDonald SM, Abdelbaki MS. Multi-institutional analysis of central nervous system germ cell tumors in patients with Down syndrome. Pediatr Blood Cancer 2022; 69:e29830. [PMID: 35686831 DOI: 10.1002/pbc.29830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/03/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Primary germ cell tumors (GCTs) are the most common central nervous system (CNS) neoplasm in patients with Down syndrome (DS). However, a standard of care has not been established due to paucity of data. METHODS A retrospective multi-institutional analysis was conducted, in addition to a comprehensive review of the literature. RESULTS Ten patients from six institutions (five USA, one Brazil) were identified, in addition to 31 patients in the literature from 1975 to 2021. Of the 41 total patients (mean age 9.9 years; 61% male), 16 (39%) had non-germinomatous germ cell tumors (NGGCTs), 16 (39%) had pure germinomas, and eight (19.5%) had teratomas. Basal ganglia was the most common tumor location (n = 13; 31.7%), followed by posterior fossa (n = 7; 17%). Nine patients (22%) experienced disease relapse or progression, of which four died from tumor progression (one germinoma, three teratomas). Sixteen patients (39%) experienced treatment-related complications, of which eight (50%) died (five germinomas, three NGGCTs). Of the germinoma patients, two died from chemotherapy-related sepsis, one from postsurgery cardiopulmonary failure, one from pneumonia, and one from moyamoya following radiation therapy (RT). Of the NGGCT patients, one died from chemotherapy-related sepsis, one from postsurgical infection, and one from pneumonia following surgery/chemotherapy/RT. Three-year overall survival was 66% for all histological types: 62% germinomas, 79% for NGGCTs, and 53% for teratomas. CONCLUSION Patients with DS treated for CNS GCTs are at an increased risk of treatment-related adverse events. A different therapeutic approach may need to be considered to mitigate treatment-related complications and long-term neurocognitive sequelae.
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Affiliation(s)
- Micah K Harris
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Richard T Graham
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Andréa M Cappellano
- Pediatric Oncology, IOP-GRAACC/Federal University of São Paulo, São Paulo, Brazil
| | - Ashley S Margol
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - George Michaiel
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - John R Crawford
- Department of Neurology, Children's Health Orange County, Orange, California, USA
| | | | - Joseph R Stanek
- The Division of Hematology, Oncology, Blood and Marrow Transplant, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Kevin X Liu
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mohamed S Abdelbaki
- The Division of Hematology and Oncology, St. Louis Children's Hospital, Washington University, School of Medicine in St. Louis, Washington University, St. Louis, Missouri, USA
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9
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Chen Z, Tian F, Chen X. Cost-Effectiveness Analysis of a Three-Drug Regimen Containing Bevacizumab for the Treatment of Recurrent Pediatric Medulloblastoma in China: Based on a COG Randomized Phase II Screening Trial. Front Public Health 2022; 10:914536. [PMID: 35719637 PMCID: PMC9201059 DOI: 10.3389/fpubh.2022.914536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023] Open
Abstract
Background Medulloblastoma is the most common malignant brain tumor of childhood, accounting for 6 to 7 percent of all childhood CNS tumors. The purpose of this study was to evaluate the economic efficacy of a bevacizumab combined with temozolomide + irinotecan regimen for the treatment of recurrent pediatric medulloblastoma in China. Methods The data analyzed were from a randomized phase II screening trial that showed an improved survival benefit in child patients with recurrent medulloblastoma treated with a T+I+B combination regimen. A Markov model is constructed to estimate the incremental cost–effectiveness ratio (ICER) from the perspective of Chinese society. The uncertainty in the model is solved by one-way certainty and probabilistic sensitivity analysis. Results Our base case analysis showed that the total costs of treatment increased from $8,786.403 to $27,603.420 with the combination bevacizumab vs. the two-agent chemotherapy regimen. Treatment with T+I+B combination therapy was associated with an increase in effectiveness of 0.280 QALYs from 0.867 to 1.147 QALYs T+I regimen. The incremental cost-effectiveness ratio was $67,203.632/QALY, which exceeded our pre-specified willingness-to-pay threshold ($38,136.26/QALY). Cost changes associated with grade 3–4 AE management, tests used, or hospitalization costs had little effect on the ICER values predicted by sensitivity analysis. Conclusions Taken together, the results of this study suggest that the combination of bevacizumab with temozolomide and irinotecan is not a cost-effective option from the perspective of Chinese payers as a first-line treatment option for children with recurrent medulloblastoma in China.
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Affiliation(s)
- Zhaoyan Chen
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Fangyuan Tian
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Chen
- Department of Integrated Care Management Center, West China Hospital, Sichuan University, Chengdu, China
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10
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Liu ZM, Liao CY, Zhang H, Han Z, Wang JM, Ma ZY, Li CD, Gong J, Liu W, Sun T, Tian YJ. Epidemiological characteristics of central nervous system tumors in children: a 5-year review of 3180 cases from Beijing Tiantan Hospital. Chin Neurosurg J 2022; 8:11. [PMID: 35550659 PMCID: PMC9096059 DOI: 10.1186/s41016-022-00279-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 04/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background To describe the epidemiological characteristics of central nervous system (CNS) tumors in children, based on the neurosurgery department of Beijing Tiantan Hospital. Methods From January 2015 to December 2019, 3180 children were histopathologically diagnosed with CNS tumors based on the 2016 World Health Organization (WHO) classification of tumors. Patients were 0 to 15 years old. We analyzed age-related gender preferences, tumor locations, and the histological grades of the tumors. In addition, the epidemiological characteristics of the five most common intracranial tumors were compared to the previous studies. Results In this study, intracranial and spinal tumors account for 96.4% (3066) and 3.6% (114) of all tumors, with a preponderance of supratentorial tumors (57.9%). Among all pediatric patients, low-grade tumors comprise 67.1% (2 135). The integral gender ratio of males to females is 1.47: 1 and the average age of patients is 7.59 years old. The five most common intracranial tumors are craniopharyngioma (15.4%), medulloblastoma (14.3%), pilocytic astrocytoma (11.8%), diffuse astrocytoma (9.8%), and anaplastic ependymoma (4.8%). Conclusions Due to the lack of national data on childhood brain tumors, we used a large nationally representative population sample based on the largest pediatric neurosurgery center in China. We analyzed the data of the past 5 years, reflecting the incidence of CNS tumors in Chinese children to a certain extent, and laying a data foundation for subsequent clinical studies. Supplementary Information The online version contains supplementary material available at 10.1186/s41016-022-00279-z.
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Affiliation(s)
- Zhi-Ming Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Chih-Yi Liao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Heng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Zhe Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Jun-Mei Wang
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhen-Yu Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Chun-de Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Jian Gong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Wei Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Tao Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Yong-Ji Tian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China.
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11
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Wang G, Jia Y, Ye Y, Kang E, Chen H, Wang J, He X. Clinical and Epidemiological Study of Intracranial Tumors in Children and Identification of Diagnostic Biomarkers for the Most Common Tumor Subtype and Their Relationship with the Immune Microenvironment Through Bioinformatics Analysis. J Mol Neurosci 2022; 72:1208-1223. [PMID: 35347632 DOI: 10.1007/s12031-022-02003-z] [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: 02/11/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
Brain tumors are the second most common pediatric malignancy and have poor prognosis. Understanding the pathogenesis of tumors at the molecular level is essential for clinical treatment. We conducted a retrospective study on the epidemiology of brain tumors in children based on clinical data obtained from a neurosurgical center. After identifying the most prevalent tumor subtype, we identified new potential diagnostic biomarkers through bioinformatics analysis of the public database. All children (0-15 years) with brain tumors diagnosed histopathologically between 2010 and 2020 at the Department of Neurosurgery, Xijing Hospital, were reviewed retrospectively for age distribution, sex predilection, native location, tumor location, symptoms, and histological grade, and identified the most common tumor subtypes. Two datasets (GSE44971 and GSE44684) were downloaded from the Gene Expression Omnibus database, whereas the GSE44971 dataset was used to screen the differentially expressed genes between normal and tumor samples. Gene ontology, disease ontology, and gene set enrichment analysis enrichment analyses were performed to investigate the underlying mechanisms of differentially expressed genes in the tumor. Combined with methylation data in the GSE44684 dataset, we further analyzed the correlation between methylation and gene expression levels. Two algorithms, LASSO and SVM-RFE, were used to select the hub genes of the tumor. The diagnostic value of the hub genes was assessed using the receiver operating characteristic (ROC) curve. Finally, we further evaluated the relationship between the hub gene and the tumor microenvironment and immune gene sets. Overall, 650 children from 18 provinces in China were included in this study. The male-to-female ratio was 1.41:1, and the number of patients reached a peak in the 10-15-year-old group (41.4%).The most common symptoms we encountered in our institute were headache and dizziness 250 (28.2%), and nausea and vomiting 228 (25.7%). The predominant location is supratentorial, with a supratentorial to infratentorial ratio of 1.74:1. Low-grade tumors (WHO I/II) constituted 60.9% of all cases and were predominant in every age group. According to basic classification, the most common tumor subtype is pilocytic astrocytoma (PA). A total of 3264 differentially expressed genes were identified in the GSE44971 dataset, which are mainly involved in the process of neural signal transduction, immunity, and some diseases. Correlation analysis indicated that the expression of 45 differentially expressed genes was negatively correlated with promoter DNA methylation. Next, we acquired five hub genes (NCKAP1L, GPR37L1, CSPG4, PPFIA4, and C8orf46) from the 45 differentially expressed genes by intersecting the LASSO and SVM-RFE models. The ROC analysis revealed that the five hub genes had good diagnostic value for patients with PA (AUC > 0.99). Furthermore, the expression of NCKAP1L was negatively correlated with immune, stromal, and estimated scores, and positively correlated with immune gene sets. This study, based on the data analysis of intracranial tumors in children in a single center over the past 10 years, reflected the clinical and epidemiological characteristics of intracranial tumors in children in Northwest China to a certain extent. PA is considered the most common subtype of intracranial tumors in children. Through bioinformatics analysis, we suggested that NCKAP1L, GPR37L1, CSPG4, PPFIA4, and C8orf46 are potential biomarkers for the diagnosis of PA.
