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Ortega-Ruiz OR, Acevedo-Castillo CD, Pérez-Ruano LA, Caro-Osorio E. Simultaneous spine extradural and intradural teratomas in a pediatric patient: A rare presentation with insights in the flawed migration of germ cells theory. Childs Nerv Syst 2024; 40:1011-1017. [PMID: 38429504 DOI: 10.1007/s00381-024-06317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
Spinal teratomas are infrequent lesions in the pediatric population. These lesions can be extradural, intradural or intramedullary. We present a case of an 8-month-old boy that was assessed for underdevelopment of motor milestones. The neurologic examination revealed hyporeflexia, decreased sensation and flaccid paraplegia. MRI of the spine revealed two simultaneous and independent lesions in the extradural and intradural compartment. A laminectomy was performed for the T4-T7 vertebrae with total resection of both lesions. The histopathological analysis confirmed both lesions to be mature cystic teratomas. At the 1-year follow-up, the patient remained with no recovery of neurological function. A debate takes place regarding the etiology of formation of these lesions in the spine. The simultaneous presentation of two independent lesions in this patient could contribute to define the flawed migration of germ cells theory as the etiology for formation of teratomatous lesions in the spine.
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Affiliation(s)
- Omar R Ortega-Ruiz
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
- Department of Neurosurgery, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio 112, Real San Agustín, 66,260 San Pedro Garza García, Nuevo León, Mexico
| | - Carlos D Acevedo-Castillo
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México
- Department of Neurosurgery, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio 112, Real San Agustín, 66,260 San Pedro Garza García, Nuevo León, Mexico
| | - Luis Alejandro Pérez-Ruano
- Department of Neurosurgery, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio 112, Real San Agustín, 66,260 San Pedro Garza García, Nuevo León, Mexico
| | - Enrique Caro-Osorio
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México.
- Department of Neurosurgery, Hospital Zambrano Hellion, TecSalud, Av. Batallon de San Patricio 112, Real San Agustín, 66,260 San Pedro Garza García, Nuevo León, Mexico.
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Hoveyan J, Asatryan E, Grigoryan H, Hovsepyan S, Avagyan A, Hakobyan L, Sargsyan L, Iskanyan S, Avagyan M, Hovhannisyan S, Melnichenko I, Minasyan M, Papyan R, Manukyan N, Lazaryan A, Danelyan S, Muradyan A, Arakelyan J, Qaddoumi I, Boop F, Mkhitharyan A, Harutyunyan M, Tamamyan G, Bardakhchyan S. Trends in pediatric CNS tumors in Armenia: a multicenter retrospective study. Childs Nerv Syst 2024; 40:435-444. [PMID: 37837453 DOI: 10.1007/s00381-023-06179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Central nervous system (CNS) tumors are the most common solid malignancies in children worldwide, including in Armenia. The current study aims to analyze epidemiological data, treatment, and outcomes of children and young adults (≤25 years) with CNS tumors in Armenia during the last 26 years. METHODS We collected data from pediatric and young adult patients treated in selected sites in Armenia from 1st January 1995 to 31st December 2020. Incidence by sex, age at diagnosis, time from first complaints to diagnosis, histopathology results, treatment strategies, complications, and overall survival (OS) rates were calculated. RESULTS The multicenter data analysis revealed 149 patients with diagnosed primary CNS tumors over 26 years. Among them, 84 (56.4%) were male. The median age at diagnosis was 7 years (range, 3 months to 25 years), and the median time from the first complaints to diagnosis was 2 months (range, 1 week to 70 months). Medulloblastomas and other embryonal tumors (47), low-grade gliomas (32), and high-grade gliomas (22) were the most commonly diagnosed malignancies. Ependymomas, craniopharyngiomas, germ cell tumors, and other malignancies were observed in 22 patients. For 26 patients, no histopathological or radiological diagnosis was available. Follow-up information was available for 98 (65.8%) patients. The 5-year OS rate for the whole study group was 67.7%. CONCLUSION Consistent with international data, embryonal tumors, and gliomas were the most commonly diagnosed CNS malignancies in Armenia. Multimodal treatment was often not available in Armenia during the study period, especially for early cases.
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Affiliation(s)
- Julieta Hoveyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia.
