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Frankel AO, Lathara M, Shaw CY, Wogmon O, Jackson JM, Clark MM, Eshraghi N, Keenen SE, Woods AD, Purohit R, Ishi Y, Moran N, Eguchi M, Ahmed FUA, Khan S, Ioannou M, Perivoliotis K, Li P, Zhou H, Alkhaledi A, Davis EJ, Galipeau D, Randall RL, Wozniak A, Schoffski P, Lee CJ, Huang PH, Jones RL, Rubin BP, Darrow M, Srinivasa G, Rudzinski ER, Chen S, Berlow NE, Keller C. Machine learning for rhabdomyosarcoma histopathology. Mod Pathol 2022; 35:1193-1203. [PMID: 35449398 DOI: 10.1038/s41379-022-01075-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 02/07/2023]
Abstract
Correctly diagnosing a rare childhood cancer such as sarcoma can be critical to assigning the correct treatment regimen. With a finite number of pathologists worldwide specializing in pediatric/young adult sarcoma histopathology, access to expert differential diagnosis early in case assessment is limited for many global regions. The lack of highly-trained sarcoma pathologists is especially pronounced in low to middle-income countries, where pathology expertise may be limited despite a similar rate of sarcoma incidence. To address this issue in part, we developed a deep learning convolutional neural network (CNN)-based differential diagnosis system to act as a pre-pathologist screening tool that quantifies diagnosis likelihood amongst trained soft-tissue sarcoma subtypes based on whole histopathology tissue slides. The CNN model is trained on a cohort of 424 centrally-reviewed histopathology tissue slides of alveolar rhabdomyosarcoma, embryonal rhabdomyosarcoma and clear-cell sarcoma tumors, all initially diagnosed at the originating institution and subsequently validated by central review. This CNN model was able to accurately classify the withheld testing cohort with resulting receiver operating characteristic (ROC) area under curve (AUC) values above 0.889 for all tested sarcoma subtypes. We subsequently used the CNN model to classify an externally-sourced cohort of human alveolar and embryonal rhabdomyosarcoma samples and a cohort of 318 histopathology tissue sections from genetically engineered mouse models of rhabdomyosarcoma. Finally, we investigated the overall robustness of the trained CNN model with respect to histopathological variations such as anaplasia, and classification outcomes on histopathology slides from untrained disease models. Overall positive results from our validation studies coupled with the limited worldwide availability of sarcoma pathology expertise suggests the potential of machine learning to assist local pathologists in quickly narrowing the differential diagnosis of sarcoma subtype in children, adolescents, and young adults.
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Affiliation(s)
- Arthur O Frankel
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA
| | | | - Celine Y Shaw
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA
| | - Owen Wogmon
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA
| | - Jacob M Jackson
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA
| | - Mattie M Clark
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA
| | - Navah Eshraghi
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA
| | - Stephanie E Keenen
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA
| | - Andrew D Woods
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA
| | - Reshma Purohit
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA
| | - Yukitomo Ishi
- Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, 060-8638, Japan
| | - Nirupama Moran
- Department of Otorhinolaryngology, Assam Medical College and Hospital, Assam, 786002, India
| | - Mariko Eguchi
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, 791-0295, Japan
| | - Farhat Ul Ain Ahmed
- Department of Obstetrics and Gynaecology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Sara Khan
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, M5G 1×8, Canada
| | - Maria Ioannou
- Department of Pathology, University of Thessaly, Biopolis Larisa, 41110, Greece
| | | | - Pin Li
- Department of Urology, Bayi Children's Hospital, Beijing, 100700, China
| | - Huixia Zhou
- Department of Urology, Bayi Children's Hospital, Beijing, 100700, China
| | - Ahmad Alkhaledi
- Department of Oncology, Damascus University Hospitals: Damascus, Damascus, Syria
| | | | - Danielle Galipeau
- OHSU Biolibrary, Oregon Health & Science University, Portland, OR, 97239, USA
| | - R L Randall
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA, 95817, USA
| | - Agnieszka Wozniak
- Leuven Cancer Institute, University Hospitals Leuven, Department of Oncology & Research Unit Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Patrick Schoffski
- Leuven Cancer Institute, University Hospitals Leuven, Department of Oncology & Research Unit Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Che-Jui Lee
- Leuven Cancer Institute, University Hospitals Leuven, Department of Oncology & Research Unit Laboratory of Experimental Oncology, KU Leuven, Leuven, Belgium
| | - Paul H Huang
- Royal Marsden Hospital/Institute of Cancer Research, Fulham Road, London, SW3 6JJ, UK
| | - Robin L Jones
- Royal Marsden Hospital/Institute of Cancer Research, Fulham Road, London, SW3 6JJ, UK
| | - Brian P Rubin
- Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Morgan Darrow
- Department of Pathology and Laboratory Medicine, University of California Davis Medical Center, Sacramento, CA, 95817, USA
| | | | | | - Sonja Chen
- Nationwide Children's Hospital, Columbus, OH, 43205, USA. .,Department of Pathology, Rhode Island Hospital, Providence, RI, 02903, USA.
| | - Noah E Berlow
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA.
| | - Charles Keller
- Children's Cancer Therapy Development Institute, Beaverton, OR, 97005, USA.
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Ogun GO, Ezenkwa US, Babatunde TO, Obiagwu AE, Nweke MC, Adegoke OO, Olulana OO, Brown BJ. Paediatric soft tissue sarcomas in a resource constraint setting: Grade and stage at presentation and at oncologic intervention are usually of poor prognostic characteristics. Int J Clin Pract 2021; 75:e13951. [PMID: 33342027 DOI: 10.1111/ijcp.13951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022] Open
Abstract
AIM To describe the pattern of paediatric Rhabdomyosarcomas (RMS) and Non-Rhabdomyosarcomas (NRMS) with emphasis on the indices that affect survival outcomes. METHODS We reviewed all patients with histologically confirmed RMS and NRMS in the Departments of Pathology and Paediatrics, University College Hospital (UCH), Ibadan, Nigeria; in children aged 0-14 years. The study period was January 1991 to December 2016. Information obtained included age, gender, morphology and site of the tumours. The tumour grade and pathologic/clinical staging of all patients were also obtained and verified by the clinical records. Tumour grading was carried out using the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) Sarcoma group grading system and staging was done using TNM. Follow up, survival information and final outcome were retrieved. RESULTS The 104 patients included in the study had almost equal male-to-female ratio, age ranged between 5 months and 14 years (median 8.2 years). Rhabdomyosarcoma had mean age of 5.6 (±3.8) years while that of NRMS was 9.2(±4.1) years. Overall, the modal age group was 5-9 years. Rhabdomyosarcoma was the commonest histological type (76%), undifferentiated sarcomas (6.7%), fibrosarcoma (3.8%) and 2.9% each for synovial sarcoma and dermatofibrosarcoma protuberans. The common primary sites were the head and neck (including the orbit) 49 (47.1%), and the abdominopelvic 26 (25%) regions. Majority (89%) had histologic grade 3 at presentation. Seventy per cent and 64% of patients with RMS and NRMS, respectively, had high stage tumour at presentation. Median survival for all patients with Rhabdomyosarcoma was 45 weeks with a 1-year survival of 43% and 2-year survival of 25%. Non-RMS (Dermatofibrosarcoma protuberans and Solitary fibrous tumours) had survival of over 4 year's duration. CONCLUSION Majority of our patients presented at a late stage with histologic high grade which confers poor prognosis and reduced chances for good overall survival outcome.
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Affiliation(s)
- Gabriel O Ogun
- Department of Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Uchenna S Ezenkwa
- Department of Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Taiwo O Babatunde
- Department of Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Adaora E Obiagwu
- Department of Community Medicine, Edo University Iyamho, Iyamho, Nigeria
| | - Michael C Nweke
- Department of Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Omolade O Adegoke
- Department of Pathology, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Oludare O Olulana
- Department of Surgery/Paediatric Surgery, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Biobele J Brown
- Department of Paediatrics (Haematology & Oncology Unit), University of Ibadan/University College Hospital, Ibadan, Nigeria
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Unusual Case of Concurrent Retroperitoneal Congenital Infantile Fibrosarcoma and Cellular Type Congenital Mesoblastic Nephroma. J Pediatr Hematol Oncol 2020; 42:e801-e806. [PMID: 31343481 DOI: 10.1097/mph.0000000000001567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although congenital infantile fibrosarcoma (cIFS) is a rare soft tissue sarcoma among children, it constitutes one of the most common soft tissue sarcomas during the first year of life. Congenital mesoblastic nephroma (CMN) is the most common benign renal tumor usually developing during the first 3 months of life. cIFS and cellular type CMN (cCMN) share not only similar histopathologic features but identical molecular genetic abnormality including the ETV6/NTRK3 fusion gene. Here, we report an unusual case of cIFS occurring with cCMN. CASE PRESENTATION An 18-month-old girl presented with a 1-month history of abdominal distension and a few days' history of a palpable abdominal mass. A large heterogenous mass sized 9.0×11.2×11.6 cm on the right side of the abdomen and an isolated heterogenous lesion sized 4×4.5 cm within the right kidney were noted from the imaging study. Pathologic findings were consistent with cIFS and cCMN of the right kidney. In addition, both pathologic specimens contained the ETV6/NTRK3 fusion gene. CONCLUSION Although cIFS and cCMN share similar histopathologic features and molecular genetic abnormality, simultaneous occurrence of these 2 types of tumor is exceedingly rare. To our knowledge, this is the first unusual case report of concurrent cIFS and cCMN.