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Affiliation(s)
- Guanyi Wang
- Department of Neurosurgery, Xijing Hospital, Airforce Military Medical University (Fourth Military Medical University), Xi'an, 710032, China
| | - Yibin Jia
- Department of Neurosurgery, Xijing Hospital, Airforce Military Medical University (Fourth Military Medical University), Xi'an, 710032, China
| | - Yuqin Ye
- Department of Neurosurgery, Xijing Hospital, Airforce Military Medical University (Fourth Military Medical University), Xi'an, 710032, China.,Department of Neurosurgery, PLA 163Rd Hospital (Second Affiliated Hospital of Hunan Normal University), Changsha, 410000, China
| | - Enming Kang
- Department of Neurosurgery, Xijing Hospital, Airforce Military Medical University (Fourth Military Medical University), Xi'an, 710032, China
| | - Huijun Chen
- Department of Neurosurgery, Xijing Hospital, Airforce Military Medical University (Fourth Military Medical University), Xi'an, 710032, China
| | - Jiayou Wang
- Department of Neurosurgery, Xijing Hospital, Airforce Military Medical University (Fourth Military Medical University), Xi'an, 710032, China
| | - Xiaosheng He
- Department of Neurosurgery, Xijing Hospital, Airforce Military Medical University (Fourth Military Medical University), Xi'an, 710032, China.
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12
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Lamba N, Groves A, Torre M, Yeo KK, Iorgulescu JB. The epidemiology of primary and metastatic brain tumors in infancy through childhood. J Neurooncol 2022; 156:419-429. [PMID: 35037155 DOI: 10.1007/s11060-021-03927-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the epidemiology of primary and metastatic pediatric brain tumors in the United States according to the WHO CNS 4th and 5th editions classifications. METHODS Pediatric patients (age ≤ 14) presenting between 2004 and 2017 with a brain tumor were identified in the National Cancer Database and categorized by NICHD age stages. Patients' age, sex, race/ethnicity, overall survival, and tumor characteristics were evaluated according to WHO CNS 4th and 5th editions. RESULTS 23,978 pediatric brain tumor patients were identified. Overall, other (i.e. circumscribed) astrocytic gliomas (21%), diffuse astrocytic/oligodendroglial gliomas (21%; 64% of which were midline), and embryonal tumors (16%) predominated. A minority of brain tumors were of ependymal (6%), glioneuronal & neuronal (6%), germ cell tumor (GCT; 4%), mesenchymal non-meningothelial (2%), cranial nerve (2%), choroid plexus (2%), meningioma (2%), pineal (1%), and hematolymphoid (0.4%) types. GCTs were more likely in patients of Asian/Pacific Islander race/ethnicity. Brain metastases were exceedingly rare, accounting for 1.4% overall, with the most common primary tumor being neuroblastoma (61%) and non-CNS sarcoma (16%). Brain metastatic, choroid plexus, and embryonal tumors peaked during infancy and toddlerhood; whereas diffuse gliomas peaked in middle-late childhood. GCTs and glioneuronal & neuronal tumors uniquely displayed bimodal distributions, with elevated prevalence in both infancy and middle-to-late childhood. CONCLUSION We systematically described the epidemiology of pediatric brain tumors in the context of contemporary classification schema, thereby validating our current understanding and providing key insights.
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Affiliation(s)
- Nayan Lamba
- Department of Radiation Oncology, Harvard Medical School, Boston, MA, United States of America
| | - Andrew Groves
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, United States of America
| | - Matthew Torre
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, United States of America
| | - Kee Kiat Yeo
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, United States of America
| | - J Bryan Iorgulescu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA, 02115, United States of America.
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13
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Krishnanswamy R, Rajendran J. Histomorphological spectrum of pediatric supratentorial CNS tumors: A 3-year retrospective study in a tertiary care center. J Pediatr Neurosci 2021; 16:199-205. [PMID: 36160612 PMCID: PMC9496602 DOI: 10.4103/jpn.jpn_88_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 12/02/2022] Open
Abstract
Objective: Central nervous system (CNS) tumors are the second most common neoplasms in children and they differ from their adult counterparts in terms of incidence, topography, clinical features, histology, and outcome. This article analyzes the incidence of supratentorial tumors, various histopathological entities, and their characteristics in pediatric patients <18 years of age. Materials and Methods: This was a retrospective study conducted at the Department of Neuropathology, Institute of Neurosurgery, MMC/RGGGH Chennai from January 2017 to December 2019. Data of supratentorial tumors in children less than 18 years of age procured and their histomorphological profile were analyzed. Results: In our institution, of a total of 1134 CNS and spinal neoplasms, 117 pediatric intracranial and 7 spinal neoplasms were reported and the incidence of supratentorial pediatric tumors was 44.44% (52 cases). Among which intraaxial tumors account for 38.46% with 20 cases, extraaxial tumors 51.92% with 27 cases, and intraventricular tumors 9.61% with five reported cases. Most common tumors reported were astrocytomas, craniopharyngioma, followed by ependymoma among others Conclusion: Though posterior fossa neoplasms are more common in children, supratentorial tumors show a rising trend worldwide in the pediatric population. Our study gives an overview of the incidence and histopathological profile of supratentorial CNS tumors.
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14
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Chang HY, Chiu CF, Jung SM, Wong AMC, Wu CT, Lo FS. Neurological and endocrinological manifestations of 49 children with intracranial pure germinoma at initial diagnosis in Taiwan. Pediatr Neonatol 2021; 62:106-112. [PMID: 33218934 DOI: 10.1016/j.pedneo.2020.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/16/2020] [Accepted: 07/27/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Intracranial pure germinoma is a rare extragonadal neoplasm. Affected patients may have motor impairment, visual disturbance, neurological signs, and endocrine disorder, depending on the size and location of the tumor. This study investigated and analyzed patients' demographic data and neuroimaging, clinical, laboratory, and endocrinological findings. METHODS We performed a retrospective chart review of 49 children diagnosed with pure germinoma in Taiwan from 1990 to 2018. The initial clinical presentation, tumor markers (beta-hCG, alpha fetoprotein, and carcinoembryonic antigen), pituitary function, and brain images were reviewed and analyzed. RESULTS This study included 49 patients (37 boys and 12 girls). Their ages ranged from 7.5 to 17.9 years, and the mean age at diagnosis was 13.6 years. Initial symptoms included visual disturbance (n = 23, 47.9%), motor impairment (n = 20, 40.8%), polyuria (n = 20, 40.8%), headache (n = 17, 34.7%), dizziness or vertigo (n = 14, 28.6%), nausea/vomiting (n = 13, 26.5%), and short stature (n = 8, 18.2%). Laboratory data indicated growth hormone deficiency or low IGF-1 levels (n = 18, 85.7%), adrenal insufficiency (n = 21, 77.8%), central diabetes insipidus (n = 27, 55.1%), central hypothyroidism (n = 15, 48.4%), and hypogonadotropic hypogonadism (n = 4, 44.4%). CONCLUSION Intracranial pure germinomas may initially manifest as neurological symptoms or endocrinological findings at diagnosis. As endocrinologic presentation is related to delayed diagnosis, clinicians should be aware of patients with such complaints. Laboratory data should be surveyed carefully, and neuroimaging must be considered if the result is abnormal.
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Affiliation(s)
- Hsin-Yuan Chang
- Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Chiao-Fan Chiu
- Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Shih-Ming Jung
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Alex Mun-Ching Wong
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung/Linkou, and Chang Gung University, Taiwan
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Fu-Sung Lo
- Division of Pediatric Endocrinology and Genetics, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan.
