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Zahnreich S, Schmidberger H. Childhood Cancer: Occurrence, Treatment and Risk of Second Primary Malignancies. Cancers (Basel) 2021; 13:cancers13112607. [PMID: 34073340 PMCID: PMC8198981 DOI: 10.3390/cancers13112607] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/22/2021] [Indexed: 12/14/2022] Open
Abstract
Cancer represents the leading cause of disease-related death and treatment-associated morbidity in children with an increasing trend in recent decades worldwide. Nevertheless, the 5-year survival of childhood cancer patients has been raised impressively to more than 80% during the past decades, primarily attributed to improved diagnostic technologies and multiagent cytotoxic regimens. This strong benefit of more efficient tumor control and prolonged survival is compromised by an increased risk of adverse and fatal late sequelae. Long-term survivors of pediatric tumors are at the utmost risk for non-carcinogenic late effects such as cardiomyopathies, neurotoxicity, or pneumopathies, as well as the development of secondary primary malignancies as the most detrimental consequence of genotoxic chemo- and radiotherapy. Promising approaches to reducing the risk of adverse late effects in childhood cancer survivors include high precision irradiation techniques like proton radiotherapy or non-genotoxic targeted therapies and immune-based treatments. However, to date, these therapies are rarely used to treat pediatric cancer patients and survival rates, as well as incidences of late effects, have changed little over the past two decades in this population. Here we provide an overview of the epidemiology and etiology of childhood cancers, current developments for their treatment, and therapy-related adverse late health consequences with a special focus on second primary malignancies.
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Risk of second malignancies among survivors of pediatric thyroid cancer. Int J Clin Oncol 2018; 23:625-633. [DOI: 10.1007/s10147-018-1256-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/24/2018] [Indexed: 01/29/2023]
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Orr WS, Denbo JW, Saab KR, Ng CY, Wu J, Li K, Garner JM, Morton CL, Du Z, Pfeffer LM, Davidoff AM. Curcumin potentiates rhabdomyosarcoma radiosensitivity by suppressing NF-κB activity. PLoS One 2013; 8:e51309. [PMID: 23408929 PMCID: PMC3567084 DOI: 10.1371/journal.pone.0051309] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/31/2012] [Indexed: 12/12/2022] Open
Abstract
Ionizing radiation (IR) is an essential component of therapy for alveolar rhabdomyosarcoma. Nuclear factor-kappaB (NF-κΒ) transcription factors are upregulated by IR and have been implicated in radioresistance. We evaluated the ability of curcumin, a putative NF-κΒ inhibitor, and cells expressing genetic NF- κΒ inhibitors (IκBα and p100 super-repressor constructs) to function as a radiosensitizer. Ionizing radiation induced NF-κΒ activity in the ARMS cells in vitro in a dose- and time-dependent manner, and upregulated expression of NF-κΒ target proteins. Pretreatment of the cells with curcumin inhibited radiation-induced NF-κΒ activity and target protein expression. In vivo, the combination of curcumin and IR had synergistic antitumor activity against Rh30 and Rh41 ARMS xenografts. The greatest effect occurred when tumor-bearing mice were treated with curcumin prior to IR. Immunohistochemistry revealed that combination therapy significantly decreased tumor cell proliferation and endothelial cell count, and increased tumor cell apoptosis. Stable expression of the super-repressor, SR-IκBα, that blocks the classical NF-κB pathway, increased sensitivity to IR, while expression of SR-p100, that blocks the alternative pathway, did not. Our results demonstrate that curcumin can potentiate the antitumor activity of IR in ARMS xenografts by suppressing a classical NF-κΒ activation pathway induced by ionizing radiation. These data support testing of curcumin as a radiosensitizer for the clinical treatment of alveolar rhabdomyosarcoma. IMPACT OF WORK: The NF-κΒ protein complex has been linked to radioresistance in several cancers. In this study, we have demonstrated that inhibiting radiation-induced NF-κΒ activity by either pharmacologic (curcumin) or genetic (SR-IκBα) means significantly enhanced the efficacy of radiation therapy in the treatment of alveolar rhabdomyosarcoma cells and xenografts. These data suggest that preventing the radiation-induced activation of the NF-κΒ pathway is a promising way to improve the antitumor efficacy of ionizing radiation and warrants clinical trials.