- Immune Oncology Research Institute, Yerevan, Armenia.
| | - Eduard Asatryan
- Division of Neurosurgery, Department of Surgery, Wigmore Hospital for Children, Yerevan, Armenia
| | - Henrik Grigoryan
- Department of Pediatric Hematology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Shushan Hovsepyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Immune Oncology Research Institute, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Anna Avagyan
- Department of Pediatric Hematology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Lusine Hakobyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Lilit Sargsyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Samvel Iskanyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Manushak Avagyan
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Saten Hovhannisyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Irina Melnichenko
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Mariam Minasyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Ruzanna Papyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Immune Oncology Research Institute, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Narek Manukyan
- National Center of Oncology named after V. A. Fanarjyan, Yerevan, Armenia
| | - Armine Lazaryan
- Department of Radiation Oncology, National Center of Oncology named after V. A. Fanarjyan, Yerevan, Armenia
| | - Samvel Danelyan
- Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Armen Muradyan
- Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | | | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Frederick Boop
- Global Pediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Armen Mkhitharyan
- HistoGen Pathology Center, Yerevan, Armenia
- Department of Pathology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Martin Harutyunyan
- Adult's Solid Tumor Chemotherapy Department, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
| | - Gevorg Tamamyan
- Department of Pediatric Oncology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Immune Oncology Research Institute, Yerevan, Armenia
- Department of Pediatric Hematology, Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
- Department of Hematology and Pediatric Oncology, Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia
| | - Samvel Bardakhchyan
- Immune Oncology Research Institute, Yerevan, Armenia
- Adult's Solid Tumor Chemotherapy Department, Hematology Center after Prof. R. H. Yeolyan, Yerevan, Armenia
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Kertels O, Krauß J, Monoranu CM, Samnick S, Dierks A, Kircher M, Mihovilovic MI, Pham M, Buck AK, Eyrich M, Schlegel PG, Frühwald MC, Bison B, Lapa C. [ 18F]FET-PET in children and adolescents with central nervous system tumors: does it support difficult clinical decision-making? Eur J Nucl Med Mol Imaging 2023; 50:1699-1708. [PMID: 36670283 PMCID: PMC10119036 DOI: 10.1007/s00259-023-06114-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE Positron emission tomography (PET) with O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) is a well-established tool for non-invasive assessment of adult central nervous system (CNS) tumors. However, data on its diagnostic utility and impact on clinical management in children and adolescents are limited. METHODS Twenty-one children and young adults (13 males; mean age, 8.6 ± 5.2 years; range, 1-19 at initial diagnosis) with either newly diagnosed (n = 5) or pretreated (n = 16) CNS tumors were retrospectively analyzed. All patients had previously undergone neuro-oncological work-up including cranial magnetic resonance imaging. In all cases, [18F]FET-PET was indicated in a multidisciplinary team conference. The impact of PET imaging on clinical decision-making was assessed. Histopathology (n = 12) and/or clinical and imaging follow-up (n = 9) served as the standard of reference. RESULTS The addition of [18F]FET-PET to the available information had an impact on further patient management in 14 out of 21 subjects, with avoidance of invasive surgery or biopsy in four patients, biopsy guidance in four patients, change of further treatment in another five patients, and confirmation of diagnosis in one patient. CONCLUSION [18F]FET-PET may provide important additional information for treatment guidance in pediatric and adolescent patients with CNS tumors.
