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Prasad K, Serencsits BE, Chu BP, Dauer LT, Donzelli M, Basu E, Kramer K, Pandit-Taskar N. Feasibility of safe outpatient treatment in pediatric patients following intraventricular radioimmunotherapy with 131I-omburtamab for leptomeningeal disease. EJNMMI Res 2024; 14:70. [PMID: 39083105 PMCID: PMC11291838 DOI: 10.1186/s13550-024-01127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 07/06/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Radiolabeled antibody 131I-omburtamab was administered intraventricularly in patients with leptomeningeal disease under an institutionally approved study (#NCT03275402). Radiation safety precautions were tailored for individual patients, enabling outpatient treatment based on in-depth, evidence-based recommendations for such precautions. The imperative advancement of streamlined therapeutic administration procedures, eliminating the necessity for inpatient isolation and resource-intensive measures, holds pivotal significance. This development bears broader implications for analogous therapies within the pediatric patient demographic. METHODS Intraventricular radioimmunotherapy (RIT) with 925-1850 MBq (25-50 mCi) of 131I-omburtamab was administered via the Ommaya reservoir, in designated rooms within the pediatric ambulatory care center. Dosimeters were provided to staff involved in patient care to evaluate exposure during injection and post-administration. Post-administration exposure rate readings from the patient on contact, at 0.3 m, and at 1 m were taken within the first 30 min, and the room was surveyed after patient discharge. Duration of radiation exposure was calculated using standard U.S. Nuclear Regulatory Commission (US NRC) regulatory guidance recommendations combined with mean exposure rates and whole-body clearance estimates. Exposure rate measurements and clearance data provided patient-specific precautions for four cohorts by age: < 3 y/o, 3-10 y/o, 10-18 y/o, and 18+. RESULTS Post-administration exposure rates for patients ranged from 0.16 to 0.46 µSv/hr/MBq at 0.3 m and 0.03-0.08 µSv/hr/MBq at 1 m. Radiation exposure precautions ranged from 1 to 10 days after release for the four evaluated cohorts. Based on the highest measured exposure rates and slowest whole-body clearance, the longest precautions were approximately 78% lower than the regulatory guidance recommendations. Radiation exposure to staff associated with 131I-omburtamab per administration was substantially below the annual regulatory threshold for individual exposure monitoring. CONCLUSION 131I-omburtamab can be administered on an outpatient basis, using appropriate patient-based radiation safety precautions that employ patient-specific exposure rate and biological clearance parameters. This trial is registered with the National Library of Medicine's ClinicalTrials.gov. The registration number is NCT03275402, and it was registered on 7 September 2017. The web link is included here. https://clinicaltrials.gov/study/NCT03275402 .
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Affiliation(s)
- Kavya Prasad
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Brian E Serencsits
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Bae P Chu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Maria Donzelli
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Ellen Basu
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Kim Kramer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Neeta Pandit-Taskar
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Prasad K, Serencsits BE, Chu BP, Dauer LT, Donzelli M, Basu E, Kramer K, Pandit-Taskar N. Feasibility of safe outpatient treatment in pediatric patients following intraventricular radioimmunotherapy with 131I-omburtamab for leptomeningeal disease. RESEARCH SQUARE 2024:rs.3.rs-3969388. [PMID: 38464207 PMCID: PMC10925439 DOI: 10.21203/rs.3.rs-3969388/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Radiolabeled antibody 131I-omburtamab was administered intraventricularly in patients with leptomeningeal disease under an institutionally approved study (#NCT03275402). Radiation safety precautions were tailored for individual patients, enabling outpatient treatment based on in-depth, evidence-based recommendations for such precautions. The imperative advancement of streamlined therapeutic administration procedures, eliminating the necessity for inpatient isolation and resource-intensive measures, holds pivotal significance. This development bears