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Collignon C, Brisse HJ, Lemelle L, Cardoen L, Gauthier A, Pierron G, Roussel A, Dumont B, Alimi A, Cordero C, Rouffiange L, Orbach D. [Diagnostic strategy in pediatrics soft tissue sarcomas]. Bull Cancer 2020; 107:963-971. [PMID: 32950242 DOI: 10.1016/j.bulcan.2020.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 02/08/2023]
Abstract
Soft tissue sarcomas in children are rare tumor, representing around 6 to 7% of children cancer. They spread mostly sporadically (90%) and therefore are rarely associated to an underlying constitutional genetic disease (10%). About half of those sarcomas are rhabdomyosarcomas and the others are a very heterogenous histologic group with various bio-pathologies and prognosis. Clinical presentation is mainly a soft tissue lump often difficult to distinguish from more frequent benign causes (malformative, infectious, benign, or pseudotumor). Inappropriate initial diagnosis work-up has a strong impact on soft tissue sarcomas' prognosis. Adapted complementary investigations (first ultrasound and MRI) are important to compile arguments for a malign origin and to indicate a biopsy. However, predictive value of imaging exams still remains imperfect, and histological analysis by percutaneous image-guided biopsy and sometimes by surgical biopsy is often necessary. Authors realize an update on optimal diagnostic pathway including molecular tests in presence of a soft tissue mass in a child.
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Affiliation(s)
- Charlotte Collignon
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France.
| | - Hervé J Brisse
- Institut Curie, département d'imagerie, 26, rue d'Ulm, 75005 Paris, France
| | - Lauriane Lemelle
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Liesbeth Cardoen
- Institut Curie, département d'imagerie, 26, rue d'Ulm, 75005 Paris, France
| | - Arnaud Gauthier
- Institut Curie, département de médecine diagnostique et théranaustique, 26, rue d'Ulm, 75005 Paris, France
| | - Gaëlle Pierron
- Institut Curie, unité de génétique somatique, 26, rue d'Ulm, 75005 Paris, France
| | - Aphaia Roussel
- Hôpital Robert-Debré, service d'immuno-hématologie, 48, boulevard Sérurier, 75019 Paris, France
| | - Benoit Dumont
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Aurélia Alimi
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Camille Cordero
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Lucie Rouffiange
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
| | - Daniel Orbach
- Institut Curie, centre intégré de soins et de recherche en oncologie de l'enfant, adolescent et jeune adulte (SIREDO), 26, rue d'Ulm, 75005 Paris, France
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Yokose T, Kitago M, Oshima G, Abe K, Masugi Y, Miura E, Shinoda M, Yagi H, Abe Y, Hori S, Matsusaka Y, Endo Y, Toyama K, Okuda S, Kitagawa Y. Urgent distal pancreatectomy for intraperitoneal hemorrhage due to the spontaneous rupture of a pancreatic metastatic tumor from synovial sarcoma: a case report. BMC Surg 2020; 20:175. [PMID: 32758199 PMCID: PMC7430812 DOI: 10.1186/s12893-020-00832-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/23/2020] [Indexed: 01/02/2023] Open
Abstract
Background Synovial sarcoma is a soft tissue malignancy that frequently affects the extremities, adjacent to the large joints. Synovial sarcoma has a high rate of distant metastasis; however, pancreatic metastasis is extremely rare, and to our knowledge, there has been no report of bleeding due to spontaneous tumor rupture. This study reports the case of a patient with synovial sarcoma pancreatic metastasis causing tumor rupture and bleeding, which was successfully managed with emergent distal pancreatectomy. Case presentation A 27-year-old woman underwent extensive resection of the primary tumor and partial lung resection after chemotherapy for left femoral synovial sarcoma and multiple lung metastases 4 years prior. During the follow-up, a 35-mm tumor was noted in the pancreatic tail on abdominal computed tomography (CT), and no other distant metastases were detected via positron emission tomography CT. Laparoscopic distal pancreatectomy was scheduled for pancreatic metastasis of synovial sarcoma. However, before the scheduled pancreatectomy could be conducted, the patient visited the emergency department because of abdominal pain that occurred after consuming a small amount of alcohol, and CT showed ascites with high CT values and leakage of contrast media. She was diagnosed with intra-abdominal hemorrhage due to a ruptured metastatic pancreatic tumor, and an emergency operation was performed. In total, 1500 mL of blood was evacuated from the abdomen, and the bleeding pancreatic tail tumor was resected. Histopathological findings revealed synovial sarcoma metastasis and a ruptured tumor capsule, and tumor cells were observed in the hematoma. After discharge on postoperative day 18, the patient was carefully monitored and confirmed to be in relapse-free survival, without chemotherapy, at 6 months post-surgery. Conclusions While the rate of tumor growth varies depending on the grade of the tumor, the possibility of rupture should be considered even in metastatic pancreatic tumors. In the case of pancreatic tumor rupture with stable circulation, radiological evaluation for oncology is necessary, and primary resection may be compatible with resectable cases.
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Affiliation(s)
- Takahiro Yokose
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Go Oshima
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kodai Abe
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Eisuke Miura
- Department of Pathology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Yagi
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shutaro Hori
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yohji Matsusaka
- Department of Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yutaka Endo
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenji Toyama
- Department of Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
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Salfelder MEA, Kessel KA, Thiel U, Burdach S, Kampfer S, Combs SE. Prospective evaluation of multitarget treatment of pediatric patients with helical intensity-modulated radiotherapy. Strahlenther Onkol 2020; 196:1103-1115. [PMID: 32748147 PMCID: PMC7686189 DOI: 10.1007/s00066-020-01670-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/07/2020] [Indexed: 02/06/2023]
Abstract
Background and purpose Radiotherapy (RT) is persistently gaining significance in the treatment of pediatric tumors. However, individual features of a growing body and multifocal stages complicate this approach. Tomotherapy offers advantages in the treatment of anatomically complex tumors with low risks of side effects. Here we report on toxicity incidence and outcome of tomotherapy with a focus on multitarget RT (mtRT). Materials and methods From 2008 to 2017, 38 children diagnosed with sarcoma were treated with tomotherapy. The median age was 15 years (6–19 years). Toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03 and classified into symptoms during RT, acutely (0–6 months) and late (>6 months) after RT, and long-term sideeffects (>24 months). Results The main histologies were Ewing sarcoma (n = 23 [61%]) and alveolar rhabdomyosarcoma (n = 5 [13%]). RT was performed with a median total dose of 54 Gy (40.5–66.0 Gy) and a single dose of 2 Gy (1.80–2.27 Gy). Twenty patients (53%) received mtRT. Median follow-up was 29.7 months (95% confidence interval 15.3–48.2 months) with a 5-year survival of 55.2% (±9.5%). The 5‑year survival rate of patients with mtRT (n = 20) was 37.1 ± 13.2%, while patients who received single-target RT (n = 18) had a 5-year survival rate of 75 ± 10.8%. Severe toxicities (grade 3 and 4) emerged in 14 patients (70%) with mtRT and 7 patients (39%) with single-target RT. Two non-hematological grade 4 toxicities occurred during RT: one mucositis and one radiodermatitis. After mtRT 5 patients had grade 3 toxicities acute and after single-target RT 4 patients. One patient had acute non-hematological grade 4 toxicities (gastritis, pericarditis, and pericardial effusion) after mtRT. Severe late effects of RT occurred in 2 patients after mtRT and in none of the single-target RT patients. No severe long-term side effects appeared. Conclusion Our results showed acceptable levels of acute and late toxicities, considering the highly advanced diseases and multimodal treatment. Hence, tomotherapy is a feasible treatment method for young patients with anatomically complex tumors or multiple targets. Especially mtRT is a promising and innovative treatment approach for pediatric sarcomas, delivering unexpectedly high survival rates for patients with multifocal Ewing sarcomas in this study, whereby the limited number of patients should invariably be considered in the interpretation. Electronic supplementary material The online version of this article (10.1007/s00066-020-01670-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria-Elena A. Salfelder
- Department of Radiation Oncology, Technical University Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
| | - Kerstin A. Kessel
- Department of Radiation Oncology, Technical University Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
- DKTK Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
| | - Uwe Thiel
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Technical University of Munich School for Medicine, Munich, Germany
| | - Stefan Burdach
- Department of Pediatrics and Children’s Cancer Research Center, Kinderklinik München Schwabing, Technical University of Munich School for Medicine, Munich, Germany
| | - Severin Kampfer
- Department of Radiation Oncology, Technical University Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technical University Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
- DKTK Partner Site Munich, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Munich, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
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7
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Characterization of alveolar soft part sarcoma using a large national database. Surgery 2020; 168:825-830. [PMID: 32703677 DOI: 10.1016/j.surg.2020.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Alveolar soft part sarcoma is a rare, histologic subtype of soft tissue sarcoma that remains poorly defined. We aimed to describe patient characteristics and treatment patterns and to examine factors associated with survival for patients with alveolar soft part sarcoma. METHODS After identifying patients with alveolar soft part sarcoma in the National Cancer Database, we recorded their clinicopathologic characteristics. Univariable log-rank survival analysis and Cox proportional hazards model were employed. For context, survival comparisons were included for patients with other sarcoma subtypes. RESULTS Overall, 293 patients with alveolar soft part sarcoma were identified. Interestingly, patients with head and neck tumors were least likely to present with distant disease (40%, P = .025). The majority of patients underwent resection (n = 183, 63%). Among those, no predictors of lesser survival were identified other than the presence of metastases (hazard ratio 6.04, P ≤ .001). Patients with stage IV alveolar soft part sarcoma who underwent resections experienced improved survival relative to similar patients with more common subtypes of soft tissue sarcomas (P ≤ .001). CONCLUSION Alveolar soft part sarcoma is exceedingly rare, and patients often present with metastases. Primary tumors can occur anywhere in the body, and location impacts the rates of metastases at presentation. Resection is associated with a favorable survival advantage when compared to other, more common histologic subtypes of soft tissue sarcomas.