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Affiliation(s)
- Olivia Kertels
- Institute of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany
| | - Jürgen Krauß
- Section Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany
| | - Camelia Maria Monoranu
- Department of Neuropathology, Institute for Pathology, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany
| | - Samuel Samnick
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany
| | - Alexander Dierks
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Malte Kircher
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Milena I. Mihovilovic
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany
| | - Mirko Pham
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Andreas K. Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany
| | - Matthias Eyrich
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Würzburg, Josef-Schneider- Str. 2, 97080 Würzburg, Germany
| | - Paul-Gerhardt Schlegel
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Children’s Hospital, University of Würzburg, Josef-Schneider- Str. 2, 97080 Würzburg, Germany
| | - Michael C. Frühwald
- Paediatric and Adolescent Medicine, University Medical Center Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Neuroradiological Reference Center for Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Faculty of Medicine, University of Augsburg, Stenglinstr. 2, 86156 Augsburg, Germany
| | - Constantin Lapa
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany
- Nuclear Medicine, Faculty of Medicine, University of Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany
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Wang C, Liu Y, Chen R, Wang X, Wang Y, Wei J, Zhang K, Zhang C. Electrochemical biosensing of circulating microRNA-21 in cerebrospinal fluid of medulloblastoma patients through target-induced redox signal amplification. Mikrochim Acta 2022; 189:105. [DOI: 10.1007/s00604-022-05210-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/30/2022] [Indexed: 12/21/2022]
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Weusthof K, Lüttich P, Regnery S, König L, Bernhardt D, Witt O, Herfarth K, Unterberg A, Jungk C, Farnia B, Combs SE, Debus J, Rieken S, Harrabi S, Adeberg S. Neurocognitive Outcomes in Pediatric Patients Following Brain Irradiation. Cancers (Basel) 2021; 13:cancers13143538. [PMID: 34298751 PMCID: PMC8307409 DOI: 10.3390/cancers13143538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/18/2021] [Accepted: 06/26/2021] [Indexed: 11/16/2022] Open
Abstract
Advanced radiation techniques can reduce the severity of neurocognitive sequelae in young brain tumor patients. In the present analysis, we sought to compare neurocognitive outcomes after proton irradiation with patients who underwent photon radiotherapy (RT) and surgery. Neurocognitive outcomes were evaluated in 103 pediatric brain tumor patients (proton RT n = 26, photon RT n = 30, surgery n = 47) before and after treatment. Comparison of neurocognitive outcomes following different treatment modalities were analyzed over four years after treatment completion. Longitudinal analyses included 42 months of follow-up after proton RT and 55 months after photon RT and surgery. Neurocognitive assessment included standardized tests examining seven domains. A comparison of neurocognitive outcomes after RT (proton and photon with >90% additional surgery) and surgery showed no significant differences in any neurocognitive domain. Neurocognitive functioning tests after proton RT failed to identify alterations compared to baseline testing. Long-term follow up over four years after photon RT showed a decrease in non-verbal intelligence (-9.6%; p = 0.01) and visuospatial construction (-14.9%; p = 0.02). After surgery, there was a decline in non-verbal intelligence (-10.7%; p = 0.01) and processing speed (14.9%; p = 0.002). Differences in neurocognitive outcomes between RT and surgical cohorts in direct intermodal comparison at long-term follow-up were not identified in our study, suggesting that modern radiation therapy does not affect cognition as much as in the past. There were no alterations in long-term neurocognitive abilities after proton RT, whereas decline of processing speed, non-verbal intelligence, and visuospatial abilities were observed after both photon RT and surgery. Domains dependent on intact white matter structures appear particularly vulnerable to brain tumor treatment irrespective of treatment approach.
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Affiliation(s)
- Katharina Weusthof
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Peggy Lüttich
- Section of Pediatric Brain Tumors, Department of Pediatric Oncology, Hematology and Immunology, University Medical Center for Children and Adolescents, 69120 Heidelberg, Germany; (P.L.); (O.W.)
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Technische Universität München, 81675 München, Germany; (D.B.); (S.E.C.)
- Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Olaf Witt
- Section of Pediatric Brain Tumors, Department of Pediatric Oncology, Hematology and Immunology, University Medical Center for Children and Adolescents, 69120 Heidelberg, Germany; (P.L.); (O.W.)
- Translational Program, Hopp Children’s Cancer Center at NCT Heidelberg (KiTZ), 69120 Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.U.); (C.J.)
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany; (A.U.); (C.J.)
| | - Benjamin Farnia
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA;
| | - Stephanie E. Combs
- Department of Radiation Oncology, Technische Universität München, 81675 München, Germany; (D.B.); (S.E.C.)
- Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Goettingen, 37075 Goettingen, Germany;
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (K.W.); (S.R.); (L.K.); (K.H.); (J.D.); (S.H.)
- Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-56-8201
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Hahn G, Mentzel HJ. [Tumors of the central nervous system in children and adolescents]. Radiologe 2021; 61:601-610. [PMID: 34191042 DOI: 10.1007/s00117-021-00860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE Brain tumors are the most common solid tumors in childhood and the most frequent cancer after leukemia. The incidence is continuously increasing. The WHO classification of brain tumors, valid since 2016, is now based on the combination of histological and molecular genetic diagnostics. STANDARD RADIOLOGICAL METHODS Diagnostics are mainly performed with magnetic resonance imaging (MRI); only in emergencies with computed tomography (CT). METHODOLOGICAL INNOVATIONS Diffusion and susceptibility weighted and dynamic contrast-enhanced imaging and spectroscopy are used. PERFORMANCE Improved diagnosis regarding dignity, size determination, adjacency assessment, and morphological description of tumor composition. ACHIEVEMENTS Modern MRI with functional techniques is now the gold standard for differential diagnosis and staging of central nervous system (CNS) tumors in pediatrics.
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Affiliation(s)
- G Hahn
- Bereich für Kinderradiologie, Institut und Poliklinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - H-J Mentzel
- Sektion Kinderradiologie, Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Deutschland
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Pollul G, Bostel T, Grossmann S, Akbaba S, Karle H, Stockinger M, Schmidberger H. Pediatric craniospinal irradiation with a short partial-arc VMAT technique for medulloblastoma tumors in dosimetric comparison. Radiat Oncol 2020; 15:256. [PMID: 33153495 PMCID: PMC7643335 DOI: 10.1186/s13014-020-01690-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022] Open
Abstract
Background This study aimed to contrast four different irradiation methods for pediatric medulloblastoma tumors in a dosimetric comparison regarding planning target volume (PTV) coverage and sparing of organs at risk (OARs). Methods In sum 24 treatment plans for 6 pediatric patients were realized. Besides the clinical standard of a 3D-conformal radiotherapy (3D-CRT) treatment plan taken as a reference, volumetric modulated arc therapy (VMAT) treatment plans (“VMAT_AVD” vs. “noAVD” vs. “FullArc”) were optimized and calculated for each patient. For the thoracic and abdominal region, the short partial-arc VMAT_AVD technique uses an arc setup with reduced arc-length by 100°, using posterior and lateral beam entries. The noAVD uses a half 180° (posterior to lateral directions) and the FullArc uses a full 360° arc setup arrangement. The prescription dose was set to 35.2 Gy. Results We identified a more conformal dose coverage for PTVs and a better sparing of OARs with used VMAT methods. For VMAT_AVD mean dose reductions in organs at risk can be realized, from 16 to 6.6 Gy, from 27.1 to 8.7 Gy and from 8.0 to 1.9 Gy for the heart, the thyroid and the gonads respectively, compared to the 3D-CRT treatment method. In addition we have found out a superiority of VMAT_AVD compared to the noAVD and FullArc trials with lower exposure to low-dose radiation to the lungs and breasts. Conclusions With the short partial-arc VMAT_AVD technique, dose exposures to radiosensitive OARS like the heart, the thyroid or the gonads can be reduced and therefore, maybe the occurrence of late sequelae is less likely. Furthermore the PTV conformity is increased. The advantages of the VMAT_AVD have to be weighed against the potentially risks induced by an increased low dose exposure compared to the 3D-CRT method.
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Affiliation(s)
- Gerhard Pollul
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Tilman Bostel
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Sascha Grossmann
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Sati Akbaba
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Heiko Karle
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Marcus Stockinger
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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Kollerud RDR, Cannon-Albright LA, Haugnes HS, Ruud E, Thoresen M, Nafstad P, Blaasaas KG, Næss Ø, Claussen B. Childhood central nervous system tumors and leukemia: Incidence and familial risk. A comparative population-based study in Utah and Norway. Pediatr Blood Cancer 2020; 67:e28408. [PMID: 32437093 PMCID: PMC7313725 DOI: 10.1002/pbc.28408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND In this study, we aimed to evaluate incidence rates and family risk of the most common childhood cancers, tumors in the central nervous system (CNS), and leukemia among individuals from Norway and individuals with Scandinavian ancestry living in Utah. METHODS We used the Utah Population Database and the Norwegian National Population Register linked to Cancer registries to identify cancers in children born between 1966 and 2015 and their first-degree relatives. We calculated incidence rates and hazards ratios. RESULTS The overall incidence of CNS tumors increased with consecutive birth cohorts similarly in Utah and Norway (both P < 0.001). Incidence rates of leukemia were more stable and similar in both Utah and in Norway with 4.6/100 000 person-years among children (<15 years) born in the last cohort. A family history of CNS tumors was significantly associated with risk of childhood CNS tumors in Utah HR = 3.05 (95% CI 1.80-5.16) and Norway HR = 2.87 (95% CI 2.20-3.74). In Norway, children with a first-degree relative diagnosed with leukemia had high risk of leukemia (HR = 2.39, 95% CI 1.61-3.55). CONCLUSION Despite geographical distance and assumed large lifestyle differences, two genetically linked pediatric populations show similar incidences of CNS tumors and leukemia in the period 1966-2015. CNS tumors and leukemia aggregated in families in both countries.