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Affiliation(s)
- W. Shannon Orr
- University of Tennessee Health Science Center, Department of Surgery, Memphis, Tennessee, United States of America
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, Tennessee, United States of America
| | - Jason W. Denbo
- University of Tennessee Health Science Center, Department of Surgery, Memphis, Tennessee, United States of America
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, Tennessee, United States of America
| | - Karim R. Saab
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, Tennessee, United States of America
| | - Catherine Y. Ng
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, Tennessee, United States of America
| | - Jianrong Wu
- St. Jude Children's Research Hospital, Department of Biostatistics, Memphis, Tennessee, United States of America
| | - Kui Li
- University of Tennessee Health Science Center, Department of Microbiology, Immunology and Biochemistry, Memphis, Tennessee, United States of America
| | - Jo Meagan Garner
- University of Tennessee Health Science Center, Department of Pathology and the Center for Cancer Research, Memphis, Tennessee, United States of America
| | - Christopher L. Morton
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, Tennessee, United States of America
| | - Ziyun Du
- University of Tennessee Health Science Center, Department of Pathology and the Center for Cancer Research, Memphis, Tennessee, United States of America
| | - Lawrence M. Pfeffer
- University of Tennessee Health Science Center, Department of Pathology and the Center for Cancer Research, Memphis, Tennessee, United States of America
| | - Andrew M. Davidoff
- University of Tennessee Health Science Center, Department of Surgery, Memphis, Tennessee, United States of America
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, Tennessee, United States of America
- University of Tennessee Health Science Center, Department of Pathology and the Center for Cancer Research, Memphis, Tennessee, United States of America
- * E-mail:
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Sutton EJ, Tong RT, Gillis AM, Henning TD, Weinberg VA, Boddington S, Haas-Kogan DA, Matthay K, Sha V, Gooding C, Coakley FV, Daldrup-Link H. Decreased aortic growth and middle aortic syndrome in patients with neuroblastoma after radiation therapy. Pediatr Radiol 2009; 39:1194-202. [PMID: 19763559 PMCID: PMC2765626 DOI: 10.1007/s00247-009-1351-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 05/26/2009] [Accepted: 06/22/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-term CT follow-up studies are required in pediatric patients who have received intraoperative radiation therapy (IORT) and external beam radiation therapy (EBRT) to assess vascular toxicities and to determine the exact complication rate. OBJECTIVE To analyze with CT the effects of radiation therapy (RT) on the growth of the aorta in neuroblastoma patients. MATERIALS AND METHODS Abdominal CT scans of 31 patients with intraabdominal neuroblastoma (stage II-IV), treated with RT (20 IORT+/-EBRT, 11 EBRT alone), were analyzed retrospectively. The diameter of the abdominal aorta was measured before and after RT. These data were compared to normal and predicted normal aortic diameters of children, according to the model of Fitzgerald, Donaldson and Poznanski (aortic diameter in centimeters = 0.844 + 0.0599 x age in years), and to the diameters of a control group of children who had not undergone RT. Statistical analyses for the primary aims were performed using the chi-squared test, t-test, Mann-Whitney test, nonparametric Wilcoxon matched-pairs test and analysis of variance for repeated measures. Clinical files and imaging studies were evaluated for signs of late vascular complications of neuroblastoma patients who had received RT. RESULTS The mean diameter before and after RT and the growth of the aorta were significantly lower than expected in patients with neuroblastoma (P<0.05 for each) and when compared to the growth in a control group with normal and nonirradiated aortas. Among the patients who had received RT, there was no difference due to the type of RT. Seven patients from the IORT+/-EBRT group developed vascular complications, which included hypertension (five), middle aortic syndrome (two), death due to mesenteric ischemia (one) and critical aortic stenosis, which required aortic bypass surgery (two). CONCLUSION Patients with neuroblastoma who had received RT showed impaired growth of the abdominal aorta. Significant long-term vascular complications occurred in seven patients who received IORT+/-EBRT. Thus, CT evaluation of patients with neuroblastoma who receive RT should include not only reports of changes in tumor extension, but also documentation of perfusion, and the size and growth of the aorta and its branches over time.