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8
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Deep Functional and Molecular Characterization of a High-Risk Undifferentiated Pleomorphic Sarcoma. Sarcoma 2020; 2020:6312480. [PMID: 32565715 PMCID: PMC7285280 DOI: 10.1155/2020/6312480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 11/29/2022] Open
Abstract
Nonrhabdomyosarcoma soft-tissue sarcomas (STSs) are a class of 50+ cancers arising in muscle and soft tissues of children, adolescents, and adults. Rarity of each subtype often precludes subtype-specific preclinical research, leaving many STS patients with limited treatment options should frontline therapy be insufficient. When clinical options are exhausted, personalized therapy assignment approaches may help direct patient care. Here, we report the results of an adult female STS patient with relapsed undifferentiated pleomorphic sarcoma (UPS) who self-drove exploration of a wide array of personalized Clinical Laboratory Improvement Amendments (CLIAs) level and research-level diagnostics, including state of the art genomic, proteomic, ex vivo live cell chemosensitivity testing, a patient-derived xenograft model, and immunoscoring. Her therapeutic choices were also diverse, including neoadjuvant chemotherapy, radiation therapy, and surgeries. Adjuvant and recurrence strategies included off-label and natural medicines, several immunotherapies, and N-of-1 approaches. Identified treatment options, especially those validated during the in vivo study, were not introduced into the course of clinical treatment but did provide plausible treatment regimens based on FDA-approved clinical agents.
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9
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Tully K, Pastor J, Noldus J, Roghmann F. Open surgical resection of a rare extraskeletal chondroma of the retropubic space. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415818785794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Karl Tully
- Department of Urology, Marien Hospital, Ruhr University Bochum, Germany
| | - Jobst Pastor
- Department of Urology, Marien Hospital, Ruhr University Bochum, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital, Ruhr University Bochum, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr University Bochum, Germany
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10
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Ricker CA, Berlow NE, Crawford KA, Georgopapadakos T, Huelskamp AN, Woods AD, Dhimolea E, Ramkissoon SH, Spunt SL, Rudzinski ER, Keller C. Undifferentiated small round cell sarcoma in a young male: a case report. Cold Spring Harb Mol Case Stud 2020; 6:mcs.a004812. [PMID: 32014859 PMCID: PMC6996518 DOI: 10.1101/mcs.a004812] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/09/2019] [Indexed: 12/12/2022] Open
Abstract
CIC-rearranged sarcomas (CRSs) have recently been characterized as a distinct sarcoma subgroup with a less favorable prognosis compared to other small round cell sarcomas. CRSs share morphologic features with Ewing's sarcoma and prior to 2013 were grouped under undifferentiated sarcomas with round cell phenotype by the WHO classification. In this report, whole-genome sequencing and RNA sequencing were performed for an adolescent male patient with CRS who was diagnosed with undifferentiated pleomorphic sarcoma (UPS) by three contemporary institutions. Somatic mutation analysis identified mutations in IQGAP1, CCNC, and ATXN1L in pre- and post-treatment tissue samples, as well as a CIC–DUX4 fusion that was confirmed by qPCR and DUX4 immunohistochemistry. Of particular interest was the overexpression of the translation factor eEF1A1, which has oncogenic properties and has recently been identified as a target of the investigational agent plitidepsin. This case may provide a valuable waypoint in the understanding and classification of CRSs and may provide a rationale for targeting eEF1A1 in similar soft tissue sarcoma cases.
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Affiliation(s)
- Cora A Ricker
- Children's Cancer Therapy Development Institute, Beaverton, Oregon 97005, USA
| | - Noah E Berlow
- Children's Cancer Therapy Development Institute, Beaverton, Oregon 97005, USA
| | - Kenneth A Crawford
- Children's Cancer Therapy Development Institute, Beaverton, Oregon 97005, USA
| | | | - Audrey N Huelskamp
- Children's Cancer Therapy Development Institute, Beaverton, Oregon 97005, USA
| | - Andrew D Woods
- Children's Cancer Therapy Development Institute, Beaverton, Oregon 97005, USA
| | - Eugen Dhimolea
- Dana-Farber Cancer Institute, Boston, Massachusetts 02215, USA
| | | | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California 94304, USA
| | | | - Charles Keller
- Children's Cancer Therapy Development Institute, Beaverton, Oregon 97005, USA
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11
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The impact of 18F-FDG PET on initial staging and therapy planning of pediatric soft-tissue sarcoma patients. Pediatr Radiol 2020; 50:252-260. [PMID: 31628508 DOI: 10.1007/s00247-019-04530-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/15/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Soft-tissue sarcomas in children are a histologically heterogenous group of malignant tumors accounting for approximately 7% of childhood cancers. There is a paucity of data on the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for initial staging and whether PET influenced management of these patients. OBJECTIVE The aim of this analysis is to assess the use of 18F-FDG PET exclusively, and as a supplement to cross-sectional imaging in comparison to typical imaging protocols (CT and magnetic resonance imaging [MRI]) for initial staging as well as therapy planning in pediatric soft-tissue sarcoma patients. MATERIALS AND METHODS The list of 18F-FDG PET/CT performed for soft-tissue sarcoma between March 2007 and October 2017 was obtained from the Hospital Information System database. Twenty-six patients who had received 18F-FDG PET, MRI and/or CT at initial diagnosis were included in the study. 18F-FDG PET and concurrent diagnostic CT and MRI at initial staging were independently reviewed to note the number of primary and metastatic lesions detected by each modality. A chart review was conducted to collect information on final diagnosis, staging and treatment plan. RESULTS During the study period, 26 patients (15 females) ages 1.3-17.9 years (median age: 6 years) had received 18F-FDG PET/CT at initial diagnosis of soft-tissue sarcoma. Diagnostic CT was available for comparison in all 26 patients and MRI was available in 18 patients. The mean interval between cross-sectional imaging and 18F-FDG PET was 5.9 days (range: 0-30 days). All 26 primary lesions were equally detected by 18F-FDG PET compared to CT and MRI. From 84 metastatic lesions, 16 were detected by PET as well as CT and MRI, 12 by 18F-FDG PET only (included mainly lymph node metastases) and 56 by CT and MRI only (included mainly lung metastases). 18F-FDG PET changed therapy planning in 5 patients out of 26 (19%) by showing additional lesions not detected by CT and MRI. CONCLUSION 18F-FDG PET proved to be a valuable tool for precise initial staging of pediatric soft-tissue sarcoma patients, especially in detecting lymph node metastasis, and could be included in their initial work-up. Given the relative rarity and heterogeneity of this group of tumors, additional investigations are required to definitely establish a role for 18F-FDG PET in the initial staging and therapy planning of soft-tissue sarcoma in the pediatric population.
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12
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Overview of the clinical and imaging features of the most common non-rhabdomyosarcoma soft-tissue sarcomas. Pediatr Radiol 2019; 49:1524-1533. [PMID: 31620852 DOI: 10.1007/s00247-019-04427-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/08/2019] [Accepted: 05/14/2019] [Indexed: 12/15/2022]
Abstract
Non-rhabdomyosarcoma soft-tissue sarcoma (NRSTS) refers to a widely heterogeneous group of extraskeletal mesenchymal neoplasms accounting for approximately 4% of all childhood cancers. This article summarizes the clinical and imaging features of these rare tumors and describes in detail the three most common histological types of NRSTSs encountered in children - synovial sarcoma, malignant peripheral nerve sheath tumor and infantile fibrosarcoma. The author discusses the role of non-cross-sectional and cross-sectional imaging.
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13
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Helm BR, Zhan X, Pandya PH, Murray ME, Pollok KE, Renbarger JL, Ferguson MJ, Han Z, Ni D, Zhang J, Huang K. Gene Co-Expression Networks Restructured Gene Fusion in Rhabdomyosarcoma Cancers. Genes (Basel) 2019; 10:genes10090665. [PMID: 31480361 PMCID: PMC6770752 DOI: 10.3390/genes10090665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 01/28/2023] Open
Abstract
Rhabdomyosarcoma is subclassified by the presence or absence of a recurrent chromosome translocation that fuses the FOXO1 and PAX3 or PAX7 genes. The fusion protein (FOXO1-PAX3/7) retains both binding domains and becomes a novel and potent transcriptional regulator in rhabdomyosarcoma subtypes. Many studies have characterized and integrated genomic, transcriptomic, and epigenomic differences among rhabdomyosarcoma subtypes that contain the FOXO1-PAX3/7 gene fusion and those that do not; however, few investigations have investigated how gene co-expression networks are altered by FOXO1-PAX3/7. Although transcriptional data offer insight into one level of functional regulation, gene co-expression networks have the potential to identify biological interactions and pathways that underpin oncogenesis and tumorigenicity. Thus, we examined gene co-expression networks for rhabdomyosarcoma that were FOXO1-PAX3 positive, FOXO1-PAX7 positive, or fusion negative. Gene co-expression networks were mined using local maximum Quasi-Clique Merger (lmQCM) and analyzed for co-expression differences among rhabdomyosarcoma subtypes. This analysis observed 41 co-expression modules that were shared between fusion negative and positive samples, of which 17/41 showed significant up- or down-regulation in respect to fusion status. Fusion positive and negative rhabdomyosarcoma showed differing modularity of co-expression networks with fusion negative (n = 109) having significantly more individual modules than fusion positive (n = 53). Subsequent analysis of gene co-expression networks for PAX3 and PAX7 type fusions observed 17/53 were differentially expressed between the two subtypes. Gene list enrichment analysis found that gene ontology terms were poorly matched with biological processes and molecular function for most co-expression modules identified in this study; however, co-expressed modules were frequently localized to cytobands on chromosomes 8 and 11. Overall, we observed substantial restructuring of co-expression networks relative to fusion status and fusion type in rhabdomyosarcoma and identified previously overlooked genes and pathways that may be targeted in this pernicious disease.