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Affiliation(s)
| | - Lisa A. Cannon-Albright
- Department of Internal Medicine, University of Utah School of Medicine, United States of America
| | - Hege S. Haugnes
- Department of Oncology, University Hospital of North Norway, Norway
- Institute of Clinical Medicine, UIT- The Arctic University, Norway
| | - Ellen Ruud
- Department ofPediatricHematology and Oncology, Division for Pediatric- and AdolescenceMedicine, Oslo University Hospital, Norway
- Institute of Clinical Medicine, University of Oslo, Norway
| | - Magne Thoresen
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Norway
| | - Per Nafstad
- Institute of Health and Society, University of Oslo, Norway
| | | | - Øyvind Næss
- Institute of Health and Society, University of Oslo, Norway
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Schulz M, Afshar-Bakshloo M, Koch A, Capper D, Driever PH, Tietze A, Grün A, Thomale UW. Management of pineal region tumors in a pediatric case series. Neurosurg Rev 2020; 44:1417-1427. [PMID: 32504201 PMCID: PMC8121748 DOI: 10.1007/s10143-020-01323-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/23/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Pineal region tumors commonly present with non-communicating hydrocephalus. These heterogeneous histological entities require different therapeutic regimens. We evaluated our surgical experience concerning procurance of a histological diagnosis, management of hydrocephalus, and choice of antitumoral treatment. We analyzed the efficacy of neuroendoscopic biopsy and endoscopic third ventriculocisternostomy (ETV) in patients with pineal region tumors between 2006 and 2019 in a single-center retrospective cross-sectional study with regard to diagnostic yield, hydrocephalus treatment, as well as impact on further antitumoral management. Out of 28 identified patients, 23 patients presented with untreated hydrocephalus and 25 without histological diagnosis. One patient underwent open biopsy, and 24 received a neuroendoscopic biopsy with concomitant hydrocephalus treatment if necessary. Eighteen primary ETVs, 2 secondary ETVs, and 2 ventriculoperitoneal shunts (VPSs) were performed. Endoscopic biopsy had a diagnostic yield of 95.8% (23/24) and complication rates of 12.5% (transient) and 4.2% (permanent), respectively. ETV for hydrocephalus management was successful in 89.5% (17/19) with a median follow-up of more than 3 years. Following histological diagnosis, 8 patients (28.6%) underwent primary resection of their tumor. Another 9 patients underwent later-stage resection after either adjuvant treatment (n = 5) or for progressive disease during observation (n = 4). Eventually, 20 patients received adjuvant treatment and 7 were observed after primary management. One patient was lost to follow-up. Heterogeneity of pineal region tumor requires histological confirmation. Primary biopsy of pineal lesions should precede surgical resection since less than a third of patients needed primary surgical resection according to the German pediatric brain tumor protocols. Interdisciplinary decision making upfront any treatment is warranted in order to adequately guide treatment.