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Affiliation(s)
- Elizabeth J. Sutton
- Department of Radiology, Mount Auburn Hospital, Harvard University, Cambridge, MA USA ,Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94131 USA
| | - Ricky T. Tong
- Department of Medicine, Stanford University, Palo Alto, CA USA
| | - Amy M. Gillis
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA USA
| | - Tobias D. Henning
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94131 USA
| | - Vivian A. Weinberg
- Comprehensive Cancer Center, Biostatistics Core, University of California, San Francisco, San Francisco, CA USA
| | - Sophie Boddington
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94131 USA
| | - Daphne A. Haas-Kogan
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA USA
| | - Katherine Matthay
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA USA
| | - Vinil Sha
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94131 USA
| | - Charles Gooding
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94131 USA
| | - Fergus V. Coakley
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94131 USA
| | - Heike Daldrup-Link
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., San Francisco, CA 94131 USA
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Oertel S, Niethammer AG, Krempien R, Roeder F, Eble MJ, Baer C, Huber PE, Kulozik A, Waag KL, Treiber M, Debus J. Combination of external-beam radiotherapy with intraoperative electron-beam therapy is effective in incompletely resected pediatric malignancies. Int J Radiat Oncol Biol Phys 2006; 64:235-41. [PMID: 16257132 DOI: 10.1016/j.ijrobp.2005.06.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Revised: 06/20/2005] [Accepted: 06/22/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Intraoperative electron-beam radiotherapy (IOERT) has been applied for local dose escalation in over 1,400 patients in Heidelberg since 1991. Among these were 30 children, in 18 of whom IOERT was employed in radiation treatment with external-beam radiotherapy (EBRT) on account of incomplete resection. We address the question whether IOERT is able to compensate for microscopic or macroscopic tumor residue if employed in the overall radiation regimen. METHODS AND MATERIALS The data of the aforementioned 18 children were analyzed with regard to local recurrence, overall survival, and complication rates. All children suffered from either sarcomas or neuroblastomas. In all children, IOERT was employed for local dose escalation after or before EBRT. RESULTS After a median follow-up of 60.5 months, 15 of the treated children are alive. One local failure has been observed. Six children show clinically significant late morbidity, including the loss of a treated limb (Radiation Therapy Oncology Group Grade 4 [RTOG 4]), a severe nerve lesion (RTOG 3), an orthopedic complication (RTOG 2), a ureteral stenosis (not clinically significant), and a kidney hypotrophy (not clinically significant). In 1 child a fracture due to radionecrosis (RTOG 4) was diagnosed; however, in the follow-up, local tumor relapse was diagnosed as another possible reason for the fracture. CONCLUSIONS Regarding the low incidence of local failure, IOERT seems to be able to compensate incomplete tumor resection in childhood sarcoma and neuroblastoma patients. The incidence of late morbidity is low enough to justify the employment of IOERT as part of the radiation treatment regimen for pediatric patients.
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Affiliation(s)
- Susanne Oertel
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
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Haas-Kogan DA, Fisch BM, Wara WM, Swift PS, Farmer DL, Harrison MR, Albanese C, Weinberg V, Matthay KK. Intraoperative radiation therapy for high-risk pediatric neuroblastoma. Int J Radiat Oncol Biol Phys 2000; 47:985-92. [PMID: 10863069 DOI: 10.1016/s0360-3016(00)00432-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the efficacy of intraoperative radiation therapy (IORT) in the treatment of high-risk pediatric neuroblastoma. METHODS AND MATERIALS Between 1986 and 1998, 23 children received IORT for pediatric neuroblastoma. Electron beam energies ranged from 4 MeV to 16 MeV and median dose was 10 Gy (7-16 Gy). RESULTS Twenty-one of 23 patients were classified as high-risk. A gross total resection (GTR) was achieved in 18 patients, of whom 6 experienced disease recurrence, 2 of which included a locoregional relapse as a component of failure. Fourteen of 18 patients receiving IORT after a GTR are disease-free survivors. A second subset of 5 patients had a subtotal resection (STR), with gross residual disease remaining after surgery. All 5 patients recurred locally, and all died of their disease. IORT was extremely well-tolerated in our cohort. Surgical resection and IORT resulted in the narrowing of the abdominal aorta and an atrophic kidney in 1 patient. CONCLUSIONS For high-risk neuroblastoma patients, IORT as the only radiotherapy to the primary, produced excellent local control after a GTR. However, IORT as the sole radiotherapy to the primary was inadequate for patients with extensive adenopathy or an STR. In this setting, we are exploring the use of IORT as a boost in conjunction with external beam radiation therapy.
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Affiliation(s)
- D A Haas-Kogan
- Departments of Radiation Oncology, University of California, San Francisco, CA, USA.
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