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Affiliation(s)
- Bryan R Helm
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA
| | - Xiaohui Zhan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Pankita H Pandya
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA
| | - Mary E Murray
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA
| | - Karen E Pollok
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA
- Department of Pharmacology and Toxicology, Indiana University, Indianapolis, IN 46202-3082, USA
| | - Jamie L Renbarger
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA
| | - Michael J Ferguson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA
| | - Zhi Han
- Department of Pharmacology and Toxicology, Indiana University, Indianapolis, IN 46202-3082, USA
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China
| | - Jie Zhang
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA.
| | - Kun Huang
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202-3082, USA.
- Regenstrief Institute, Indianapolis, IN 46202, USA.
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14
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Jones DTW, Banito A, Grünewald TGP, Haber M, Jäger N, Kool M, Milde T, Molenaar JJ, Nabbi A, Pugh TJ, Schleiermacher G, Smith MA, Westermann F, Pfister SM. Molecular characteristics and therapeutic vulnerabilities across paediatric solid tumours. Nat Rev Cancer 2019; 19:420-438. [PMID: 31300807 DOI: 10.1038/s41568-019-0169-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 02/06/2023]
Abstract
The spectrum of tumours arising in childhood is fundamentally different from that seen in adults, and they are known to be divergent from adult malignancies in terms of cellular origins, epidemiology, genetic complexity, driver mutations and underlying mutational processes. Despite the immense knowledge generated through sequencing efforts and functional characterization of identified (epi-)genetic alterations over the past decade, the clinical implications of this knowledge have so far been limited. Novel preclinical platforms such as the European Innovative Therapies for Children with Cancer-Paediatric Preclinical Proof-of-Concept Platform and the US-based Pediatric Preclinical Testing Consortium are being developed to try to change this by aiming to recapitulate the extensive heterogeneity of paediatric tumours and thereby, hopefully, improve the ability to predict clinical benefit. Numerous studies have also been established worldwide to provide patients with access to real-time molecular profiling and the possibility of more precise mechanism-of-action-based treatments. In addition to tumour-intrinsic findings and mechanisms, ongoing studies are investigating features such as the immune microenvironment of paediatric tumours in comparison with adult cancers - currently of very timely clinical relevance. However, there is an ongoing need for rigorous preclinical biomarker and target validation to feed into the next generation of molecularly stratified clinical trials. This Review aims to provide a comprehensive state-of-the-art overview of the molecular landscape of paediatric solid tumours, including their underlying genomic alterations and interactions with the microenvironment, complemented with our current understanding of potential therapeutic vulnerabilities and how these can be preclinically tested using more accurate predictive methods. Finally, we provide an outlook on the challenges and opportunities associated with translating this overwhelming scientific progress into real clinical benefit.
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Affiliation(s)
- David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Pediatric Glioma Research Group, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ana Banito
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Pediatric Soft Tissue Sarcoma Research Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas G P Grünewald
- Max-Eder Research Group for Pediatric Sarcoma Biology, Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Michelle Haber
- Children's Cancer Institute, Lowy Cancer Research Centre, UNSW Australia, Randwick, NSW, Australia
- School of Women's & Children's Health, UNSW Australia, Randwick, NSW, Australia
| | - Natalie Jäger
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Till Milde
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Clinical Cooperation Unit Pediatric Oncology, German Cancer Research Center (DKFZ) and German Consortium for Translational Cancer Research (DKTK), Heidelberg, Germany
- KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan J Molenaar
- Princess Maxima Center for Pediatric Cancer, Utrecht, The Netherlands
| | - Arash Nabbi
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Trevor J Pugh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Gudrun Schleiermacher
- SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
- INSERM U830, Laboratoire de Génétique et Biologie des Cancers, Research Center, Institut Curie, Paris, France
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, MD, USA
| | - Frank Westermann
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Neuroblastoma Genomics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.
- KiTZ Clinical Trial Unit (ZIPO), Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany.
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15
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Vairy S, Jouan L, Bilodeau M, Dormoy-Raclet V, Gendron P, Couture F, Léveillé F, Tihy F, Lemyre E, Bouron-Dal Soglio D, Jabado N, Kleinman CL, Marzouki M, Cellot S. Novel PDE10A-BRAF Fusion With Concomitant NF1 Mutation Identified in an Undifferentiated Sarcoma of Infancy With Sustained Response to Trametinib. JCO Precis Oncol 2018; 2:1-13. [DOI: 10.1200/po.18.00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Stéphanie Vairy
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Loubna Jouan
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Mélanie Bilodeau
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Virginie Dormoy-Raclet
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Patrick Gendron
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Françoise Couture
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - France Léveillé
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Frédérique Tihy
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Emmanuelle Lemyre
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Dorothée Bouron-Dal Soglio
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Nada Jabado
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Claudia L. Kleinman
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Monia Marzouki
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
| | - Sonia Cellot
- Stéphanie Vairy, Mélanie Bilodeau, Monia Marzouki, and Sonia Cellot, Charles-Bruneau Cancer Center; Stéphanie Vairy, Loubna Jouan, Mélanie Bilodeau, Françoise Couture, France Léveillé, Frédérique Tihy, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Centre Hospitalier Universitaire Sainte-Justine; Patrick Gendron, Emmanuelle Lemyre, Dorothée Bouron-Dal Soglio, Monia Marzouki, and Sonia Cellot, Université de Montréal; Nada Jabado and Claudia L. Kleinman, McGill University
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16
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Wu LW, Pavlock T, Patterson A, Post A, Ambrose C, Rajaram V, Pavlick DC, Cooke M, Miller VA, Albacker LA, Ali SM, Smith S, Cox MC, Martin A, Megison S, Laetsch TW. Durable Clinical Response to Larotrectinib in an Adolescent Patient With an Undifferentiated Sarcoma Harboring an STRN- NTRK2 Fusion. JCO Precis Oncol 2018; 2:1800101. [PMID: 32913990 PMCID: PMC7446438 DOI: 10.1200/po.18.00101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Lawrence W Wu
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Tara Pavlock
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Alison Patterson
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Anne Post
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Caitlyn Ambrose
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Veena Rajaram
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Dean C Pavlick
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Matthew Cooke
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Vincent A Miller
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Lee A Albacker
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Siraj M Ali
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Steven Smith
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Michael C Cox
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Andrew Martin
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Steve Megison
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
| | - Theodore W Laetsch
- , , , , and , The University of Texas Southwestern Medical Center; , , , , , , , and , Children's Health, Dallas, TX; , , , , and , Foundation Medicine, Cambridge, MA; and and , Loxo Oncology, South San Francisco, CA
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Pediatric soft tissue sarcoma of the limbs: clinical outcome of 97 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:1-7. [PMID: 28766068 DOI: 10.1007/s00590-017-2019-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/19/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE Soft tissue sarcomas (STS) of the extremities in children are a heterogeneous group of tumors with a very different prognosis for which optimal treatment remains controversial. PATIENTS AND METHODS We retrospectively evaluated 97 patients younger than 15 years old affected by limb soft tissue sarcomas. All cases were histologically revised, and tumor grade was assessed according to the FNLCC system. Thirty-two were rhabdomyosarcoma (RMS) and 65 non-rhabdomyosarcoma (NRMSTS); among these, 40 (61.5%) were grade 3 according to FNLCC classification. Overall survival, local recurrence and distant metastasis were analyzed. RESULTS Overall survival was 77.8% at 5 years and 69.7% at 10 years. Among grade 3 tumors, RMS had a worse prognosis over NRSTS. Similarly, tumors larger than 5 cm had a worse prognosis compared to smaller ones. Local recurrence-free survival was 90.7% at 5 years and 87.1% at 10 years with a better local control in grade 3 NRSTS over RMS and in tumors smaller than 2 cm. CONCLUSION Children affected by extremities RMS were confirmed to have the worst prognosis, in particular in case of metastasis at presentation. Differently from adult patients, hand and feet locations are frequent site for STS and 2 cm diameter should be taken as cut off for higher risk of LR. Similarly to adulthood STS, grading correlates with prognosis in NRSTS. The identification of prognostic variables should enable risk-adapted therapies to be planned.