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Affiliation(s)
- Matthias Schulz
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Melissa Afshar-Bakshloo
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Arend Koch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David Capper
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Arne Grün
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
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10
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Adile AA, Kameda-Smith MM, Bakhshinyan D, Banfield L, Salim SK, Farrokhyar F, Fleming AJ. Salvage therapy for progressive, treatment-refractory or recurrent pediatric medulloblastoma: a systematic review protocol. Syst Rev 2020; 9:47. [PMID: 32127049 PMCID: PMC7055028 DOI: 10.1186/s13643-020-01307-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Central nervous system tumors remain the leading cause of cancer-related mortality amongst children with solid tumors, with medulloblastoma (MB) representing the most common pediatric brain malignancy. Despite best current therapies, patients with recurrent MB experience have an alarmingly high mortality rate and often have limited therapeutic options beyond inadequate chemotherapy or experimental clinical trials. Therefore, a systematic review of the literature regarding treatment strategies employed in recurrent pediatric MB will evaluate previous salvage therapies in order to guide future clinical trials. The aim of this systematic review will be to investigate the efficacy and safety of salvage therapies for the management of children with progressive, treatment-refractory, or recurrent MB. METHODS We will conduct literature searches (from 1995 onwards) in MEDLINE, EMBASE, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and Cochrane Central Register of Controlled Trials. Studies examining the survival and toxicity of therapies administered to treatment-refractory pediatric MB patients will be included. Two reviewers will independently assess the search results based on predefined selection criteria, complete data abstraction, and quality assessment. The primary outcomes of this review will be overall and progression-free survival. Secondary outcomes will include safety and toxicity of each therapy administered. The study methodological quality (or bias) will be appraised using an appropriate tool. Due to the nature of the research question and published literature, we expect large inter-study heterogeneity and therefore will use random effects regression analysis to extract the combined effect. In additional analyses, we will investigate the role of re-irradiation and mono- vs. poly-therapy in recurrent disease, and whether molecular subgrouping of MB influences salvage therapy. DISCUSSION This systematic review will provide an overview of the current literature regarding salvage therapies for relapsed MB patients. Investigation of clinically tested therapies for children with recurrent MB has significant implications for clinical practice. By reviewing the efficacy and toxicity of MB salvage therapies, this study will identify effective therapeutic strategies administered to recurrent MB patients and can inform future clinical trials aimed to improve patient survivorship and quality of life. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020167421.
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Affiliation(s)
- Ashley A. Adile
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, ON Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON Canada
| | - Michelle M. Kameda-Smith
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, ON Canada
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON Canada
| | - David Bakhshinyan
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, ON Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario Canada
| | - Sabra K. Salim
- McMaster Stem Cell and Cancer Research Institute, McMaster University, Hamilton, ON Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON Canada
| | - Forough Farrokhyar
- Department of Surgery, Division of Neurosurgery, McMaster University, Hamilton, ON Canada
- Department of Health, Evidence and Impact, McMaster University, Hamilton, Ontario Canada
| | - Adam J. Fleming
- Department of Pediatrics, Division of Hematology-Oncology, McMaster University, Hamilton, Canada
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11
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García-Romero N, Carrión-Navarro J, Areal-Hidalgo P, Ortiz de Mendivil A, Asensi-Puig A, Madurga R, Núñez-Torres R, González-Neira A, Belda-Iniesta C, González-Rumayor V, López-Ibor B, Ayuso-Sacido A. BRAF V600E Detection in Liquid Biopsies from Pediatric Central Nervous System Tumors. Cancers (Basel) 2019; 12:cancers12010066. [PMID: 31881643 PMCID: PMC7016762 DOI: 10.3390/cancers12010066] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 12/17/2022] Open
Abstract
Pediatric Central Nervous System (CNS) tumors are the most fatal cancer diseases in childhood. Due to their localization and infiltrative nature, some tumor resections or biopsies are not feasible. In those cases, the use of minimally invasive methods as diagnostic, molecular marker detection, prognostic or monitoring therapies are emerging. The analysis of liquid biopsies which contain genetic information from the tumor has been much more widely explored in adults than in children. We compare the detection of BRAF V600E targetable mutation by digital-PCR from cell-free-DNA and EV-derived DNA (ctDNA) in serum, plasma and cerebrospinal fluid (CSF) isolated from a cohort of 29 CNS pediatric patients. Here we demonstrate that ctDNA isolated from serum and plasma could be successfully analyzed to obtain tumor genetic information which could be used to guide critical treatment decisions.