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15
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Ham EI, Kim J, Kanmounye US, Lartigue JW, Gupta S, Esene IN, Park KB. Cohesion Between Research Literature and Health System Level Efforts to Address Global Neurosurgical Inequity: A Scoping Review. World Neurosurg 2020; 143:e88-e105. [PMID: 32673809 DOI: 10.1016/j.wneu.2020.06.237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research output on global neurosurgery (GNS) has exponentially increased in recent years. As research efforts increase, we must first analyze how the current body of GNS literature fits into the macroscopic schema of systems-based policies. The aim of this study was to identify and categorize GNS research based on health system domains. METHODS PubMed, CINAHL, and Embase were searched for GNS literature published from 1999 to 2019. Then, health system domains were defined and itemized based on publicly available documents from the Program in Global Surgery and Social Change. This items chart was subsequently used to categorize the GNS literature into health system domains. RESULTS A total 63 articles were determined to focus on a health system domain. Of these articles, 6 focused on multiple domains, yielding an adjusted total of 70 articles. Overall, the most represented health system domain was service delivery (21 articles), followed by workforce (19), infrastructure (15), financing (12) and information management (3). A total of 30 low- and middle-income countries (LMICs) were represented across all articles. In addition, the first author was affiliated with an institution from a high-income country for 71.4% of the articles. CONCLUSIONS This review highlighted the pressing need for more research into information management in the context of GNS. In addition, health system-focused GNS literature represented only 20% of all LMICs (30/143). The trends in authorship should be noted, because many ethical (and practical) issues may arise if there is a disconnect in the objectives of the authors and the neurosurgeons in LMICs.
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Affiliation(s)
- Edward I Ham
- Stony Brook School of Medicine, Stony Brook, New York, USA; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA.
| | | | - Ulrick Sidney Kanmounye
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Jean Wilguens Lartigue
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Saksham Gupta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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16
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Borde TD, Arimappamagan A, Srinivas D, Narasinga Rao KVL, Devi BI, Somanna S, Santosh V. Intracranial Germ Cell Tumors: Spectrum of Disease in an Indian Cohort and Management Strategies. J Neurosci Rural Pract 2019; 9:291-297. [PMID: 30069081 PMCID: PMC6050793 DOI: 10.4103/jnrp.jnrp_86_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Germ cell tumors (GCTs) represent approximately 3% of primary pediatric brain tumors in the West, whereas in Asia, they constitute between 8% and 15% of pediatric brain tumors. Methods: We retrospectively studied all patients with intracranial GCT managed at our institute from January 1998 to December 2013. The clinical data and radiological data were analyzed. Results: Forty-eight patients with intracranial GCT including 36 males and 16 females formed the cohort. The proportion of GCT in our study was 0.29%. The mean age was 16.5 ± 2.5 years. Germinomas constituted 56.3% and nongerminomatous GCTs constituted 43.7% of all the tumors. The most common location was posterior third ventricle (58.3%) followed by suprasellar (22.9%). Histopathological diagnosis was obtained in almost all patients (96%). Surgical procedures included tumor decompression (71.7%), stereotactic biopsy (13%), and endoscopic third ventriculostomy and biopsy (15%). Patient's age, location of the tumor, and histology did not influence the survival. Women with GCTs had poorer survival when compared to men. Conclusions: The present study documented a lower hospital-based incidence of GCT in Indian cohort. A multidisciplinary approach including surgical strategy based on location, appropriate radiation planning, and chemotherapy is needed for effective treatment and improved outcomes.
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Affiliation(s)
- Tushar Deepak Borde
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K V L Narasinga Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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17
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Mehta DP, Anand AS, Patel D, Trivedi P, Panchal H, Patel A, Shah SA. Demographic and Histopathologic Profile of Pediatric Patients with Primary Brain Tumors Attending a Regional Cancer Center. Indian J Med Paediatr Oncol 2019. [DOI: 10.4103/ijmpo.ijmpo_137_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Background: Primary brain tumors (PBTs) are the most common solid childhood malignancies. However, epidemiologic profile of these tumors is scarce in developing nation like India. Objective of Study: The objective of this study was to study the demographic and histopathologic profile of pediatric patients with PBTs residing in Gujarat, and attending the Gujarat Cancer and Research Institute, Ahmedabad. Materials and Methods: Data regarding age, gender, anatomical site, and histopathology (according to the World Health Organization classification) of 242 patients with brain tumors (0–18 years) operated over 10 years (January 2006 to December 2015) were collected retrospectively, and analyzed. Results: Of total 242 patients with PBTs, 78.1% were from 5 to 14 years age group with the mean age being 9.38 ± 3.82 years (95% confidence interval). Brain tumors were more common in males (64.1%) as compared to females (35.9%) with a male-to-female ratio of 1.78:1. The most common anatomical site was cerebellum (46.3%), followed by cerebral hemispheres (14.1%). Infratentorial tumors (60.9%) were predominant than supratentorial tumors (39.1%) in 0–14 years age group while supratentorial tumors (58.3%) were predominant than infratentorial tumors (41.7%) in 15–18 years age group. Astrocytic tumors (38.9%) and embryonal tumors including medulloblastomas, supratentorial primitive neuroectodermal tumors, and atypical teratoid/rhabdoid teratomas (34.7%) were the most common histological subtypes comprising three-quarters of all tumors. Ependymomas (16.1%) and craniopharyngiomas (5%) were third and fourth most common tumors, respectively. Among astrocytic tumors, 71.3% were of lower grade histology (Grade I and II). Conclusions: Astrocytomas and medulloblastomas, which form the major histologic subtypes in children residing in Gujarat, needs special attention with respect to the distribution of infrastructure and resources. Histopathological profiles of cohort in this study do not differ substantially from other hospital-based and population-based studies.
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Affiliation(s)
- Dhruv Pankaj Mehta
- Departments of Medical and Paediatric Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Asha S Anand
- Departments of Medical and Paediatric Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Dipak Patel
- Departments of Neurosurgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Priti Trivedi
- Departments of Pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Harsha Panchal
- Departments of Medical and Paediatric Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Apurva Patel
- Departments of Medical and Paediatric Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
| | - Sandip A Shah
- Departments of Medical and Paediatric Oncology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
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18
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Elhassan MMA, Mohamedani AA, Osman HHM, Yousif NO, Elhaj NM, Qaddoumi I. Patterns, treatments, and outcomes of pediatric central nervous system tumors in Sudan: a single institution experience. Childs Nerv Syst 2019; 35:437-444. [PMID: 30610484 DOI: 10.1007/s00381-018-04032-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/17/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Studies of epidemiology, treatment modalities, and outcomes of childhood central nervous system (CNS) tumors in Sudan are scarce. To address this shortcoming, we evaluated baseline information about the epidemiology, treatment types, and outcomes of childhood CNS tumors at the National Cancer Institute, University of Gezira (NCI-UG) in Wad Madani, Sudan. METHODS We performed a retrospective health facility-based study of children with CNS tumors who were treated at the NCI-UG from January 2000 to December 2015. RESULTS A total of 62 (5.4% of all childhood cancers) pediatric patients with CNS tumors were identified over the study period. Tumors were more common among male children and involved the infratentorial compartment in 58% of cases. The median age at diagnosis was 9 years (range, 2-14 years). Approximately 60% (n = 37) of the study population had histology-determined diagnoses. Astrocytomas and medulloblastomas were the most common tumors in these cases. The mean time to diagnosis was 6 months (SD, 9). During the study period, the number of children with CNS tumors who were referred for treatment at the NCI-UG increased every year. Of the 37 patients who received surgical interventions, 8 received gross total resections, 20 received partial resections, and 24 received postoperative radiotherapy. The treatment abandonment rate was 11%. The 2-year and 5-year survival rates were 33% and 13%, respectively. CONCLUSION Our findings reveal a high incidence of poor outcomes for patients with CNS tumors in Sudan, which is most likely due to many distinct factors.
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Affiliation(s)
- M Mohammed Ali Elhassan
- Department of Oncology, National Cancer Institute, University of Gezira, PO Box 20, Wad Madani, Sudan.
| | - A Abdalla Mohamedani
- Department of Pathology, Faculty of Medicine, University of Gezira, Wad Madani, Sudan
| | | | - N Osman Yousif
- Department of Oncology, National Cancer Institute, University of Gezira, PO Box 20, Wad Madani, Sudan
| | - N Mohamed Elhaj
- Department of Oncology, National Cancer Institute, University of Gezira, PO Box 20, Wad Madani, Sudan
| | - I Qaddoumi
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
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Govindan A, Parambil RM, Alapatt JP. Pediatric Intracranial Tumors over a 5-Year Period in a Tertiary Care Center of North Kerala, India: A Retrospective Analysis. Asian J Neurosurg 2018; 13:1112-1117. [PMID: 30459878 PMCID: PMC6208207 DOI: 10.4103/ajns.ajns_251_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Pediatric brain tumors are unique in terms of distribution, clinical presentation, pathologic types, management, and prognosis. There are not many studies from India which have looked into the epidemiology of pediatric brain tumors. Aims: This study aimed to analyze the epidemiology of pediatric brain tumors in North Kerala and compare it with data from the rest of India and other countries. Materials and Methods: This is a retrospective study of 5-year data of pediatric brain tumors which were operated in a tertiary referral center in North Kerala, India, from 2009 to 2013. The data were procured from the departments of neurosurgery and pathology of the institution. The data were tabulated and analyzed using SPSS software. Results: A total of 71 children had histologically proven brain tumors during the 5-year period. There were 34 boys and 37 girls. Distribution in different age groups was as follows: infancy –5 (7%), 1–5 years –22 (31%), 6–10 years – 21 (29.6%), and 11–18 years – 23 (32.4%). The most common tumors were primitive neuroectodermal tumors (PNETs). In infancy, the number of high-grade tumors was more, whereas in the 11–18 years’ age group, there were a significantly higher number of low-grade tumors (P = 0.04). Discussion: Pediatric brain tumors were distributed almost equally in both sexes. PNET was the most common. We could not get statistical significance in many of our values due to small sample size. Conclusion: This study highlights the need for diligent collection of data and maintenance of a registry for brain tumors to study the disease in the Indian population.