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Re-excision after unplanned resection of nonmetastatic nonrhabdomyosarcoma soft tissue sarcoma in children: Comparison with planned excision. J Pediatr Surg 2017; 52:1340-1343. [PMID: 28132767 DOI: 10.1016/j.jpedsurg.2017.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/31/2016] [Accepted: 01/15/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is not exceptional to come by children with initial unplanned surgical intervention for nonrhabdomyosarcoma soft tissue sarcomas (NRSTS). The aim of this study was to evaluate the presence of residual disease in these patients after re-excision and compare the treatment outcomes with patients who had planned upfront excision. METHODS The data of patients with primary nonmetastatic NRSTS with initially unplanned excision who underwent re-excision between March 2006 and December 2014 were analyzed and the results compared with patients having planned upfront excision in the similar period. RESULTS Of the 84 patients, 40 (48%) had an unplanned excision elsewhere; 35 of these patients had a re-excision. Twenty-one of the remaining 44 patients underwent upfront planned excision. A residual tumor was present in 16 (45.7%) patients. There was no significant difference in the local recurrence, distant metastases, or deaths in patients with re-excision or planned excision. The 5-year overall, disease-free survival and local control rates were, respectively, 93.5%, 90.2% and 96.6% for the re-excision group and 84.9%, 65.2% and 88.5% in the planned excision group (p=NS). CONCLUSIONS The probability of residual disease following unplanned excision of NRSTS is high. The outcomes following re-excision are similar to that with planned excision. PROGNOSIS STUDY Level II evidence.
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Tinkle CL, Fernandez-Pineda I, Sykes A, Lu Z, Hua CH, Neel MD, Bahrami A, Shulkin BL, Kaste SC, Pappo A, Spunt SL, Krasin MJ. Nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) in pediatric and young adult patients: Results from a prospective study using limited-margin radiotherapy. Cancer 2017; 123:4419-4429. [PMID: 28759114 DOI: 10.1002/cncr.30793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/14/2017] [Accepted: 04/25/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Indications for and delivery of adjuvant therapies for pediatric nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) have been derived largely from adult studies; therefore, significant concern remains regarding radiation exposure to normal tissue. The authors report long-term treatment outcomes and toxicities for pediatric and young adult patients with high-grade NRSTS who were treated on a prospective trial using limited-margin radiotherapy. METHODS Sixty-two patients (ages 3-22 years) with predominantly high-grade NRSTS requiring radiation were treated on a phase 2 institutional study of conformal external-beam radiotherapy and/or brachytherapy using a 1.5-cm to 2-cm anatomically constrained margin. The estimated cumulative incidence of local failure, Gray's method estimated cumulative incidence of local failure, Kaplan-Meier method estimated survival, competing-risk regression model determined predictors of disease outcome, and toxicity was reported according to CTCAE v2.0. RESULTS At a median follow-up of 5.1 years (range, 0.2-10.9 years), 9 patients had experienced local failure. The 5-year overall cumulative incidence of local failure was 14.8% (95% confidence interval [CI], 7.2%-25%), and all but 1 local failure occurred outside the highest-dose irradiation volume. The 5-year Kaplan-Meier estimates for event-free and overall survival were 49.3% (95% CI, 36.3%-61.1%) and 67.9% (95% CI, 54.2%-78.3%), respectively. Multivariable analysis indicated that younger age was the only independent predictor of local recurrence (P = .004). The 5-year cumulative incidence of grade 3 or 4 late toxicity was 15% (95% CI, 7.2%-25.3%). CONCLUSIONS The delivery of limited-margin radiotherapy using conformal external-beam radiotherapy or brachytherapy provides a high rate of local tumor control without an increase in marginal failures and with acceptable treatment-related morbidity. Cancer 2017;123:4419-29. © 2017 American Cancer Society.
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Affiliation(s)
- Christopher L Tinkle
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - April Sykes
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michael D Neel
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sue C Kaste
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Alberto Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University, Stanford, California
| | - Matthew J Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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20
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Abstract
Pediatric sarcomas are a heterogeneous group of tumors accounting for approximately 10% of childhood solid tumors. Treatment is focused on multimodality therapy, which has improved the prognosis over the past two decades. Current regimens focus on decreasing treatment for low-risk patients to decrease the long-term side effects while maximizing therapy for patients with metastatic disease to improve survival. Pediatric sarcomas can be divided into soft tissue sarcomas and osseous tumors. Soft tissue sarcomas are further delineated into rhabdomyosarcomas, which affect young children and nonrhabdomyosarcomas, which are most common in adolescents. The most common bone sarcomas are osteosarcomas and Ewing's sarcoma.
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21
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Chemotherapy and Multidisciplinary Approaches to Pediatric Sarcomas. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abstract
BACKGROUND Nearly half of soft tissue sarcomas are nonrhabdomyosarcomas (NRSTSs). The low-grade (LG) form comprises a heterogenous group of diseases that rarely metastasize but are known for local recurrence. AIM OF THE STUDY The aim of the study was to retrospectively evaluate pediatric LG-NRSTS with regard to demography, survival, and factors affecting outcome in Egyptian patients. PATIENTS AND METHODS The study reviewed 66 NRSTS patients who presented to the Pediatric Oncology Department, National Cancer Institute, Cairo University, between January 2008 and December 2013. RESULTS Out of the reviewed cases 32 patients had LG tumors and were eligible for analysis. The male to female ratio was 1:1 and the median age was 7.5 years (range, 1 mo to 18 y). Desmoid fibromatosis (N=18) showed frequent local recurrence and nearly half of this group was alive without disease. No recurrence of the disease occurred in the nonfibromatosis group (n=14) and all patients were alive and free of disease. The 5-year overall survival was 88% for the entire group of study patients versus 45% for event-free survival. Tumors >5 cm in diameter and fibromatosis histology subtype were associated with lower EFS. CONCLUSIONS LG-NRSTS generally has good prognosis, with overall survival reaching 90%. However, aggressive fibromatosis usually runs a poorer course in the form of high incidence of local recurrence and lower survival rates. This needs to be further assessed in larger prospective studies including novel therapies in addition to the current conventional modalities.
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Adesina OOO, Zaugg BE, Dries DC, Palmer CA, Patel BCK. Undifferentiated Nonrhabdomyosarcoma Soft Tissue Sarcoma of the Orbit. Ophthalmic Plast Reconstr Surg 2016; 33:e57-e60. [PMID: 27429224 DOI: 10.1097/iop.0000000000000744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 6-month-old boy presented with recurrent, poorly differentiated orbital sarcoma diagnosed as nonrhabdomyosarcoma soft tissue sarcoma, as pathologic and immunohistochemical evaluation was inconsistent with rhabdomyosarcoma or other specific sarcoma subtypes. He responded favorably to a treatment regimen for poorly differentiated sarcomas.
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Affiliation(s)
- Ore-Ofe O Adesina
- *John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, The University of Utah School of Medicine, Salt Lake City, Utah, †Ruiz Department of Ophthalmology and Visual Science and Department of Neurology, McGovern Medical School at The University of Health Science Center at Houston (UTHealth), Houston, Texas, ‡Robert Cizik Eye Clinic, Houston, Texas, and §Department of Pathology, University of Utah, Salt Lake City, Utah, U.S.A.Supported in part by National Eye Institute Vision Core Grant P30EY010608 (UT), a Challenge Grant to the McGovern Medical School from Research to Prevent Blindness, New York, NY (UT), an Unrestricted Grant from Research to Prevent Blindness, Inc., New York, NY, to the Department of Ophthalmology & Visual Sciences, University of Utah, and the Hermann Eye Fund, Houston, TX (UT)
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Qureshi SS, Bhagat M. Non-rhabdomyosarcoma soft-tissue sarcomas in children: Contemporary appraisal and experience from a single centre. J Indian Assoc Pediatr Surg 2015; 20:165-9. [PMID: 26628806 PMCID: PMC4586977 DOI: 10.4103/0971-9261.154664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nonrhabdmyosarcoma soft tissue sarcomas (NRSTS) include a cluster of different types of soft tissue sarcomas clubbed together due to the rarity of individual subtypes. The diagnostic accuracy is lately reinforced due to the availability of immunohistochemical and molecular markers. Surgery is the central modality of treatment since many of them are insensitive to chemotherapy. With the availability of rational risk stratification system, efforts are in progress to evaluate the role of neoadjuvant chemotherapy and radiotherapy to improve outcomes especially for the locally advanced disease. The survival remains dismal for metastatic disease. This review highlights the current status of NRSTS and also describes the experience from a single centre in treatment of NRSTS.
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Affiliation(s)
- Sajid S Qureshi
- Department of Pediatric Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Monica Bhagat
- Department of Pediatric Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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25
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Alaggio R, Coffin CM. The Evolution of Pediatric Soft Tissue Sarcoma Classification in the Last 50 Years. Pediatr Dev Pathol 2015; 18:481-94. [PMID: 26701753 DOI: 10.2350/15-07-1666-misc.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This review discusses the history of the classification of soft tissue sarcomas in children and adolescents, the current transition toward integration of morphology and molecular genetics as new entities emerge, and future perspectives.
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Affiliation(s)
- Rita Alaggio
- 1 Department of Medicine-DIMED, Pathology Unit, University of Padova, Via Gabelli, 61 35124, Padova, Italy
| | - Cheryl M Coffin
- 2 Department of Pathology, Vanderbilt Medical Center, 1161 21st Avenue South, Nashville, TN 37232, USA
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Abstract
Malignant bone tumors (osteosarcoma, Ewing sarcoma) and soft-tissue sarcomas (rhabdomyosarcoma, nonrhabdomyosarcoma) account for approximately 14% of childhood malignancies. Successful treatment of patients with sarcoma depends on a multidisciplinary approach to therapy, including oncology, surgery, radiation oncology, radiology, pathology, and physiatry. By combining systemic treatment with chemotherapy and primary tumor control using surgery and/or radiation, survival rates for localized disease range from 70% to 75%. However, children with metastatic or recurrent disease continue to have dismal outcomes. A better understanding of the biology underlying both bone and soft-tissue sarcomas is required to further improve outcomes for children with these tumors.