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Affiliation(s)
- Noemi García-Romero
- Fundación de Investigación HM Hospitales, HM Hospitales, 28015 Madrid, Spain; (N.G.-R.); (J.C.-N.); (P.A.-H.); (A.O.d.M.); (R.M.); (C.B.-I.)
| | - Josefa Carrión-Navarro
- Fundación de Investigación HM Hospitales, HM Hospitales, 28015 Madrid, Spain; (N.G.-R.); (J.C.-N.); (P.A.-H.); (A.O.d.M.); (R.M.); (C.B.-I.)
| | - Pilar Areal-Hidalgo
- Fundación de Investigación HM Hospitales, HM Hospitales, 28015 Madrid, Spain; (N.G.-R.); (J.C.-N.); (P.A.-H.); (A.O.d.M.); (R.M.); (C.B.-I.)
- Pediatric Hematology and Oncology Unit, Madrid Montepríncipe Hospital, 28660 Madrid, Spain
| | - Ana Ortiz de Mendivil
- Fundación de Investigación HM Hospitales, HM Hospitales, 28015 Madrid, Spain; (N.G.-R.); (J.C.-N.); (P.A.-H.); (A.O.d.M.); (R.M.); (C.B.-I.)
| | | | - Rodrigo Madurga
- Fundación de Investigación HM Hospitales, HM Hospitales, 28015 Madrid, Spain; (N.G.-R.); (J.C.-N.); (P.A.-H.); (A.O.d.M.); (R.M.); (C.B.-I.)
| | - Rocio Núñez-Torres
- Spanish National Cancer Research Center (CNIO), 28029 Madrid, Spain; (R.N.-T.); (A.G.-N.)
| | - Anna González-Neira
- Spanish National Cancer Research Center (CNIO), 28029 Madrid, Spain; (R.N.-T.); (A.G.-N.)
| | - Cristobal Belda-Iniesta
- Fundación de Investigación HM Hospitales, HM Hospitales, 28015 Madrid, Spain; (N.G.-R.); (J.C.-N.); (P.A.-H.); (A.O.d.M.); (R.M.); (C.B.-I.)
| | | | - Blanca López-Ibor
- Fundación de Investigación HM Hospitales, HM Hospitales, 28015 Madrid, Spain; (N.G.-R.); (J.C.-N.); (P.A.-H.); (A.O.d.M.); (R.M.); (C.B.-I.)
- Pediatric Hematology and Oncology Unit, Madrid Montepríncipe Hospital, 28660 Madrid, Spain
- Correspondence: (B.L.-I.); (A.A.-S.); Tel.: +34-91372-4700 (A.A.-S.)
| | - Angel Ayuso-Sacido
- Fundación de Investigación HM Hospitales, HM Hospitales, 28015 Madrid, Spain; (N.G.-R.); (J.C.-N.); (P.A.-H.); (A.O.d.M.); (R.M.); (C.B.-I.)
- Facultad de Medicina (IMMA), Universidad San Pablo-CEU, 28668 Madrid, Spain
- Correspondence: (B.L.-I.); (A.A.-S.); Tel.: +34-91372-4700 (A.A.-S.)
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12
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Christy JB. Considerations for Testing and Treating Children with Central Vestibular Impairments. Semin Hear 2018; 39:321-333. [PMID: 30038458 DOI: 10.1055/s-0038-1666821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
This perspective explores common pediatric diagnoses that could present with central vestibular pathway dysfunction, leading to delays in motor development and postural control, and gaze instability. Specifically, the following diagnoses are considered: cerebral palsy, myelomeningocele, vestibular migraine, attention-deficit hyperactivity disorder, developmental coordination disorder, concussion, childhood cancer, congenital muscular torticollis, adolescent idiopathic scoliosis, and autism. Suggestions for clinical screening, vestibular function testing, and vestibular rehabilitation for children with these diagnoses are based on evidence for the efficacy of testing and interventions for children with peripheral vestibular hypofunction. More research is needed to explore peripheral and central vestibular function in children with these diagnoses. Testing and intervention methods may need to be modified to accommodate for the specific behavior and motor challenges that some children might present. Researchers should develop technology so that gaze stabilization exercises can be delivered in a fun, functional, and effective way.