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Affiliation(s)
- Aparna Govindan
- Department of Pathology, Government Medical College, Kozhikode, Kerala, India
| | | | - Jacob Paul Alapatt
- Department of Neurosurgery, Government Medical College, Kozhikode, Kerala, India.,Department of Neurosurgery, Aster MIMS Hospital, Kozhikode, Kerala, India
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Shirazi N, Gupta M, Bhat NK, Kalra BP, Kumar R, Saini M. Profile of Primary Pediatric Brain and Spinal Cord Tumors from North India. Indian J Med Paediatr Oncol 2017; 38:10-14. [PMID: 28469330 PMCID: PMC5398098 DOI: 10.4103/0971-5851.203514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The study was carried out to find the profile of pediatric brain and spinal cord tumors during 2006-2015 in a tertiary referral center of North India. MATERIALS AND METHODS It was a retrospective medical record-based observational study. All children <18 years of age with confirmed histopathological diagnosis of cancer were included in the study. RESULTS Central nervous system (CNS) tumors constituted 5.6% of all pediatric solid malignancies in our hospital. A total of 54 brain tumors and 13 spinal cord tumors were studied. Medulloblastoma was the most common brain tumor (20.3%) followed by pilocytic astrocytoma (16.6%) and glioblastoma multiforme (9.2%). The most common spinal cord tumor was Ewing's sarcoma/primitive neuroectodermal tumor (30.7%) followed by ependymoma (23%). Mean age was 10.5 years and 12.1 years for brain and spinal cord tumors, respectively. There was male predominance in brain tumors while the sex ratio was almost equal in spinal cord tumors. Histomorphologically, necrosis and angiogenesis were associated with higher grades of tumor. Approximately 35% children were alive after a mean follow-up of 36 ± 6 months. CONCLUSION Compared with most international studies, we found a higher percentage of medulloblastoma in the brain, thus stressing the role of regional and ethnic influences in the pathogenesis of CNS tumors.
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Affiliation(s)
- Nadia Shirazi
- Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Meenu Gupta
- Department of Radiation Oncology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Nowneet Kumar Bhat
- Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Braham Prakash Kalra
- Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Ranjit Kumar
- Department of Neurosurgery, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Manju Saini
- Department of Radiodiagnosis, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Suresh SG, Srinivasan A, Scott JX, Rao SM, Chidambaram B, Chandrasekar S. Profile and Outcome of Pediatric Brain Tumors - Experience from a Tertiary Care Pediatric Oncology Unit in South India. J Pediatr Neurosci 2017; 12:237-244. [PMID: 29204198 PMCID: PMC5696660 DOI: 10.4103/jpn.jpn_31_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Tumors of the central nervous system (CNS) constitute the second most common pediatric cancers. Unlike leukemia, management of CNS tumors requires a good multidisciplinary team. Higher rates of treatment abandonment are documented in view of complexity of the treatment with long duration, involving neurosurgery, radiation, chemotherapy, and high cost of treatment. Morbidity associated with CNS tumors may be significant in terms of physical deficits as well as neuropsychological and neuroendocrine sequelae. Pediatric neurooncology is still at a very nascent stage in the developing countries. There are only a few reports on the multidisciplinary approach and outcomes of pediatric brain tumors in developing countries. Aims The aim of this study is to identify the clinicopathological profile of Pediatric CNS tumors in a tertiary care center located in South India in comparison with reports from other low-and middle-income Countries. Settings and Design A retrospective analysis of medical records of all children diagnosed with brain tumors from January 2012 to November 2016 at our institute was done. Subjects and Methods A retrospective study of clinical, pathological profile, and outcomes of children <18 years diagnosed with brain tumors at our institute from January 2012 to November 2016 was done. Histopathological categorization was done as per the WHO classification 2007. The multidisciplinary treatment with respect to surgery, radiation, and chemotherapy was noted and the outcomes were recorded. Statistical Analysis Used R for Statistical Computing (Version 3.0.2; 2013-09-25). Results A total of 52 children were diagnosed with male preponderance of 66.6%. Highest incidence was noted in the age group of 0-4 years (50%). Majority of them were supratentorial (59.6%). CNS embryonal tumors contributed to 48% of all our brain tumors. 73% of them underwent either resection or biopsy. Eight (15.3%) of them died due to the progression of disease, but 44% abandoned treatment due to the progression/recurrence of disease. Those lost to follow-up were mostly among the high-risk groups with poor prognosis such as pontine glioma, medulloblastoma (high risk), and primitive neuroectodermal tumor. Conclusions Although brain tumors constituted 30% of all our solid tumors, only 56% of them received appropriate treatment and 25% abandoned treatment. High rates of abandonment were a consequence of late diagnosis, complex multidisciplinary treatment involved, high treatment cost, lack of uniformity in management between different oncology centers and poor prognosis of the tumor subtype.
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Affiliation(s)
- Supriya Gujjar Suresh
- Department of Pediatric Hematology and Oncology, Kanchi Kamakoti CHILDS Trust Hospital and the CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Arathi Srinivasan
- Department of Pediatric Hematology and Oncology, Kanchi Kamakoti CHILDS Trust Hospital and the CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Julius Xavier Scott
- Department of Pediatric Hematology and Oncology, Kanchi Kamakoti CHILDS Trust Hospital and the CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Santosh Mohan Rao
- Department of Pediatric Neurosurgery, Kanchi Kamakoti CHILDS Trust Hospital and the CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Balasubramaniam Chidambaram
- Department of Pediatric Neurosurgery, Kanchi Kamakoti CHILDS Trust Hospital and the CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Sanjay Chandrasekar
- Department of Radiation-Oncology, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
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Kakkar A, Biswas A, Kalyani N, Chatterjee U, Suri V, Sharma MC, Goyal N, Sharma BS, Mallick S, Julka PK, Chinnaswamy G, Arora B, Sridhar E, Chatterjee S, Jalali R, Sarkar C. Intracranial germ cell tumors: a multi-institutional experience from three tertiary care centers in India. Childs Nerv Syst 2016; 32:2173-2180. [PMID: 27476038 DOI: 10.1007/s00381-016-3167-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/04/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Central nervous system germ cell tumors (CNS GCTs) are relatively rare neoplasms. Incidence of CNS GCTs in Western literature is low (0.3-0.6 %) as compared to East Asia (3-4 %). No large study is available on CNS GCTs from India. METHODS Intracranial GCT cases were retrieved from databases of three tertiary care institutes in India; clinicopathological data was reviewed. RESULTS Ninety-five intracranial GCT cases were identified, accounting for 0.43 % of CNS tumors. Median age was 12 years (range, birth to 48 years); male preponderance was noted (66 %). Most patients (86.3 %) were aged <18 years. Pineal location was most common (45 %) and was associated with male gender and age >14 years. Germinoma was the commonest histopathological type (63.2 %), followed by teratoma (20 %). Suprasellar location was associated with germinoma histology. Follow-up was available for 71 patients (median, 15 months). Of these, 48 received adjuvant chemotherapy and/or radiotherapy. At the last follow-up, 44 patients showed no evidence of disease. Age >10 years, male gender, pineal location, and germinoma histology were associated with favorable outcome. CONCLUSION This is the first multicentric study from India establishing that incidence of CNS GCT in India is similar to that in the West and differs from that in East Asian countries. However, similar to both, germinoma is the commonest histological type, and pineal location is most frequent. Studies on molecular alterations based on ethnicity and geographical location are necessary to provide clarity on differences in incidence. Attention needs to be focused on decreasing treatment heterogeneity and minimizing treatment-related morbidity and mortality, improving the cure rate of these highly treatable tumors.