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Affiliation(s)
- Josephine H HaDuong
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Pediatrics, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS 54, Los Angeles, CA 90027, USA
| | - Andrew A Martin
- Division of Hematology/Oncology, Department of Pediatrics, Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, MC 9063, Dallas, TX 75390, USA
| | - Stephen X Skapek
- Division of Hematology/Oncology, Department of Pediatrics, Pauline Allen Gill Center for Cancer and Blood Disorders, Children's Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, MC 9063, Dallas, TX 75390, USA
| | - Leo Mascarenhas
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, Department of Pediatrics, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 Sunset Boulevard, MS 54, Los Angeles, CA 90027, USA.
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27
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Comparative pathology of canine soft tissue sarcomas: possible models of human non-rhabdomyosarcoma soft tissue sarcomas. J Comp Pathol 2014; 152:22-7. [PMID: 25435513 DOI: 10.1016/j.jcpa.2014.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 09/30/2014] [Indexed: 01/06/2023]
Abstract
Comparative analyses of canine and human soft tissue sarcomas (STSs) are lacking. This study compared the histological and immunohistochemical (labelling for desmin, smooth muscle actin [SMA], CD31, pancytokeratin, S100 and CD34) appearance of 32 archived, formalin-fixed, paraffin wax-embedded canine STS tumour specimens by board-certified veterinary and medical pathologists, both blinded to the other's interpretations. Comparison between the veterinary and human diagnoses revealed a generally consistent pattern of interpretation with few notable variations. Most tumours (13/32) were judged to display similar histomorphological appearance to human low-grade spindle cell sarcomas, appearing non-distinctive and morphologically of a fibroblastic/myofibroblastic type. Five canine cases resembled human liposarcoma, but with atypical desmin-positive epithelioid cells present. Five canine cases resembled human spindle cell sarcoma with myxoid features and two additional cases resembled human myxofibrosarcoma. Seven canine cases were noted to resemble human undifferentiated sarcoma. Findings in the present study demonstrate that canine STSs display histological and immunohistochemical features similar to their human equivalents. Because of these cross-species similarities, a particular opportunity exists to understand the biology and treatment of human STS by potentially including dogs as clinical models.
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28
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Bates JE, Peterson CR, Dhakal S, Giampoli EJ, Constine LS. Malignant peripheral nerve sheath tumors (MPNST): a SEER analysis of incidence across the age spectrum and therapeutic interventions in the pediatric population. Pediatr Blood Cancer 2014; 61:1955-60. [PMID: 25130403 DOI: 10.1002/pbc.25149] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/19/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Malignant peripheral nerve sheath tumors (MPNST) are very rare in the general population and challenging to treat. A paucity of data exists regarding the incidence of MPNST across all age groups and treatment outcomes in the pediatric population. We aimed to characterize both using the Survival, Epidemiology, and End Results (SEER) database. PROCEDURE The SEER-18 database with information on the United States population from 1973 to 2009 was queried for cases of MPNST. For incidence data, 1,182 cases were found among the general population. Of those, 165 cases were in individuals aged 0-19. After exclusions, 139 cases from the SEER-18 database met study criteria for outcomes analysis. For each patient, variables including gender, age, race, stage (localized, regional, or distant), surgical treatment, and radiotherapy were obtained. RESULTS The overall incidence of MPNST was 1.46 per million person-years, with increased incidence among the elderly. In the pediatric population, the incidence was 0.56 per million person-years, and was higher among post-pubertal children aged 10-19. Median overall survival in the pediatric population was 30 months, with only localized disease and treatment with surgery being positive prognostic factors on multivariate analysis. CONCLUSIONS MPNST is a rare disease and, among children, is most frequent seen in adolescents. Surgery is crucial as first-line treatment for MPNST, especially if the tumor is localized at diagnosis. In patients with non-localized MPNST, the disease remains extremely difficult to manage, and both surgery and radiotherapy are interventions that should be considered.
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Affiliation(s)
- James E Bates
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
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29
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Coffin CM, Davis JL, Borinstein SC. Syndrome-associated soft tissue tumours. Histopathology 2013; 64:68-87. [DOI: 10.1111/his.12280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology; Vanderbilt University School of Medicine; Nashville TN USA
| | - Jessica L Davis
- Department of Anatomic Pathology; Laboratory Medicine; University of California at San Francisco; San Francisco CA USA
| | - Scott C Borinstein
- Division of Pediatric Hematology/Oncology; Department of Pediatrics; Vanderbilt University School of Medicine; Nashville TN USA
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30
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Skapek SX, Anderson J, Barr FG, Bridge JA, Gastier-Foster JM, Parham DM, Rudzinski ER, Triche T, Hawkins DS. PAX-FOXO1 fusion status drives unfavorable outcome for children with rhabdomyosarcoma: a children's oncology group report. Pediatr Blood Cancer 2013; 60:1411-7. [PMID: 23526739 PMCID: PMC4646073 DOI: 10.1002/pbc.24532] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/19/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is divided into two major histological subtypes: alveolar (ARMS) and embryonal (ERMS), with most ARMS expressing one of two oncogenic genes fusing PAX3 or PAX7 with FOXO1 (P3F and P7F, respectively). The Children's Oncology Group (COG) carried out a multi-institutional clinical trial to evaluate the prognostic value of PAX-FOXO1 fusion status. METHODS Study participants were treated on COG protocol D9803 for intermediate risk ARMS or ERMS using multi-agent chemotherapy, radiotherapy, and surgery. Central diagnostic pathology review and molecular testing for fusion genes were carried out on prospectively collected specimens. Event-free (EFS) and overall survival (OS) at 5 years were correlated with histological subtype and PAX-FOXO1 status. RESULTS Of 616 eligible D9803 enrollees, 434 cases had adequate clinical, molecular, and pathology data for definitive classification as ERMS, ARMS P3F+ or P7F+, or ARMSn (without detectable fusion). EFS was worse for those with ARMS P3F+ (54%) and P7F+ (65%) than those with ERMS (77%; P < 0.001). EFS for ARMSn and ERMS were not statistically different (90% vs. 77%, P = 0.15). ARMS P3F+ had poorer OS (64%) than ARMS P7F+ (87%), ARMSn (89%), and ERMS (82%; P = 0.006). CONCLUSIONS ARMSn has an outcome similar to ERMS and superior EFS compared to ARMS with either P3F or P7F, when given therapy designed for children with intermediate risk RMS. This prospective analysis supports incorporation of PAX-FOXO1 fusion status into risk stratification and treatment allocation.
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Affiliation(s)
- Stephen X. Skapek
- Children’s Medical Center and University of Texas Southwestern Medical Center, Dallas, Texas,Correspondence to: Stephen X. Skapek, Center for Cancer and Blood Disorders, Children’s Medical Center; Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, MC 9063, Dallas, TX 75390.
| | | | | | | | | | - David M. Parham
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | - Timothy Triche
- Children’s Hospital of Los Angeles, University of Southern California, Los Angeles, California
| | - Douglas S. Hawkins
- Seattle Children’s Hospital, Fred Hutchinson Cancer Research Center, and University of Washington, Seattle, Washington
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31
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Hawkins DS, Spunt SL, Skapek SX. Children's Oncology Group's 2013 blueprint for research: Soft tissue sarcomas. Pediatr Blood Cancer 2013; 60:1001-8. [PMID: 23255356 PMCID: PMC3777409 DOI: 10.1002/pbc.24435] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/12/2012] [Indexed: 12/19/2022]
Abstract
In the US, approximately 850-900 children are diagnosed each year with soft tissue sarcomas (STS). Key findings from recent Children's Oncology Group (COG) clinical trials include safe reduction in therapy for low risk rhabdomyosarcoma (RMS), validation of FOXO1 fusion as a prognostic factor, a modest improvement in outcome for high-risk RMS, and a biologically designed non-cytotoxic therapy for pediatric desmoid tumor. Planned Phase 2 trials include targeted agents for VEGF/PDGF, mTOR, and IGF-1R for children with RMS and VEGF for children with non-RMS STS (NRSTS). For RMS, COG Phase 3 trials potentially will explore VEGF/mTOR inhibition or chemotherapy interval compression. For NRSTS, a COG Phase 3 trial will explore VEGF inhibition.
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Affiliation(s)
- Douglas S Hawkins
- Seattle Children's Hospital, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, WA 98015, USA.
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32
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Abstract
Sarcomas are cancers arising from the mesenchymal layer that affect children, adolescents, young adults, and adults. Although most sarcomas are localized, many display a remarkable predilection for metastasis to the lungs, liver, bones, subcutaneous tissue, and lymph nodes. Additionally, many sarcoma patients presenting initially with localized disease may relapse at metastatic sites. While localized sarcomas can often be cured through surgery and often radiation, controversies exist over optimal management of patients with metastatic sarcoma. Combinations of chemotherapy are the most effective in many settings, and many promising new agents are under active investigation or are being explored in preclinical models. Metastatic sarcomas are excellent candidates for novel approaches with additional agents as they have demonstrated chemosensitivity and affect a portion of the population that is motivated toward curative therapy. In this paper, we provide an overview on the common sarcomas of childhood (rhabdomyosarcoma), adolescence, and young adults (osteosarcoma, Ewing sarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor) and older adults (leiomyosarcoma, liposarcoma, and undifferentiated high grade sarcoma) in terms of the epidemiology, current therapy, promising therapeutic directions and outcome with a focus on metastatic disease. Potential advances in terms of promising therapy and biologic insights may lead to more effective and safer therapies; however, more clinical trials and research are needed for patients with metastatic sarcoma.
