1
|
Wilson JS, Main C, Thorp N, Taylor RE, Majothi S, Kearns PR, English M, Dandapani M, Phillips R, Wheatley K, Pizer B. The effectiveness and safety of proton beam radiation therapy in children and young adults with Central Nervous System (CNS) tumours: a systematic review. J Neurooncol 2024; 167:1-34. [PMID: 38294638 PMCID: PMC10978619 DOI: 10.1007/s11060-023-04510-4] [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: 09/12/2023] [Accepted: 11/14/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Central nervous system (CNS) tumours account for around 25% of childhood neoplasms. With multi-modal therapy, 5-year survival is at around 75% in the UK. Conventional photon radiotherapy has made significant contributions to survival, but can be associated with long-term side effects. Proton beam radiotherapy (PBT) reduces the volume of irradiated tissue outside the tumour target volume which may potentially reduce toxicity. Our aim was to assess the effectiveness and safety of PBT and make recommendations for future research for this evolving treatment. METHODS A systematic review assessing the effects of PBT for treating CNS tumours in children/young adults was undertaken using methods recommended by Cochrane and reported using PRISMA guidelines. Any study design was included where clinical and toxicity outcomes were reported. Searches were to May 2021, with a narrative synthesis employed. RESULTS Thirty-one case series studies involving 1731 patients from 10 PBT centres were included. Eleven studies involved children with medulloblastoma / primitive neuroectodermal tumours (n = 712), five ependymoma (n = 398), four atypical teratoid/rhabdoid tumour (n = 72), six craniopharyngioma (n = 272), three low-grade gliomas (n = 233), one germ cell tumours (n = 22) and one pineoblastoma (n = 22). Clinical outcomes were the most frequently reported with overall survival values ranging from 100 to 28% depending on the tumour type. Endocrine outcomes were the most frequently reported toxicity outcomes with quality of life the least reported. CONCLUSIONS This review highlights areas of uncertainty in this research area. A well-defined, well-funded research agenda is needed to best maximise the potential of PBT. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42016036802.
Collapse
Affiliation(s)
- Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
- The Christie Hospital Foundation Trust Proton Beam Therapy Centre, Manchester, UK
| | | | - Saimma Majothi
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin English
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Madhumita Dandapani
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
| |
Collapse
|
2
|
Bartelheim K, Nemes K, Seeringer A, Kerl K, Buechner J, Boos J, Graf N, Dürken M, Gerss J, Hasselblatt M, Kortmann RD, Teichert von Luettichau I, Nagel I, Nygaard R, Oyen F, Quiroga E, Schlegel PG, Schmid I, Schneppenheim R, Siebert R, Solano-Paez P, Timmermann B, Warmuth-Metz M, Frühwald MC. Improved 6-year overall survival in AT/RT - results of the registry study Rhabdoid 2007. Cancer Med 2016; 5:1765-75. [PMID: 27228363 PMCID: PMC4884635 DOI: 10.1002/cam4.741] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/22/2016] [Accepted: 03/30/2016] [Indexed: 01/22/2023] Open
Abstract
Atypical teratoid rhabdoid tumors (AT/RT) are characterized by mutations and subsequent inactivation of SMARCB1 (INI1, hSNF5), a predilection for very young children and an unfavorable outcome. The European Registry for rhabdoid tumors (EU‐RHAB) was established to generate a common European database and to establish a standardized treatment regimen as the basis for phase I/II trials. Thus, genetic analyses, neuropathologic and radiologic diagnoses, and a consensus treatment regimen were prospectively evaluated. From 2005 to 2009, 31 patients with AT/RT from four countries were recruited into the registry study Rhabdoid 2007 and treated with systemic and intraventricular chemotherapy. Eight patients received high‐dose chemotherapy, 23 radiotherapy, and 17 maintenance therapy. Reference evaluations were performed in 64% (genetic analyses, FISH, MLPA, sequencing) up to 97% (neuropathology, INI1 stain). Germ‐line mutations (GLM) were detected in 6/21 patients. Prolonged overall survival was associated with age above 3 years, radiotherapy and achievement of a complete remission. 6‐year overall and event‐free survival rates were 46% (±0.10) and 45% (±0.09), respectively. Serious adverse events and one treatment‐related death due to insufficiency of a ventriculo peritoneal shunt (VP‐shunt) and consecutive herniation were noted. Acquisition of standardized data including reference diagnosis and a standard treatment schedule improved data quality along with a survival benefit. Treatment was feasible with significant but manageable toxicity. Although our analysis is biased due to heterogeneous adherence to therapy, EU‐RHAB provides the best available basis for phase I/II clinical trials.
Collapse
Affiliation(s)
- Kerstin Bartelheim
- Children's Hospital Augsburg, Swabian Children's Cancer Center, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Karolina Nemes
- Children's Hospital Augsburg, Swabian Children's Cancer Center, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Angela Seeringer
- Children's Hospital Augsburg, Swabian Children's Cancer Center, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Str. 33, 48149, Münster, Germany
| | - Jochen Buechner
- Department of Pediatrics, University Hospital of North-Norway, Tromsø, Norway.,Department of Pediatric Medicine, Oslo University Hospital Rikshospitalet, P.O. Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Joachim Boos
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Albert-Schweitzer-Str. 33, 48149, Münster, Germany
| | - Norbert Graf
- Department of Pediatric Hematology and Oncology, University of Saarland, Gebäude 9, 66421, Homburg, Germany
| | - Matthias Dürken
- Department of Pediatric Hematology and Oncology, University Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstraße 56, 48149, Münster, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Pottkamp 2, 48149, Münster, Germany
| | - Rolf-Dieter Kortmann
- Department of Radiooncology, University of Leipzig, Stephanstraße 9a, 04103, Leipzig, Germany
| | | | - Inga Nagel
- Institute of Human Genetics, Christian-Albrechts-University Kiel & University Hospital Schleswig- Holstein, Campus Kiel, Arnold-Heiler-Str. 3, 24105, Kiel, Germany
| | - Randi Nygaard
- Department for Children and Adolescents, Section for Pediatric Hematology/Oncology, St Olav's Hospital, University Hospital of Trondheim, 7006, Trondheim, Norway
| | - Florian Oyen
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eduardo Quiroga
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, AVDA Manuel Siurot S/N, 41013, Sevilla, Spain
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology and Oncology, University Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Irene Schmid
- Department of Pediatric Hematology and Oncology, Ludwig-Maximilian-University Munich, Lindwurmstr. 4, 80337, München, Germany
| | - Reinhard Schneppenheim
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Christian-Albrechts-University Kiel & University Hospital Schleswig- Holstein, Campus Kiel, Arnold-Heiler-Str. 3, 24105, Kiel, Germany
| | - Palma Solano-Paez
- Department of Pediatric Oncology, Hospital Infantil Virgen del Rocio, AVDA Manuel Siurot S/N, 41013, Sevilla, Spain
| | - Beate Timmermann
- Particle Therapy Clinic at West German Proton Therapy, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Monika Warmuth-Metz
- Department of Neuroradiology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Michael Christoph Frühwald
- Children's Hospital Augsburg, Swabian Children's Cancer Center, Stenglinstr. 2, 86156, Augsburg, Germany
| |
Collapse
|