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Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ahitgani Biswas
- Department Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nikhil Kalyani
- Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India
| | | | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Mehar C Sharma
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nishant Goyal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Bhawani S Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Supriya Mallick
- Department Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Pramod K Julka
- Department Radiation Oncology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Brijesh Arora
- Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India
| | - Epari Sridhar
- Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India
| | | | - Rakesh Jalali
- Neuro Oncology Group, Tata Memorial Hospital, Mumbai, 400012, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Hung PC, Wu CT, Jaing TH, Sheen JM, Chou ML, Lin KL. Primary spinal tumors in childhood: A single institution 15 year experience. Asian J Neurosurg 2016; 11:440-443. [PMID: 27695552 PMCID: PMC4974973 DOI: 10.4103/1793-5482.144148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pediatric primary spinal tumors (PST) are fairly uncommon, with little available data regarding incidence and outcomes. MATERIALS AND METHODS We conducted a retrospective review of the 22 consecutive patients less than 18 years old diagnosed with PST between March 1997 and May 2011 and treated at Chang Gung Children Hospital. All patients had undergone magnetic resonance imaging (MRI) for pre-operative evaluation and operations for PST. The extent of tumor removal was assessed by surgical report by the neurosurgeon or by post-operative MRI if available. RESULTS Ten of them had intramedullary tumors and 12 had intradural extramedullary tumors. All patients were treated with surgery to the primary site. A total of 15 patients underwent gross total tumor resection and seven patients received post-operative radiotherapy. Five patients received adjuvant chemotherapy for their primary tumor. Fourteen patients (64%) survived from study entry without tumor progression. CONCLUSIONS PST encompassed a diverse group of pathologic entities that differ markedly based on the location and age of the children. Total resection of pediatric PST in children could be performed with acceptable risk and satisfactory long-term results.
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Affiliation(s)
- Po-Cheng Hung
- Department of Pediatrics, Division of Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Chieh-Tsai Wu
- Department of Surgery, Division of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Department of Pediatrics, Divisions of Hematology and Oncology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Jiunn-Ming Sheen
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Liang Chou
- Department of Pediatrics, Division of Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
| | - Kuang-Lin Lin
- Department of Pediatrics, Division of Neurology, Chang Gung Children's Hospital, Taoyuan, Taiwan
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24
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Lee SH, Jung KW, Ha J, Oh CM, Kim H, Park HJ, Yoo H, Won YJ. Nationwide Population-Based Incidence and Survival Rates of Malignant Central Nervous System Germ Cell Tumors in Korea, 2005-2012. Cancer Res Treat 2016; 49:494-501. [PMID: 27554477 PMCID: PMC5398392 DOI: 10.4143/crt.2016.129] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/11/2016] [Indexed: 01/17/2023] Open
Abstract
Purpose Malignant central nervous system (CNS) germ cell tumors (GCTs), although rare, are thought to occur more frequently among Asians. However, a recent population-based study revealed no differences in GCT incidence between Asians and Caucasians. Therefore, this study was conducted to determine the incidence and survival rates of CNS GCTs using the national cancer incidence database, and to compare these rates to those in the United States and Japan. Materials and Methods We extracted CNS GCT patients diagnosed between 2005 and 2012 from the Korea Central Cancer Registry database. Age-standardized rates (ASRs), annual percentage change, and the male-female incidence rate ratios (IRRs) were calculated. To estimate the survival rate, we used data for patients diagnosed between 2005 and 2010 and followed their cases until December 31, 2013. Results The ASR for CNS GCT between 2005 and 2012 was 0.179 per 100,000 (95% confidence interval, 0.166 to 0.193), with an overall male-to-female (M:F) IRR of 2.95:1. However, when stratified by site, the M:F IRR was 13.62:1 for tumors of the pineal region and 1.87:1 for those located in nonpineal regions. The most frequent histologic type was germinoma (76.0%), and the most frequent location was the suprasellar region (48.5%). The 5-year survival rate of germinoma patients was 95.3%. Conclusion The incidence rate of CNS GCTs in Korea during 2005-2012 was 0.179 per 100,000, which was similar to that of the Asian/Pacific Islander subpopulation in the United States. Moreover, the CNS GCT survival rate in Korea was similar to rates in Japan and the United States.
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Affiliation(s)
- Seung Hoon Lee
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea.,Department of Neurosurgery, Eulji University School of Medicine, Daejeon, Korea
| | - Kyu-Won Jung
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Johyun Ha
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Chang-Mo Oh
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Hyeseon Kim
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Hyeon Jin Park
- Center for Pediatric Oncology, National Cancer Center, Goyang, Korea
| | - Heon Yoo
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
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Santos MM, Faria CC, Miguéns J. Pediatric central nervous system tumors: review of a single Portuguese institution. Childs Nerv Syst 2016; 32:1227-36. [PMID: 27107888 DOI: 10.1007/s00381-016-3088-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/13/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite being the second most frequent tumor in children, pediatric central nervous system (CNS) tumors are rare, and the published European epidemiological data is limited. Our goal is to present the first surgical series of pediatric CNS tumors in Portugal and to review other similar worldwide series. METHODS Retrospective review of all patients younger than 19 years old, operated to a CNS tumor in the Neurosurgery Department at Hospital de Santa Maria (Lisbon, Portugal) between January 2004 and December 2014. Demographic data, tumor location, clinical data, histopathology, and surgical treatment were analyzed and compared to surgical series of pediatric CNS tumors published in PubMed indexed journals over the last 20 years. RESULTS We performed 253 surgeries in 215 patients, with a male:female ratio of 1.2:1 and a mean age of 9.2 years old. Primary brain tumors accounted for 95 % of all tumors and had more often a supratentorial location. Tumors of neuroepithelial tissue, particularly astrocytic tumors, embryonal tumors, neuronal and mixed neuronal-glial tumors, and oligodendrogliomas accounted for 81 % of cases. A gross-total resection was achieved in most cases. There was no mortality, and the overall morbidity was low. CONCLUSIONS The demography, topography, and clinical presentation of the tumors and the surgical results of this series are comparable to other European ones. We found a higher incidence of neuronal and mixed neuronal-glial tumors and oligodendrogliomas and a slight lower incidence of ependymomas. Our results should encourage further national multi-institutional studies to better characterize these tumors in the pediatric population.
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Affiliation(s)
- Maria M Santos
- Department of Neurosurgery, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, E.P.E., Av. Professor Egas Moniz, 1649-035, Lisbon, Portugal.
| | - Cláudia C Faria
- Department of Neurosurgery, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, E.P.E., Av. Professor Egas Moniz, 1649-035, Lisbon, Portugal
| | - José Miguéns
- Department of Neurosurgery, Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, E.P.E., Av. Professor Egas Moniz, 1649-035, Lisbon, Portugal
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Ogun GO, Adeleye AO, Babatunde TO, Ogun OA, Salami A, Brown BJ, Akang E. Central nervous system tumours in children in Ibadan, Nigeria: a histopathologic study. Pan Afr Med J 2016; 24:34. [PMID: 27583098 PMCID: PMC4992396 DOI: 10.11604/pamj.2016.24.34.9344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/27/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction Contrary to some earlier teachings that central nervous system (CNS) tumours are uncommon in black children, these neoplasms are the fourth most common paediatric tumours in Ibadan. Our centre is the major referral centre for CNS tumours in Nigeria. The last major study of paediatric CNS neoplasms from Ibadan was in 1985. An update of the data on paediatric CNS neoplasms at our centre is presented. Methods A retrospective review of all histologically diagnosed CNS tumours in children (0-14 years) from January 2001 to December 2010 from the database of the Department of Pathology, University College Hospital, Ibadan, Nigeria was done. The cases were classified using the 2007 WHO Classification of Tumours of the Central Nervous System and were also based on their supratentorial and infratentorial locations. Results Seventy-seven tumours, 44 in males, were included in the study. Astrocytic tumour comprised 20 cases, embryonal tumours 15, ependymal tumours 15, germ cell tumours 6, sellar tumours (all craniopharyngiomas) 9 and other histological types- 12 cases. Thirty-seven were WHO Grade 1, eleven Grade 2, ten Grade 3 and nineteen Grade 4 neoplasms. Thirty-six cases were supratentorial and thirty-eight were infratentorial in location. The most common tumours in this series were pilocytic astrocytomas, medulloblastomas, craniopharyngiomas and ependymomas in that order. Conclusion Childhood CNS tumours are being increasingly diagnosed in our centre. This is largely explained by the recent expansion of the available neurosurgical services.
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Affiliation(s)
- Gabriel Olabiyi Ogun
- Department of Pathology, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
| | - Amos Olufemi Adeleye
- Division of Neurological Surgery, Department of Surgery, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Taiwo Olabimpe Babatunde
- Department of Pathology, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
| | - Olufunmilola Abimbola Ogun
- Neuro-Ophthalmology Unit, Department of Ophthalmology, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
| | - Ayodeji Salami
- Department of Pathology, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
| | - Biobele Jotham Brown
- Oncology Unit, Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Effiong Akang
- Department of Pathology, College of Medicine, University of Ibadan, and University College Hospital, Ibadan, Nigeria
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Brain dose-sparing radiotherapy techniques for localized intracranial germinoma: Case report and literature review of modern irradiation. Cancer Radiother 2016; 20:210-6. [DOI: 10.1016/j.canrad.2016.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/05/2016] [Accepted: 02/13/2016] [Indexed: 12/26/2022]
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Shah HC, Ubhale BP, Shah JK. Demographic and histopathologic profile of pediatric brain tumors: A hospital-based study. South Asian J Cancer 2016; 4:146-8. [PMID: 26942148 PMCID: PMC4756492 DOI: 10.4103/2278-330x.173165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Very few hospital-based or population-based studies are published in the context to the epidemiologic profile of pediatric brain tumors (PBTs) in India and Indian subcontinent. Aim: To study the demographic and histopathologic profile of PBTs according to World Health Organization 2007 classification in a single tertiary health care center in India. Materials and Methods: Data regarding age, gender, topography, and histopathology of 76 pediatric patients (0–19 years) with brain tumors operated over a period of 24 months (January-2012 to December-2013) was collected retrospectively and analyzed using EpiInfo 7. Chi-square test and test of proportions (Z-test) were used wherever necessary. Results: PBTs were more common in males (55.3%) as compared to females (44.7%) with male to female ratio of 1.23:1. Mean age was 10.69 years. Frequency of tumors was higher in childhood age group (65.8%) when compared to adolescent age group (34.2%). The most common anatomical site was cerebellum (39.5%), followed by hemispheres (22.4%). Supratentorial tumors (52.6%) were predominant than infratentorial tumors (47.4%). Astrocytomas (40.8%) and embryonal tumors (29.0%) were the most common histological types almost contributing more than 2/3rd of all tumors. Craniopharyngiomas (11.8%) and ependymomas (6.6%) were the third and fourth most common tumors, respectively. Conclusion: Astrocytomas and medulloblastomas are the most common tumors among children and adolescents in our region, which needs special attention from the neurosurgical department of our institute. Demographic and histopathologic profile of cohort in the present study do not differ substantially from that found in other hospital-based and population-based studies except for slight higher frequency of craniopharyngiomas.