broader implications for analogous therapies within the pediatric patient demographic. Methods Intraventricular radioimmunotherapy (RIT) with 925-1850 MBq (25-50 mCi) of 131I-omburtamab was administered via the Ommaya reservoir, in designated rooms within the pediatric ambulatory care center. Dosimeters were provided to staff involved in patient care to evaluate exposure during injection and post-administration. Post-administration exposure rate readings from the patient on contact, at 0.3 m, and at 1 m were taken within the first 30 minutes, and the room was surveyed after patient discharge. Duration of radiation exposure was calculated using standard U.S. Nuclear Regulatory Commission (US NRC) regulatory guidance recommendations combined with mean exposure rates and whole-body clearance estimates. Exposure rate measurements and clearance data provided patient-specific precautions for four cohorts by age: < 3 y/o, 3-10 y/o, 10-18 y/o, and 18+. Results Post-administration exposure rates for patients ranged from 0.16-0.46 μSv/hr/MBq at 1 ft and 0.03-0.08 μSv/hr/MBq at 1 m. Radiation exposure duration ranged from 1-10 days after release for the four evaluated cohorts. Based on the highest measured exposure rates and slowest whole-body clearance, the longest precautions were approximately 78% lower than the regulatory guidance recommendations. Radiation exposure to staff associated with 131I-omburtamab per administration was substantially below the annual regulatory threshold for individual exposure monitoring. Conclusion 131I-omburtamab can be administered on an outpatient basis, using appropriate patient-based radiation safety precautions that employ patient-specific exposure rate and biological clearance parameters. This trial is registered with the National Library of Medicine's ClinicalTrials.gov. The registration number is NCT03275402, and it was registered on 7 September 2017. The web link is included here. https://clinicaltrials.gov/study/NCT03275402.
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Affiliation(s)
| | | | - Bae P Chu
- Memorial Sloan Kettering Cancer Center
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Thanh Dung L, Minh Duc N. Medulloblastoma in the cerebellopontine angle mimicking a schwannoma. Clin Case Rep 2021; 9:1948-1953. [PMID: 33936621 PMCID: PMC8077292 DOI: 10.1002/ccr3.3912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/23/2021] [Indexed: 02/05/2023] Open
Abstract
The typical distinction between cerebellopontine angle (CPA) medulloblastoma and other primary CPA tumors was not fully known. While CPA medulloblastoma is very uncommon, it should be included in the differential diagnosis of patients with CPA tumors.
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Affiliation(s)
- Le Thanh Dung
- Department of RadiologyViet Duc HospitalHa NoiVietnam
- Department of RadiologyHanoi Medical UniversityHa NoiVietnam
| | - Nguyen Minh Duc
- Department of RadiologyHanoi Medical UniversityHa NoiVietnam
- Department of RadiologyPham Ngoc Thach University of MedicineHo Chi Minh CityVietnam
- Department of RadiologyChildren's Hospital 2Ho Chi Minh CityVietnam
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Camelo-Piragua S, Kesari S. Further understanding of the pathology of glioma: implications for the clinic. Expert Rev Neurother 2016; 16:1055-65. [PMID: 27228211 DOI: 10.1080/14737175.2016.1194755] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Glioma classification and grading has been historically based in morphologic appearance of tumor cells: astrocytomas, oligodendrogliomas, oligoastrocytomas and ependymomas. Recent molecular advances have transformed the field of neuro-oncology, as some molecular markers harbor diagnostic, prognostic and therapeutic implications. AREAS COVERED In this paper we will review the major molecular changes associated with gliomas and their implications in diagnosis, prognosis, and opportunities in therapeutics. Expert commentary: Based on current understanding, adult diffuse infiltrating gliomas can be molecularly divided into three to five major subgroups with different clinical outcomes. Pediatric gliomas harbor mutations for H3F3A, ATRX and DAXX but not IDH. Circumscribed low-grade gliomas tend to have BRAF alterations. Clinical behavior of ependymomas correlates more with location than WHO grading. Posterior fossa ependymomas tend to behave worse than their cerebral or spinal cord counterparts. However, with the posterior fossa ependymomas, two distinct subtypes have emerged molecularly.