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Affiliation(s)
- Ernest K Amankwah
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Anthony P Conley
- Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Damon R Reed
- Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Lettieri CK, Hingorani P, Kolb EA. Progress of oncolytic viruses in sarcomas. Expert Rev Anticancer Ther 2012; 12:229-42. [PMID: 22316371 DOI: 10.1586/era.11.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Oncolytic virotherapy has shown exciting promise for the treatment of many types of solid tumors. Pediatric sarcomas are an aggressive type of pediatric malignancy known to show limited responsiveness to current therapies, leading to unacceptably high morbidity and mortality. Oncolytic viruses have only recently been used for the treatment of this challenging cancer, and results have been encouraging. Five clinical trials are currently open evaluating the use of oncolytic viruses in pediatric malignancies. Advances in genetic engineering of the viruses include improving the ability of the virus to infect tumor cells, engineering the virus with transgenes which improve the virus' ability to kill tumor cells and manipulating the virus to enhance concomitantly administered therapies. Further understanding of the antiviral immune response and a viral induced anti-tumor immune response will permit a maximization of oncolytic virotherapy.
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Affiliation(s)
- Christina K Lettieri
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
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Coffin CM, Alaggio R, Dehner LP. Some general considerations about the clinicopathologic aspects of soft tissue tumors in children and adolescents. Pediatr Dev Pathol 2012; 15:11-25. [PMID: 22375909 DOI: 10.2350/11-08-1081-pb.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Soft tissue tumors in children and adolescents are an important group of neoplasms, pseudoneoplasms, and tumefactive malformations with some distinctive clinicopathologic, genetic, syndromic, and therapeutic implications. In addition to the basic pathologic examination, there is the availability of diagnostic adjuncts in various settings based upon the histopathologic features that facilitate and/or corroborate a diagnosis. Immunohistochemistry, cytogenetics, molecular genetics, and an ever-increasing array of new technologies are available to address specific diagnostic questions and even potential therapeutic strategies. This review focuses upon some of the unique aspects of soft tissue tumors in children, including the classification, approach to the diagnosis, grading, clinical and pathologic staging, therapy-related changes, pathogenesis, and risk factors.
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Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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Million L, Donaldson SS. Resectable pediatric nonrhabdomyosarcoma soft tissue sarcoma: which patients benefit from adjuvant radiation therapy and how much? ISRN ONCOLOGY 2012; 2012:341408. [PMID: 22523704 PMCID: PMC3316976 DOI: 10.5402/2012/341408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 01/09/2012] [Indexed: 11/23/2022]
Abstract
It remains unclear which children and adolescents with resected nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) benefit from radiation therapy, as well as the optimal dose, volume, and timing of radiotherapy when used with primary surgical resection. This paper reviews the sparse literature from clinical trials and retrospective studies of resected pediatric NRSTS to discern local recurrence rates in relationship to the use of radiation therapy.
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Affiliation(s)
- Lynn Million
- Department of Radiation Oncology, Stanford Cancer Center, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
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Davidoff AM, Fernandez-Pineda I, Santana VM, Shochat SJ. The role of neoadjuvant chemotherapy in children with malignant solid tumors. Semin Pediatr Surg 2012; 21:88-99. [PMID: 22248974 DOI: 10.1053/j.sempedsurg.2011.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pediatric surgeons play a critical role in diagnosing, staging, and treating malignant solid tumors in children. Over the years, the surgical management of the primary tumor site has evolved from an aggressive en-bloc resection at diagnosis to a more tailored surgical approach, often affecting definitive local control after the delivery of neoadjuvant therapy, as currently directed by many solid tumor protocols. In fact, inappropriate upfront resection can lead to unnecessary short- and long-term morbidity, an incomplete resection, and may be associated with a delay in the initiation of the systemic chemotherapy that is critical to the treatment of gross or occult metastatic disease. Therefore, it is important for the pediatric surgeon, as a member of the multidisciplinary team involved in the care of these children, to understand the indications for and implications of neoadjuvant therapy in the treatment of pediatric solid tumors. Here we review the current management of childhood solid tumors focusing on the role of neoadjuvant therapy.
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Affiliation(s)
- Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Abstract
Nonrhabdomyosarcoma soft-tissue sarcomas (NRSTS) represent a subgroup of sarcomas that encompass more than 50 distinct histologies. All are rare, but some are more common in patients younger than 20 years of age. The management of patients with many histologies overlap. However, this review will focus on issues unique to a select few NRSTS that are most common in pediatric and adolescent patients. Here, we will discuss the recent advances in the diagnosis, surgical management, and treatment of NRSTS. Adequate surgical local control of the primary tumor is a critical component of the treatment strategy will be emphasized in this review because it determines local and distant recurrence.
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Reed D, Altiok S. Metastatic soft tissue sarcoma chemotherapy: an opportunity for personalized medicine. Cancer Control 2011; 18:188-95. [PMID: 21666581 DOI: 10.1177/107327481101800306] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Soft tissue sarcoma (STS) includes biologically and histologically diverse mesenchymal tumors that are relatively chemotherapy-resistant compared with other sarcoma subtypes. METHODS The authors discuss the clinical challenges frequently encountered by medical oncologists and review the literature for predictive strategies to systematically approach chemotherapy decision making. RESULTS There are no clinically validated predictive tests for chemotherapeutic response or resistance in STS. Clinical features including histology, stage, and patient age are currently used to guide therapy decisions in STS. CONCLUSIONS A method to predict response or resistance to chemotherapy, utilizing both targeted and conventional agents, would be beneficial in reducing toxicity and improving response rates for patients with STS and also in designing clinical trials for this disease.
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Affiliation(s)
- Damon Reed
- Department of Sarcoma at The H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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Smith KB, Indelicato DJ, Knapik JA, Morris C, Kirwan J, Zlotecki RA, Scarborough MT, Gibbs CP, Marcus RB. Definitive radiotherapy for unresectable pediatric and young adult nonrhabdomyosarcoma soft tissue sarcoma. Pediatr Blood Cancer 2011; 57:247-51. [PMID: 21671361 DOI: 10.1002/pbc.22961] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 11/11/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND Few published articles describe outcomes following definitive radiation for unresectable pediatric and young adult nonrhabdomyosarcoma soft tissue sarcoma (NRSTS). The purpose of this study is to evaluate the prognostic factors, outcomes, and complications in patients age 30 years or younger with NRSTS treated at the University of Florida from 1973 to 2002. PROCEDURE Nineteen pediatric and young adult patients with NRSTS were treated with radiotherapy after biopsy. Thirteen patients had high-grade tumors. The median age at radiotherapy was 19.6 years; the median dose was 55.2 Gy. Twelve patients received chemotherapy. Prognostic factors for local recurrence, distant metastases, and survival were analyzed. RESULTS Median follow-up was 2.6 years. The 5-year local-control rate was 40%. Nine out of 13 local failures occurred in the absence of metastatic disease. All patients with local failures died of their cancer, and 8 patients died without evidence of distant metastases. There was a trend toward improved local control with low/intermediate-grade tumors. Freedom from distant metastases at 5 years was 68%. Fourteen patients died of their disease. The 5-year overall survival was 37%. There was one grade 4 complication based on NCI Common Terminology Criteria for Adverse Events version 3. CONCLUSION Young patients with unresectable NRSTS have a poor outcome thereby justifying current study efforts focused on treatment intensification. By demonstrating that all patients with local recurrence died of disease and more than half of these deaths occurred in the absence of distant spread, these results suggests that improved means of local control may translate into improvement in survival.
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Affiliation(s)
- Kristy B Smith
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
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Smith KB, Indelicato DJ, Knapik JA, Lagmay JP, Morris C, Kirwan JM, Zlotecki RA, Scarborough MT, Gibbs CP, Marcus RB. Adjuvant radiotherapy for pediatric and young adult nonrhabdomyosarcoma soft-tissue sarcoma. Int J Radiat Oncol Biol Phys 2011; 81:150-7. [PMID: 21550181 DOI: 10.1016/j.ijrobp.2010.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 05/04/2010] [Accepted: 05/05/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the prognostic factors, outcomes, and complications in patients aged ≤30 years with resectable nonrhabdomyosarcoma soft-tissue sarcoma treated at the University of Florida with radiotherapy (RT) during a 34-year period. METHODS AND MATERIALS A total of 95 pediatric or young adult patients with nonrhabdomyosarcoma soft-tissue sarcoma were treated with curative intent with surgery and RT at the University of Florida between 1973 and 2007. The most common histologic tumor subtypes were synovial sarcoma in 22 patients, malignant fibrous histiocytoma in 19, and malignant peripheral nerve sheath tumor in 11 patients. The mean age at RT was 22 years (range, 6-30). Of the 95 patients, 73 had high-grade tumors; 45 had undergone preoperative RT and 50 postoperative RT. The prognostic factors for survival, local recurrence, and distant recurrence were analyzed. RESULTS The median follow-up was 7.2 years (range, 0.4-30.5). The actuarial 5-year local control rate was 88%. A microscopically negative margin was associated with superior local control. Although 83% of local recurrence cases initially developed in the absence of metastases, all patients with local failure ultimately died of their disease. The actuarial estimate of 5-year overall survival and disease-free survival was 65% and 63%, respectively. Of all the deaths, 92% were disease related. An early American Joint Committee on Cancer stage, tumor<8 cm, and the absence of neurovascular invasion were associated with superior disease-free survival. The National Cancer Institute Common Toxicity Criteria, version 3, Grade 3-4 treatment complication rate was 9%. No secondary malignancies were observed. CONCLUSION In the present large single-institution study, we found positive margins and locally advanced features to be poor prognostic factors for both local progression and survival. The results from the present study have helped to characterize the therapeutic ratio of RT in pediatric and young adult sarcoma patients and have provided a basis for identifying high-risk patients for whom treatment intensification might be justified.