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Affiliation(s)
- Harshil C Shah
- Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Bhushan P Ubhale
- Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
| | - Jaimin K Shah
- Department of Neurosurgery, B. J. Medical College and Civil Hospital, Ahmedabad, Gujarat, India
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Azad TD, Shrestha RK, Vaca S, Niyaf A, Pradhananga A, Sedain G, Sharma MR, Shilpakar SK, Grant GA. Pediatric Central Nervous System Tumors in Nepal: Retrospective Analysis and Literature Review of Low- and Middle-Income Countries. World Neurosurg 2015; 84:1832-7. [DOI: 10.1016/j.wneu.2015.07.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
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Feng C, Gao P, Qiu X, Qian T, Lin Y, Zhou J, Sui B. Prediction of radiosensitivity in primary central nervous system germ cell tumors using dynamic contrast-enhanced magnetic resonance imaging. Chin J Cancer Res 2015; 27:231-8. [PMID: 26157319 DOI: 10.3978/j.issn.1000-9604.2015.05.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/13/2015] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for predicting tumor response to radiotherapy in patients with suspected primary central nervous system (CNS) germ cell tumors (GCTs). METHODS DCE-MRI parameters of 35 patients with suspected primary CNS GCTs were obtained prior to diagnostic radiation, using the Tofts and Kermode model. Radiosensitivity was determined in tumors diagnosed 2 weeks after radiation by observing changes in tumor size and markers as a response to MRI. Taking radiosensitivity as the gold standard, the cut-off value of DCE-MRI parameters was measured by receiver operating characteristic (ROC) curve. Diagnostic accuracy of DCE-MRI parameters for predicting radiosensitivity was evaluated by ROC curve. RESULTS A significant elevation in transfer constant (K(trans)) and extravascular extracellular space (Ve) (P=0.000), as well as a significant reduction in rate constant (Kep) (P=0.000) was observed in tumors. K(trans), relative K(trans), and relative Kep of the responsive group were significantly higher than non-responsive groups. No significant difference was found in Kep, Ve, and relative Ve between the two groups. Relative K(trans) showed the best diagnostic value in predicting radiosensitivity with a sensitivity of 100%, specificity of 91.7%, positive predictive value (PPV) of 95.8%, and negative predictive value (NPV) of 100%. CONCLUSIONS Relative K(trans) appeared promising in predicting tumor response to radiation therapy (RT). It is implied that DCE-MRI pre-treatment is a requisite step in diagnostic procedures and a novel and reliable approach to guide clinical choice of RT.
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Affiliation(s)
- Chenlu Feng
- 1 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 2 Beijing Neurosurgical Institute, Beijing 100050, China ; 3 Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 4 MR Collaboration NE Asia, Siemens Healthcare, Beijing 100102, China
| | - Peiyi Gao
- 1 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 2 Beijing Neurosurgical Institute, Beijing 100050, China ; 3 Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 4 MR Collaboration NE Asia, Siemens Healthcare, Beijing 100102, China
| | - Xiaoguang Qiu
- 1 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 2 Beijing Neurosurgical Institute, Beijing 100050, China ; 3 Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 4 MR Collaboration NE Asia, Siemens Healthcare, Beijing 100102, China
| | - Tianyi Qian
- 1 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 2 Beijing Neurosurgical Institute, Beijing 100050, China ; 3 Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 4 MR Collaboration NE Asia, Siemens Healthcare, Beijing 100102, China
| | - Yan Lin
- 1 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 2 Beijing Neurosurgical Institute, Beijing 100050, China ; 3 Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 4 MR Collaboration NE Asia, Siemens Healthcare, Beijing 100102, China
| | - Jian Zhou
- 1 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 2 Beijing Neurosurgical Institute, Beijing 100050, China ; 3 Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 4 MR Collaboration NE Asia, Siemens Healthcare, Beijing 100102, China
| | - Binbin Sui
- 1 Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 2 Beijing Neurosurgical Institute, Beijing 100050, China ; 3 Department of Radiotherapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China ; 4 MR Collaboration NE Asia, Siemens Healthcare, Beijing 100102, China
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Lin Y, Jea A, Melkonian SC, Lam S. Treatment of pediatric Grade II spinal ependymomas: a population-based study. J Neurosurg Pediatr 2015; 15:243-9. [PMID: 25525932 DOI: 10.3171/2014.9.peds1473] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECT Grade II spinal cord ependymomas occurring in pediatric patients are exceptionally rare neoplasms. In this paper the authors use a national cancer database to determine patient demographics, treatment patterns, and associated outcomes of this cohort. METHODS The Surveillance Epidemiology and End Results (SEER) database was used to analyze subjects younger than 18 years with histologically confirmed diagnoses of Grade II spinal cord ependymoma from the years 1973 to 2008. Descriptive data on the demographic characteristics of this cohort and the associated treatment patterns are shown. The Kaplan-Meier method was used to estimate overall survival at 1, 2, 5, and 10 years. RESULTS This cohort comprised 64 pediatric subjects with Grade II spinal ependymoma. The median age was 13 years, nearly half of the patients were male, and most were white (84%). The median follow-up was 9.2 years. Overall survival at 5 and 10 years was 86% and 83%, respectively. Gross-total resection was achieved in 57% of subjects, and radiation therapy was administered to 36%. Radiation therapy was administered to 78% of subjects after subtotal resection but only to 19% of patients after gross-total resection; this difference was significant (p < 0.001). In a multivariate regression model analyzing sex, age at diagnosis, year of diagnosis, radiotherapy, and extent of resection, female sex was found to be an independent predictor of decreased mortality (HR 0.15 [95% CI 0.02-0.94], p = 0.04). CONCLUSIONS These data show long-term outcomes for pediatric patients with Grade II spinal ependymoma. Radiotherapy was more likely to be administered in cases of subtotal resection than in cases of gross-total resection. Female sex is associated with decreased mortality, while other demographic or treatment modalities are not.
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Affiliation(s)
- Yimo Lin
- Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine; and
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Abstract
The management of central nervous system tumors in children below the age of 3 years represents a special challenge to pediatric oncologists with distinctive epidemiology, treatment considerations, and prognosis. Population-based epidemiological data on this particular patient group is lacking in Chinese. We reviewed the population-based pediatric tumor registry in Hong Kong between 1999 and 2011. Eighty-one children with primary central nervous system tumors from 0 to 3 years of age were identified (annual incidence: 4.16 cases per 100,000). Forty-one (50.6%) were male and the mean duration of follow-up was 94 months (±8.1). Primary tumors were infratentorial in 43 (53.1%). The tumor types in decreasing frequency were astrocytoma (n=17), medulloblastoma (n=16), ependymoma (n=13), choroid plexus tumor (n=7), primitive neuroectodermal tumor (n=7), atypical teratoid rhabdoid tumor (n=6), germ cell tumor (GCT, n=5), craniopharyngioma (n=4), and ganglioglioma (n=3). Three patients presented antenatally. Treatment included surgery in 82.7%, chemotherapy in 50.6%, and radiotherapy in 25.9%. There were 29 deaths (35.8%) and 19 relapses (23.5%) during the review period with the 1-year overall survival (OS), 5-year OS, 1-year event-free survival (EFS), and 5-year EFS being 79.4% (±4.6), 63.5% (±5.9), 68.9% (±5.3), and 52.5% (±5.9), respectively. Significantly better OS and EFS were observed in patients who received gross total resection, but those with high-grade tumors, antenatal diagnosis, or atypical teratoid rhabdoid tumor/primitive neuroectodermal tumor had worse outcome. Survival did not differ with age. Comparison with statistics from other studies revealed higher rates of embryonal tumor, GCT, and craniopharyngioma in Hong Kong Chinese. Disease outcome appeared to be better in our cohort comparing to previous reports probably due to the higher proportion of GCT locally.