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Affiliation(s)
- Sandra Camelo-Piragua
- a Neuropathology Division, Pathology Department , University of Michigan , Ann Arbor , MI , USA
| | - Santosh Kesari
- b Department of Translational Neuro-Oncology and Neurotherapeutics , John Wayne Cancer Institute at Providence Saint John's Health Center , Santa Monica , USA.,c Pacific Neuroscience Institute at Providence Saint John's Health Center , Santa Monica , USA.,d Los Angeles Biomedical Research Institute , Torrance , USA
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Bouffet E, Allen JC, Boyett JM, Yates A, Gilles F, Burger PC, Davis RL, Becker LE, Pollack IF, Finlay JL. The influence of central review on outcome in malignant gliomas of the spinal cord: the CCG-945 experience. J Neurosurg Pediatr 2016; 17:453-9. [PMID: 26684767 PMCID: PMC5040185 DOI: 10.3171/2015.10.peds1581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The impact of central pathology review on outcome has been described in pediatric patients with high-grade glioma (HGG). The objective of this report was to analyze the impact of the central pathology review on outcome in the subgroup of patients with institutional diagnosis of HGG of the spinal cord enrolled in the Children's Cancer Group 945 cooperative study. METHODS Five neuropathologists centrally reviewed the pathology of the 18 patients with HGG of the spinal cord who were enrolled in the study. These reviews were independent, and reviewers were blinded to clinical history and outcomes. A consensus diagnosis was established for each patient, based on the outcome of the review. RESULTS Of 18 patients, only 10 were confirmed to have HGG on central review. At a median follow-up of 12 years, event-free and overall survival for all 18 patients was 43.2% ± 13.3% and 50% ± 13.4%, respectively. After central review, 10-year event-free and overall survival for confirmed HGGs and discordant diagnoses was 30% ± 12.5% versus 58.3% ± 18.8% (p = 0.108) and 30% ± 12.5% versus 75% ± 14.2% (p = 0.0757), respectively. CONCLUSIONS The level of discordant diagnoses in children and adolescents with institutional diagnosis of HGG of the spinal cord was 44% in this experience. However, there was no significant difference in outcome between patients with confirmed and discordant diagnosis. This group of tumor deserves a specific attention in future trials.
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Affiliation(s)
- Eric Bouffet
- The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | | | - James M. Boyett
- Biostatistics, Saint Jude Children’s Research Hospital, Memphis, Tennessee
| | - Allen Yates
- Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Floyd Gilles
- Department of Pathology, Children’s Hospital Los Angeles, California
| | - Peter C. Burger
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard L. Davis
- Department of Pathology, University of California, San Francisco, California
| | - Laurence E. Becker
- Department of Pathology, The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Ian F. Pollack
- Department of Neurosurgery, Children’s Hospital of Pittsburgh, Pennsylvania
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Pant I, Chaturvedi S, Gautam VKS, Pandey P, Kumari R. Extra-axial medulloblastoma in the cerebellopontine angle: Report of a rare entity with review of literature. J Pediatr Neurosci 2016; 11:331-334. [PMID: 28217158 PMCID: PMC5314849 DOI: 10.4103/1817-1745.199477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
With only 33 cases reported so far, a purely extra-axial position of medulloblastoma at cerebellopontine (CP) angle is quite exceptional. We report a case of extra-axial medulloblastoma in a 15-year-old male child located in the CP angle that was surgically treated with a provisional diagnosis of schwannoma. Histopathological diagnosis of medulloblastoma was made with the routine hematoxylin and eosin stain and immunohistochemical markers. This case report highlights the fact that although extremely rare, the possibility of an extra-axial mass being a medulloblastoma does exist.