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Affiliation(s)
- Kristy B Smith
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
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Bid HK, Houghton PJ. Targeting angiogenesis in childhood sarcomas. Sarcoma 2010; 2011:601514. [PMID: 21197468 PMCID: PMC3005857 DOI: 10.1155/2011/601514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 10/29/2010] [Indexed: 12/19/2022] Open
Abstract
Angiogenesis and vasculogenesis constitute two processes in the formation of new blood vessels and are essential for progression of solid tumors. Consequently, targeting angiogenesis, and to a lesser extent vasculogenesis, has become a major focus in cancer drug development. Angiogenesis inhibitors are now being tested in pediatric populations whereas inhibitors of vasculogenesis are in an earlier stage of development. Despite the initial enthusiasm for targeting angiogenesis for treatment of cancer, clinical trials have shown only incremental increases in survival, and agents have been largely cytostatic rather than inducing tumor regressions. Consequently, the role of such therapeutic approaches in the context of curative intent for childhood sarcomas is less clear. Here we review the literature on blood vessel formation in sarcomas with a focus on pediatric sarcomas and developments in targeting angiogenesis for treatment of these rare cancers.
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Affiliation(s)
- Hemant K. Bid
- Center for Childhood Cancer, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Peter J. Houghton
- Center for Childhood Cancer, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
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Pinto A, Dickman P, Parham D. Pathobiologic markers of the ewing sarcoma family of tumors: state of the art and prediction of behaviour. Sarcoma 2010; 2011:856190. [PMID: 20981347 PMCID: PMC2957858 DOI: 10.1155/2011/856190] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/20/2010] [Accepted: 09/23/2010] [Indexed: 01/08/2023] Open
Abstract
Over the past three decades, the outcome of Ewing sarcoma family tumor (ESFT) patients who are nonmetastatic at presentation has improved considerably. The prognosis of patients with metastatic disease at the time of diagnosis and recurrence after therapy remains dismal. Drug-resistant disease at diagnosis or at relapse remains a major cause of mortality among patients diagnosed with ESFT. In order to improve the outcome for patients with potential relapse, there is an urgent need to find reliable markers that either predict tumor behaviour at diagnosis or identify therapeutic molecular targets at the time of recurrence. An improved understanding of the cell of origin and the molecular pathways that regulate tumorigenicity in ESFT should aid us in the search for novel therapies for ESFT. The purpose of this paper is thus to outline current concepts of sarcomagenesis in ESFT and to discuss ESFT patterns of differentiation and molecular markers that might affect prognosis or direct future therapeutic development.
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Affiliation(s)
- Alfredo Pinto
- Calgary Laboratory Services, University of Calgary, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB, Canada T3B 6A8
| | - Paul Dickman
- Department of Pathology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ 85016, USA
- Departments of Pathology and Pediatrics, University of Arizona, College of Medicine, Phoenix, AZ 85016, USA
| | - David Parham
- Health Sciences Center, University of Oklahoma, Oklahoma City, OK 73104, USA
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Khoury JD, Coffin CM, Spunt SL, Anderson JR, Meyer WH, Parham DM. Grading of nonrhabdomyosarcoma soft tissue sarcoma in children and adolescents: a comparison of parameters used for the Fédération Nationale des Centers de Lutte Contre le Cancer and Pediatric Oncology Group Systems. Cancer 2010; 116:2266-74. [PMID: 20166208 DOI: 10.1002/cncr.24929] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Two systems for grading soft tissue sarcoma are widely used currently: the National Cancer Institute (NCI) and the Fédération Nationale des Centers de Lutte Contre le Cancer (FNCLCC) systems. Both were developed using cohorts of predominantly adult patients. The Pediatric Oncology Group (POG) system, based on the NCI system, was adapted for grading pediatric nonrhabdomyosarcoma soft tissue sarcoma (NRSTS). The applicability and prognostic utility of the FNCLCC system in pediatric NRSTS has not been assessed or compared with the POG system. METHODS Tumors from 130 patients with malignant NRSTS enrolled on 3 completed multi-institutional clinical trials were assessed. Of 130 tumors, 102 (78%) were localized and 28 (22%) metastatic. Of the localized tumors, 55 of 102 (54%) were >5 cm. The estimated 5-year event-free survival (EFS) for the entire group was 47%. RESULTS As expected, stage and tumor sizes were predictive of EFS (P < .001). Both systems were predictive of 5-year EFS (POG, P = .0095 and FNCLCC, P = .0075). Patients whose tumors received discrepant grades (POG-G3 vs FNCLCC-G2/G1) (n = 44) had an intermediate outcome between those with concordant (G3 [n = 44] or G1/G2 [n = 42]) grades on both systems (P = .0018). By multivariate analysis, the mitotic index was predictive of EFS, using a cutoff of 10 mitotic figures per 10 high-power fields (P < .001). CONCLUSIONS In conclusion, both FNCLCC and POG systems provide an adequate prognostic measure of outcome for pediatric NRSTS; albeit, a sizeable subset of cases with apparently intermediate prognosis was graded differently by the 2 systems. The mitotic index appears to be a key parameter in grading pediatric NRSTS.
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Affiliation(s)
- Joseph D Khoury
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
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Bien E, Rapala M, Krawczyk M, Balcerska A. The serum levels of soluble interleukin-2 receptor alpha and lactate dehydrogenase but not of B2-microglobulin correlate with selected clinico-pathological prognostic factors and response to therapy in childhood soft tissue sarcomas. J Cancer Res Clin Oncol 2009; 136:293-305. [PMID: 19693535 DOI: 10.1007/s00432-009-0661-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 08/04/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To establish the clinical utility of serum soluble IL-2 receptor (sIL-2R alpha), lactate dehydrogenase (LDH) [corrected] and B2-microglobulin [corrected] (B2-M) as markers for diagnosis, prognosis and treatment monitoring in childhood soft tissue sarcomas (STS). METHODS The markers[corrected] were measured prospectively before treatment, in complete remission (CR) during and after therapy and at relapse [corrected] in 35 children with STS and in 50 healthy children [corrected] (once). RESULTS Serum sIL-2R alpha and LDH [corrected] correlated with age thus they were [corrected] presented as multiplications [corrected] of the upper normal ranges [corrected] for age. Pre-treatment levels [corrected] of sIL-2R alpha and LDH [corrected] but not of B2-M exceeded significantly those of controls. [corrected] Elevated [corrected] sIL-2R alpha levels correlated with more [corrected] advanced stages, poor-risk histology and poor response to chemotherapy, higher LDH with incomplete primary tumour [corrected] resection and increased B2-M with poor-risk histology. [corrected] Patients' age >10 years, male gender and unfavourable tumour localisation were not accompanied by the markers' elevation. [corrected] None of the markers predicted EFS and OS. [corrected] Good response to chemotherapy was paralleled by significant decline of sIL-2R alpha and LDH pre-treatment levels while relapse--by sIL-2R alpha and LDH increase to values similar to those at diagnosis. [corrected] Monitoring of B2-M did not reflect the disease course. [corrected] CONCLUSIONS sIL-2R alpha and LDH were [corrected] proven to be promising markers [corrected] for diagnosis and treatment monitoring in children with STS. The markers [corrected] correlated also with some [corrected] important prognostic clinico-pathological factors for childhood [corrected] STS; however, they [corrected] failed to predict EFS and OS. Measurements of serum [corrected] B2-M were shown [corrected] to have no clinical value in the diagnostics, prognostics and treatment monitoring in paediatric STS.
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Affiliation(s)
- Ewa Bien
- Department of Paediatrics, Haematology, Oncology and Endocrinology, Medical University of Gdansk, 7 Debinki Street, 80-211, Gdansk, Poland.
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Abstract
PURPOSE OF REVIEW The survival curves for many pediatric sarcomas have remained flat for the past 2 decades or more and novel therapeutics - those small molecule medicines that selectively inhibit specific signaling molecules - have been slow to enter into pediatric practice. The preclinical basis for their use is reviewed here. RECENT FINDINGS Preclinical and phase I studies showing efficacy of antiinsulin-like growth factor receptor 1 therapies for Ewing sarcoma have led to numerous ongoing clinical trials using these agents for Ewing and other sarcomas. Early studies of ERBB signaling as a target in sarcoma therapy have been tantalizing, but progress in this area has been controversial. In-vitro analysis of Src inhibitors suggested that these agents would prevent metastasis in osteosarcoma, whereas in-vivo analysis showed no effect on metastasis, underscoring the need for thorough preclinical investigations of promising new therapies to guide future clinical trials. Antiangiogenic and immunomodulatory therapies are gaining momentum in the pediatric arena and should be tested in combination with traditional cytotoxic agents for recurrent and high-risk primary pediatric sarcomas. SUMMARY Pediatric sarcomas have diverse biology and distinct signaling pathways, making detailed preclinical evaluation of small molecule inhibitors essential to guiding the design of further clinical investigations.
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