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Beygi S, Saadat S, Jazayeri SB, Rahimi-Movaghar V. Epidemiology of pediatric primary malignant central nervous system tumors in Iran: A 10 year report of National Cancer Registry. Cancer Epidemiol 2013; 37:396-401. [DOI: 10.1016/j.canep.2013.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 02/28/2013] [Accepted: 03/02/2013] [Indexed: 10/27/2022]
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Makino K, Nakamura H, Yano S, Kuratsu JI. Incidence of primary central nervous system germ cell tumors in childhood: a regional survey in Kumamoto prefecture in southern Japan. Pediatr Neurosurg 2013; 49:155-8. [PMID: 24751890 DOI: 10.1159/000358806] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 01/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Central nervous system germ cell tumors (CNS-GCTs) are relatively rare. While their incidence was thought to be higher in East Asia than the USA, recent evidence suggests the difference between Japan and the USA is not statistically significant. The aim of this study was to determine the rate of pediatric primary CNS-GCTs in Kumamoto prefecture, Japan. METHODS We surveyed 6,615 new cases of primary intracranial tumors diagnosed in Kumamoto prefecture between 1989 and 2011. Among these, 251 (3.8%) occurred in patients younger than 15 years. The age-adjusted incidence rates were calculated by the direct method using 5-year age groupings; the incidence in the total Japanese population in the year 2000 was the standard. RESULTS During the 23-year period, 70 cases of primary GCT were diagnosed. Of these tumors, 31 (44.3%) arose in patients aged between 0 and 14 years (22 boys, 9 girls). Their tumor location was pineal in 45.2%; the other sites were nonpineal. There were more germinomas (64.5%) than nongerminomas (35.5%) in this group. The age-adjusted annual incidence rate was 0.45 cases (boys: 0.64, girls: 0.28) per 10(5) children. At 2.29, the ratio of CNS-GCTs was higher in these boys than girls. Our data showed higher rates than data from CBTRUS 2012 (0.18/10(5)), SEER 2008 (0.15/10(5)) and Germany (0.10/10(5)). CONCLUSIONS Our survey showed that the incidence of primary CNS-GCTs in children was higher in Kumamoto prefecture than in the USA and other Western countries, suggesting that racial backgrounds play a role.
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Affiliation(s)
- Keishi Makino
- Department of Neurosurgery, Kumamoto University, Kumamoto, Japan
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Ramanan M, Chaseling R. Paediatric brain tumours treated at a single, tertiary paediatric neurosurgical referral centre from 1999 to 2010 in Australia. J Clin Neurosci 2012; 19:1387-91. [PMID: 22898201 DOI: 10.1016/j.jocn.2012.01.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 01/10/2012] [Accepted: 01/10/2012] [Indexed: 12/18/2022]
Abstract
Paediatric brain tumours are the most common solid tumour of childhood and the most common cancer cause of death among children. A retrospective review of 313 histopathologically proven brain tumours over an 11-year period has been performed at the Children's Hospital Westmead, New South Wales, Australia, to determine proportions and locations of different tumours, age distribution, survival rates and usage of various treatment modalities. Pilocytic astrocytoma was the most common paediatric brain tumour (29%) followed by medulloblastoma (12%) and ependymoma (6%). Most tumours were histologically benign (59%), and 42% of tumours were located in the posterior fossa. The average age at diagnosis was 7.9 years. About 50% of children were treated with surgery alone, whereas the other 50% had surgery or biopsy plus adjuvant treatment. The overall one-year survival rate was 89% and the five-year survival rate was 80%. The five-year survival rates for pilocytic astrocytoma was 91%; medulloblastoma, 75%; ependymoma, 82%; and high grade glioma, 15%. Thus, a large proportion of paediatric brain tumours were histologically benign and were treated with surgery alone, but a subset of benign tumours required adjuvant treatment and were associated with mortality (25%). The overall survival rates were high and are improving, although for some tumours, such as high grade glioma, the outlook remains poor.
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Affiliation(s)
- Mahesh Ramanan
- TY Nelson Department of Neurology and Neurosurgery, Childrens Hospital Westmead, Hawkesbury Road, Westmead, New South Wales 2145, Australia.
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Sun T, Warrington NM, Rubin JB. Why does Jack, and not Jill, break his crown? Sex disparity in brain tumors. Biol Sex Differ 2012; 3:3. [PMID: 22277186 PMCID: PMC3293746 DOI: 10.1186/2042-6410-3-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 01/25/2012] [Indexed: 02/06/2023] Open
Abstract
It is often reported that brain tumors occur more frequently in males, and that males suffer a worse outcome from brain tumors than females. If correct, these observations suggest that sex plays a fundamental role in brain tumor biology. The following review of the literature regarding primary and metastatic brain tumors, reveals that brain tumors do occur more frequently in males compared to females regardless of age, tumor histology, or region of the world. Sexually dimorphic mechanisms that might control tumor cell biology, as well as immune and brain microenvironmental responses to cancer, are explored as the basis for this sex disparity. Elucidating the mechanisms by which sex chromosomes and sex hormones impact on brain tumorigenesis and progression will advance our understanding of basic cancer biology and is likely to be essential for optimizing the care of brain tumor patients.
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Affiliation(s)
- Tao Sun
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Washington University School of Medicine, CB 8208, 660 South Euclid Ave, St Louis, MO 63110, USA.
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Asirvatham JR, Deepti AN, Chyne R, Prasad MSN, Chacko AG, Rajshekhar V, Chacko G. Pediatric tumors of the central nervous system: a retrospective study of 1,043 cases from a tertiary care center in South India. Childs Nerv Syst 2011; 27:1257-63. [PMID: 21344241 DOI: 10.1007/s00381-011-1407-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 01/27/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study is to describe the age, sex, location, and histopathology of pediatric tumors of the central nervous system diagnosed at a tertiary care center in South India. PATIENTS AND METHODS One thousand forty-three tumors that occurred in children between 0 and 18 years of age diagnosed between 1 January 1990 and 31 December 2004 were reclassified according to the WHO 2007 classification, and the clinical data were analyzed. RESULTS The mean age at diagnosis was 10.9 years with a male/female ratio of 1.7:1 with a male preponderance in most tumors. The five most frequent tumors were: astrocytoma (47.3%), medulloblastoma (11.4%), craniopharyngioma (9.7%), ependymal tumors (4.8%), and nerve sheath tumors (4.1%). Of these, 53.3% of the tumors were supratentorial, 40.6% were infratentorial, and 6.1% occurred in the spinal cord. Although the number of patients treated annually steadily increased over the study period, there was no relative increase in pediatric neoplasms compared to adults. CONCLUSIONS The majority of tumors showed a male preponderance with astrocytoma being the most common tumor type. Although the cerebellum was the most frequent single site of occurrence, tumors involved the supraratentorial compartment more often than the infratentorial compartment.
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Affiliation(s)
- Jaya Ruth Asirvatham
- Division of Neuropathology, Departments of Pathology, Christian Medical College, Vellore, 632004, India
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Neurosurgery Center of Beijing Tiantan Hospital, Flagship of Neurosurgery in China. World Neurosurg 2011; 75:377-82. [DOI: 10.1016/j.wneu.2011.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 02/14/2011] [Indexed: 01/05/2023]
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El-Gaidi MA. Descriptive epidemiology of pediatric intracranial neoplasms in Egypt. Pediatr Neurosurg 2011; 47:385-95. [PMID: 22776798 DOI: 10.1159/000337872] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 03/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The characteristics of 451 Egyptian children (aged 0-14 years) with primary intracranial neoplasms were investigated for demographic, clinical, topographical and pathological features using the most recent 2007 Classification of Central Nervous System Tumors. PATIENTS AND METHODS This was a retrospective study performed in the Departments of Pediatric Neurosurgery of the Cairo University Hospitals from 2005 to 2008. RESULTS There was a slight male predominance (51.4%) observed in our study, and the most affected age group was 5-9 years old (43.2%). Most of the tumors were confined to a single compartment (infratentorial in 49.7%, supratentorial in 46.6%), while 3.8% of the tumors involved multiple compartments. The most common intracranial tumors were astrocytomas (35%), medulloblastomas (18.8%), craniopharyngiomas (11.3%) and ependymomas (10%). Pilocytic astrocytomas constituted 55% of all astrocytomas and 19.3% of all brain tumors, only slightly ahead of medulloblastomas. Less common types were primitive neuroectodermal tumors (2.7%), followed by meningiomas, germ cell tumors and choroid plexus tumors (2.4% each). According to the International Classification of Diseases for Oncology Coding (ICD-O-4), benign, borderline and malignant tumors constituted 7.54, 36.14 and 56.32%, respectively. CONCLUSION The characteristics of pediatric intracranial tumors in Egypt are generally similar to those reported in the literature, with only minor differences.
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Affiliation(s)
- Mohamed Ali El-Gaidi
- Department of Neurosurgery, Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt.