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Affiliation(s)
- Ishita Pant
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Sujata Chaturvedi
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Vinod K S Gautam
- Department of Neurosurgery, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Pranjal Pandey
- Department of Neurosurgery, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Rima Kumari
- Department of Neuroradiology, Institute of Human Behaviour and Allied Sciences, New Delhi, India
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Brain tumors. Mol Oncol 2013. [DOI: 10.1017/cbo9781139046947.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Khuong-Quang DA, Buczkowicz P, Rakopoulos P, Liu XY, Fontebasso AM, Bouffet E, Bartels U, Albrecht S, Schwartzentruber J, Letourneau L, Bourgey M, Bourque G, Montpetit A, Bourret G, Lepage P, Fleming A, Lichter P, Kool M, von Deimling A, Sturm D, Korshunov A, Faury D, Jones DT, Majewski J, Pfister SM, Jabado N, Hawkins C. K27M mutation in histone H3.3 defines clinically and biologically distinct subgroups of pediatric diffuse intrinsic pontine gliomas. Acta Neuropathol 2012; 124:439-47. [PMID: 22661320 PMCID: PMC3422615 DOI: 10.1007/s00401-012-0998-0] [Citation(s) in RCA: 711] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 05/18/2012] [Accepted: 05/19/2012] [Indexed: 11/28/2022]
Abstract
Pediatric glioblastomas (GBM) including diffuse intrinsic pontine gliomas (DIPG) are devastating brain tumors with no effective therapy. Here, we investigated clinical and biological impacts of histone H3.3 mutations. Forty-two DIPGs were tested for H3.3 mutations. Wild-type versus mutated (K27M-H3.3) subgroups were compared for HIST1H3B, IDH, ATRX and TP53 mutations, copy number alterations and clinical outcome. K27M-H3.3 occurred in 71 %, TP53 mutations in 77 % and ATRX mutations in 9 % of DIPGs. ATRX mutations were more frequent in older children (p < 0.0001). No G34V/R-H3.3, IDH1/2 or H3.1 mutations were identified. K27M-H3.3 DIPGs showed specific copy number changes, including all gains/amplifications of PDGFRA and MYC/PVT1 loci. Notably, all long-term survivors were H3.3 wild type and this group of patients had better overall survival. K27M-H3.3 mutation defines clinically and biologically distinct subgroups and is prevalent in DIPG, which will impact future therapeutic trial design. K27M- and G34V-H3.3 have location-based incidence (brainstem/cortex) and potentially play distinct roles in pediatric GBM pathogenesis. K27M-H3.3 is universally associated with short survival in DIPG, while patients wild-type for H3.3 show improved survival. Based on prognostic and therapeutic implications, our findings argue for H3.3-mutation testing at diagnosis, which should be rapidly integrated into the clinical decision-making algorithm, particularly in atypical DIPG.
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Affiliation(s)
| | - Pawel Buczkowicz
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Pathology, The Hospital for Sick Children, Toronto, Canada
| | - Patricia Rakopoulos
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Xiao-Yang Liu
- Department of Human Genetics, McGill University, Montreal, QC Canada
| | | | - Eric Bouffet
- Division of Haematology–Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Ute Bartels
- Division of Haematology–Oncology, The Hospital for Sick Children, Toronto, Canada
| | - Steffen Albrecht
- Department of Pathology, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H1P 2P3 Canada
| | | | - Louis Letourneau
- McGill University and Genome Quebec Innovation Center, Montreal, Canada
| | - Mathieu Bourgey
- McGill University and Genome Quebec Innovation Center, Montreal, Canada
| | - Guillaume Bourque
- McGill University and Genome Quebec Innovation Center, Montreal, Canada
| | | | - Genevieve Bourret
- McGill University and Genome Quebec Innovation Center, Montreal, Canada
| | - Pierre Lepage
- McGill University and Genome Quebec Innovation Center, Montreal, Canada
| | - Adam Fleming
- Department of Paediatrics, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H1P 2P3 Canada
| | - Peter Lichter
- Division of Molecular Genetics, The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Division of Pediatric Neuro-oncology, The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dominik Sturm
- Division of Pediatric Neuro-oncology, The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andrey Korshunov
- Clinical Cooperation Unit Neuropathology, The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Damien Faury
- Department of Paediatrics, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H1P 2P3 Canada
| | - David T. Jones
- Division of Pediatric Neuro-oncology, The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jacek Majewski
- Department of Human Genetics, McGill University, Montreal, QC Canada
- McGill University and Genome Quebec Innovation Center, Montreal, Canada
| | - Stefan M. Pfister
- Division of Pediatric Neuro-oncology, The German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nada Jabado
- Department of Human Genetics, McGill University, Montreal, QC Canada
- Division of Experimental Medicine, McGill University, Montreal, Canada
- Department of Paediatrics, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H1P 2P3 Canada
| | - Cynthia Hawkins
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Pathology, The Hospital for Sick Children, Toronto, Canada
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Affiliation(s)
- Adam J Fleming
- Department of Pediatric Neuro-Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
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MicroRNA 128a increases intracellular ROS level by targeting Bmi-1 and inhibits medulloblastoma cancer cell growth by promoting senescence. PLoS One 2010; 5:e10748. [PMID: 20574517 PMCID: PMC2888574 DOI: 10.1371/journal.pone.0010748] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 04/30/2010] [Indexed: 01/07/2023] Open
Abstract
Background MicroRNAs (miRNAs) are a class of short non-coding RNAs that regulate cell homeostasis by inhibiting translation or degrading mRNA of target genes, and thereby can act as tumor suppressor genes or oncogenes. The role of microRNAs in medulloblastoma has only recently been addressed. We hypothesized that microRNAs differentially expressed during normal CNS development might be abnormally regulated in medulloblastoma and are functionally important for medulloblastoma cell growth. Methodology and Principal Findings We examined the expression of microRNAs in medulloblastoma and then investigated the functional role of one specific one, miR-128a, in regulating medulloblastoma cell growth. We found that many microRNAs associated with normal neuronal differentiation are significantly down regulated in medulloblastoma. One of these, miR-128a, inhibits growth of medulloblastoma cells by targeting the Bmi-1 oncogene. In addition, miR-128a alters the intracellular redox state of the tumor cells and promotes cellular senescence. Conclusions and Significance Here we report the novel regulation of reactive oxygen species (ROS) by microRNA 128a via the specific inhibition of the Bmi-1 oncogene. We demonstrate that miR-128a has growth suppressive activity in medulloblastoma and that this activity is partially mediated by targeting Bmi-1. This data has implications for the modulation of redox states in cancer stem cells, which are thought to be resistant to therapy due to their low ROS states.
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Kim CY, Kim SK, Phi JH, Lee MM, Kim IA, Kim IH, Wang KC, Jung HL, Lee MJ, Cho BK. A prospective study of temozolomide plus thalidomide during and after radiation therapy for pediatric diffuse pontine gliomas: preliminary results of the Korean Society for Pediatric Neuro-Oncology study. J Neurooncol 2010; 100:193-8. [PMID: 20309719 DOI: 10.1007/s11060-010-0157-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 03/08/2010] [Indexed: 10/19/2022]
Abstract
This prospective study was performed to determine the efficacy and safety of temozolomide (TMZ) plus thalidomide during and after radiation therapy (RT) in pediatric patients with newly diagnosed diffuse pontine glioma (DPG). Seventeen patients with pediatric DPG were enrolled between November 2004 and March 2008. The median age was eight years (range, 3-16 years); seven patients were male and ten were female. With the exception of one glioblastoma case, which was diagnosed via open biopsy, all diagnoses were established using neuroradiological studies. The authors used the Korean Society for Pediatric Neuro-Oncology (KSPNO)-A053 protocol. The mean follow-up period was 12 months (range, 8.5-25 months). Five patients were withdrawn from the study. The rates of response to treatment and survival were analyzed in 12 patients. Ten out of the 12 patients showed a partial response (PR), whereas one patient exhibited stable disease (SD) and another patient had progressive disease (PD). The tumor control rate was 92% (11/12) and the response rate was 83% (10/12). The median progression-free survival (PFS) of the 12 patients was 7.2 months (95% confidence interval (CI), 3.6-10.7). Six-month and twelve-month PFS were 58.3 and 16.7%, respectively. Overall survival (OS) was 12.7 months (95% CI, 10.4-15.1). One and two-year survival were 58.3 and 25%, respectively. The main adverse effect was hematological toxicity, with four patients exhibiting grade 3 or 4 toxicity. All patients tolerated the regimen well enough to continue the adjuvant chemotherapy. No Pneumocystis jiroveci pneumonia was noted. The TMZ plus thalidomide regimen was safe and tolerated well enough to be administered on an outpatient basis. Larger studies are required to demonstrate the efficacy of this regimen.