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Nayil K, Makhdoomi R, Ramzan A, Zahoor S, Rasool M, Wani A, Dhar A, Mubeen B, Singh S, Bhat R, Kirmani A. Childhood tumors of the brain: demographic pattern over a ten-year period in the Kashmir Valley. Pediatr Neurosurg 2011; 47:31-7. [PMID: 21546761 DOI: 10.1159/000327143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 03/08/2011] [Indexed: 11/19/2022]
Abstract
Brain tumors in children represent the second most frequent tumors in this age group after hematologic malignancies. We highlight the demographic pattern after retrospective analysis of brain tumors in children from geographically and ethnically distinct Kashmir Valley managed in our center between 2000 and 2009. We had a total of 248 pediatric patients with brain tumors. The parameters analyzed were age, gender, location of tumors and histopathological subtypes as well as WHO grade of tumor. We also did a comparison between the frequencies of common varieties of tumor in the first and second 5-year periods. We found that 111 tumors (44.75%) were supratentorial, and 137 (55.25%) were infratentorial. The male-to-female ratio was 1.4:1. The proportions of low-grade and high-grade tumors were 60 and 40%, respectively. The most common tumor in our series was astrocytoma. The most common tumors in the supratentorial and infratentorial compartments were craniopharyngioma and medulloblastoma, respectively. Our experience reflects a different demographic profile of pediatric brain tumors as compared with other regions of the world.
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Affiliation(s)
- Khursheed Nayil
- Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India.
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Population-based epidemiological study of primary intracranial tumors in childhood. Childs Nerv Syst 2010; 26:1029-34. [PMID: 20349186 DOI: 10.1007/s00381-010-1126-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
Abstract
OBJECT Brain tumors are the most common solid tumors in children and their prognosis is poor. Epidemiologic data from a population-based cancer registry provide the information necessary to determine the incidence rate of pediatric brain tumors. The aim of this study was to determine the epidemiology of childhood primary intracranial tumors in Kumamoto Prefecture, Japan. METHODS We surveyed 210 patients younger than 15 years who were diagnosed with primary intracranial tumors between 1989 and 2008; 159 (75.7%) of the tumors were confirmed microscopically. RESULTS The age-adjusted annual incidence rate was 36.1 cases per million children. The boys/girls ratio was 1.31. The age-specific annual incidence rate was 28.5-, 40.9-, and 38.4 cases per million for the 0- to 4-, 5- to 9-, and 10- to 14-year age group, respectively. The incidence was highest in 10- to 14-year-old boys (53.6 per million) and lowest in 10- to 14-year-old girls (22.6 per million). The most common tumor was astrocytoma (35.7%) with an annual incidence rate of 13.2 per million, followed by germ cell tumor (14.3%, 5.0 per million), craniopharyngioma (10.5%, 3.8 per million), medulloblastoma (10.0%, 3.7 per million), and ependymoma (4.8%, 1.5 per million). The distribution of the tumor type varied with the patient age and gender. Although there were no germ cell tumors in 0- to 4-year-old boys, they were the second-most common tumor in 10- to 14-year-old boys. Conversely, while there were no medulloblastomas in 10- to 14-year-old girls, their incidence was high in 0- to 4-year-old girls. CONCLUSIONS In this Kumamoto survey, the incidence rate of primary intracranial tumors in children was similar to that in Western countries. However, the incidence and relative frequency of particular histological types of childhood brain tumors such as germ cell tumors and craniopharyngiomas were different between Japan and Western countries.
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Intensity-modulated and 3D-conformal radiotherapy for whole-ventricular irradiation as compared with conventional whole-brain irradiation in the management of localized central nervous system germ cell tumors. Int J Radiat Oncol Biol Phys 2009; 76:608-14. [PMID: 19879065 DOI: 10.1016/j.ijrobp.2009.06.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 05/30/2009] [Accepted: 06/01/2009] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the sparing potential of cerebral hemispheres with intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) for whole-ventricular irradiation (WVI) and conventional whole-brain irradiation (WBI) in the management of localized central nervous system germ cell tumors (CNSGCTs). METHODS AND MATERIALS Ten cases of patients with localized CNSGCTs and submitted to WVI by use of IMRT with or without a "boost" to the primary lesion were selected. For comparison purposes, similar treatment plans were produced by use of 3D-CRT (WVI with or without boost) and WBI (opposed lateral fields with or without boost), and cerebral hemisphere sparing was evaluated at dose levels ranging from 2 Gy to 40 Gy. RESULTS The median prescription dose for WVI was 30.6 Gy (range, 25.2-37.5 Gy), and that for the boost was 16.5 Gy (range, 0-23.4 Gy). Mean irradiated cerebral hemisphere volumes were lower for WVI with IMRT than for 3D-CRT and were lower for WVI with 3D-CRT than for WBI. Intensity-modulated radiotherapy was associated with the lowest irradiated volumes, with reductions of 7.5%, 12.2%, and 9.0% at dose levels of 20, 30, and 40 Gy, respectively, compared with 3D-CRT. Intensity-modulated radiotherapy provided statistically significant reductions of median irradiated volumes at all dose levels (p = 0.002 or less). However, estimated radiation doses to peripheral areas of the body were 1.9 times higher with IMRT than with 3D-CRT. CONCLUSIONS Although IMRT is associated with increased radiation doses to peripheral areas of the body, its use can spare a significant amount of normal central nervous system tissue compared with 3D-CRT or WBI in the setting of CNSGCT treatment.
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Abstract
BACKGROUND Incidence patterns of central nervous system (CNS) germ cell tumors (GCTs) have been reported, but the influence of underlying host risk factors has not been rigorously explored. We aimed to determine in a large, population-based cancer registry how age, sex, and race, influence the occurrence of CNS GCTs in the pediatric population. METHODS Using the Surveillance, Epidemiology, and End Results registry, we identified cases of histologically confirmed GCTs in children, adolescents, and young adults (age 0 to 29 y), diagnosed between 1973 and 2004. The cases were limited to only those with the International Classification of Childhood Cancer Xa: intracranial and intraspinal germ-cell tumors. Incidence rates (per 10,000) for each sex and race were plotted for single-age groups, and then stratified by tumor location and pathology subtype. RESULTS The sample included a total of 638 cases (490 males). Males had significantly higher rates of CNS GCTs than females. Male and female rates diverged significantly starting at the age of 11 years and remained widely discrepant until the age of 30 years. There were more germinomas than nongerminomas in both sexes. Germinomas peaked in incidence during adolescence, whereas nongerminoma incidence remained relatively constant in children and young adults. Tumor location differed strikingly by sex (P<0.0001) with pineal location more common in males (61.0% vs. 15.5%). Asian race was associated with a higher rate of CNS GCTs than other races. CONCLUSIONS Males have higher incidence of CNS GCTs, primarily germinomas, than females, starting in the second decade. Pineal location is strongly associated with male sex, with pineal germinomas representing over half of all CNS GCTs in males. Asian-Americans have higher rates than other races. These findings suggest a robust but poorly understood influence of sex, either genetic or hormonal, and race on the occurrence of CNS GCTs.
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Incidence of first primary central nervous system tumors in California, 2001-2005: children, adolescents and teens. J Neurooncol 2009; 94:263-73. [PMID: 19099198 PMCID: PMC2724634 DOI: 10.1007/s11060-009-9860-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 03/16/2009] [Indexed: 11/22/2022]
Abstract
This study used data from the California Cancer Registry to comprehensively examine first primary central nervous system tumors (PCNST) by the International Classification of Childhood Cancers (ICCC) diagnostic groups and to compare their incidence by age groups, sex, race/ethnicity, socioeconomic status and tumor behavior. The study period, 2001–2005, represents the first 5 years of benign PCNST data collection in the state. The age-adjusted incidence rates were 2.1 for malignant and 1.3 for benign per 100,000. Children younger than 5 years old had the highest incidence of malignant PCNST (2.6 per 100,000). Teens aged 15–19 had the highest incidence of benign PCNST (1.8 per 100,000). Age-specific incidence rates were nearly the same for Hispanics, non-Hispanic whites, and Asian/Pacific Islanders for malignant PCNST among children younger than 5 (2.6–2.7 per 100,000); non-Hispanic whites had the highest rates in the 5–14 year-old age group (2.5 per 100,000) and Asian/Pacific Islanders the highest among the 15–19 year old age group (2.3 per 100,000). We found no statistically significant differences in the incidence of malignant PCNST by race/ethnicity in any age group. Astrocytoma had the highest incidence for both malignant and benign histology in most age groups.
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New approaches to pharmacotherapy of tumors of the nervous system during childhood and adolescence. Pharmacol Ther 2009; 122:44-55. [PMID: 19318043 DOI: 10.1016/j.pharmthera.2009.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Indexed: 12/20/2022]
Abstract
Tumors of the nervous system are among the most common and most chemoresistant neoplasms of childhood and adolescence. Malignant tumors of the brain collectively account for 21% of all cancers and 24% of all cancer-related deaths in this age group. Neuroblastoma, a peripheral nervous system tumor, is the most common extracranial solid tumor of childhood, and 65% of children with this tumor have only a 10 or 15% chance of living 5 years beyond the time of initial diagnosis. Novel pharmacological approaches to nervous system tumors are urgently needed. This review presents the role of and current challenges to pharmacotherapy of malignant tumors of the nervous system during childhood and adolescence and discusses novel approaches aimed at overcoming these challenges.
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