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Affiliation(s)
- Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
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Yanagisawa T, Bartels U, Bouffet E. Role of prognostic factors in the management of pediatric solid tumors. Ann N Y Acad Sci 2008; 1138:32-42. [PMID: 18837880 DOI: 10.1196/annals.1414.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The importance of prognostic factors in predicting outcome in pediatric oncology is largely recognized, and most current protocols tailor treatment based on risk stratification. Further refinements of classical staging systems are ongoing, and the future of pediatric oncology is in the development of strategies based on individual tumor characteristics. This review details significant advances in our understanding of prognostic factors in the most common pediatric solid tumors and potential applications for clinical management.
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Affiliation(s)
- Takaaki Yanagisawa
- Division of Paediatric Neuro-Oncology, Department of Neuro-Oncology, Saitama Medical University International Medical Center, Saitama, Japan
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Abdullah S, Qaddoumi I, Bouffet E. Advances in the management of pediatric central nervous system tumors. Ann N Y Acad Sci 2008; 1138:22-31. [PMID: 18837879 DOI: 10.1196/annals.1414.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Central nervous system tumors are the most common pediatric solid tumors and a leading cause of cancer-related mortality and morbidity in this age group. Survival rates have improved significantly over the last decades for most of the tumor types, as a consequence of improvements in neuroimaging, neurosurgery and neuroanesthesia, radiation oncology, and medical oncology. The complexity of the management of these patients requires a multidisciplinary approach and has led to the emergence of a new subspecialty of pediatric neuro-oncologists who are dedicated to the management and follow-up of this population. This review highlights the most critical advances in the diagnostic and treatment modalities of pediatric brain tumors. A specific review of the most common tumor types discusses treatment options, controversies, and ongoing developments, with an emphasis on cooperative trials.
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Affiliation(s)
- Shaker Abdullah
- Department of Oncology, King Abdulaziz Medical City-Jeddah, Jeddah, Kingdom of Saudi Arabia
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Regulation of cyclin dependent kinase 6 by microRNA 124 in medulloblastoma. J Neurooncol 2008; 90:1-7. [PMID: 18607543 DOI: 10.1007/s11060-008-9624-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 05/28/2008] [Indexed: 12/15/2022]
Abstract
Despite recent advances in treatment medulloblastoma continues to remain a vexing problem. Recently increased expression of cyclin dependent kinase 6 (CDK6) was identified as an adverse prognostic marker in medulloblastoma. Genomic amplification accounts for some, but not all of the CDK6 over-expression. We hypothesized that CDK6 expression is also regulated by microRNAs in medulloblastoma. We identified putative miR sites in the CDK6 including microRNA 124a, a brain enriched microRNA. Expression of miR 124a was significantly decreased in medulloblastoma cells compared to normal adult cerebellum. Functional association between miR 124a and CDK6 in medulloblastoma was established using luciferase assays. Additionally, re-expression of miR 124a in medulloblastoma cells decreased expression of CDK6 protein. Transfection of miR 124 significantly decreases medulloblastoma cell growth but does not alter apoptosis. Furthermore, in patient samples expression of miR 124a is significantly decreased. Our data strongly indicate that CDK6 is regulated by microRNA 124 in medulloblastoma and that miR 124 modulates medulloblastoma cell growth.
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