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Affiliation(s)
- Jennifer B Christy
- Department of Physical Therapy, School of Health Professions, The University of Alabama at Birmingham, Birmingham, Alabama
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13
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Fischer C, Petriccione M, Donzelli M, Pottenger E. Improving Care in Pediatric Neuro-oncology Patients: An Overview of the Unique Needs of Children With Brain Tumors. J Child Neurol 2016; 31:488-505. [PMID: 26245798 PMCID: PMC5032907 DOI: 10.1177/0883073815597756] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/29/2015] [Indexed: 02/06/2023]
Abstract
Brain tumors represent the most common solid tumors in childhood, accounting for almost 25% of all childhood cancer, second only to leukemia. Pediatric central nervous system tumors encompass a wide variety of diagnoses, from benign to malignant. Any brain tumor can be associated with significant morbidity, even when low grade, and mortality from pediatric central nervous system tumors is disproportionately high compared to other childhood malignancies. Management of children with central nervous system tumors requires knowledge of the unique aspects of care associated with this particular patient population, beyond general oncology care. Pediatric brain tumor patients have unique needs during treatment, as cancer survivors, and at end of life. A multidisciplinary team approach, including advanced practice nurses with a specialty in neuro-oncology, allows for better supportive care. Knowledge of the unique aspects of care for children with brain tumors, and the appropriate interventions required, allows for improved quality of life.
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Affiliation(s)
- Cheryl Fischer
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mary Petriccione
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Donzelli
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elaine Pottenger
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Germ cell tumors, which constitute approximately 3-5% of tumors of the central nervous system (CNS), can be subdivided into germinomas, embryonal carcinomas, yolk sac tumors, choriocarcinomas, teratomas and mixed germ cell tumors. The diagnosis of intracranial germ cell tumor is based on the clinical symptoms, detection of tumor markers, such as alpha fetoprotein (AFP) and the beta subunit of human chorionic gonadotropin (beta-hCG) in blood and cerebrospinal fluid (CSF), magnetic resonance imaging (MRI) of the brain and spinal cord, CSF cytology and histology. The diagnosis of a secreting germ cell tumor, i.e. a non-germinoma, can be made by the determination of AFP and hCG as tumor markers. Germinomas are radiosensitive but are equally as sensitive to chemotherapy. Teratomas of the CNS are mostly diagnosed in newborns and infants. The most decisive role in the treatment of teratomas is played by as complete a resection as possible. Chemotherapy and irradiation play a subordinate role.Embryonal tumors, which constitute approximately 15-20% of CNS tumors, include medulloblastomas, primitive neuroectodermal tumors (PNET) of the CNS and the atypical teratoid rhabdoid tumor of the CNS. Medulloblastoma is the most common malignant brain tumor in childhood and adolescence. The incidence peak is the fifth year of life with a male predisposition in a ratio of 1.5:1. Medulloblastomas constitute 12-25% of all pediatric CNS tumors and 30-40% of pediatric tumors of the posterior cranial fossa. At the time of diagnosis evidence of dissemination in the CSF cavity is found in approximately 40% of patients. The extreme cell density makes medulloblastomas hyperdense in computed tomography (CT) and can therefore be differentiated from hypodense astrocytomas. The PNETs are histologically related to medulloblastomas, pineoblastomas, atypical teratoid rhabdoid tumors and peripheral neuroblastomas. They are relatively rare in children constituting less than 5% of supratentorial neoplasms. Patients are mostly clinically conspicuous due to macrocephalus and signs of brain pressure and/or seizures. In native CT the solid components of PNETs show a hyperdensity compared to the surrounding brain parenchyma probably due to the high cell density. Cysts and calcification are often detectable. The survival rate of children with CNS tumors has continuously increased in recent years. When corresponding clinical symptoms appear, such as headache, nausea or vomiting when fasting, all of which are evidence of increased intracranial pressure, MRI should be carried out as quickly as possible. Children should be treated in centers with departments of pediatric oncology and hematology and within the framework of studies.
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Affiliation(s)
- W Reith
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg/Saar, Deutschland,
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15
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Epigenetic repression of the dopamine receptor D4 in pediatric tumors of the central nervous system. J Neurooncol 2013; 116:237-49. [PMID: 24264533 DOI: 10.1007/s11060-013-1313-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 11/10/2013] [Indexed: 01/11/2023]
Abstract
Epigenetic alterations are common events in cancer. Using a genome wide methylation screen (Restriction Landmark Genomic Scanning-RLGS) we identified the gene for the dopamine receptor D4 (DRD4) as tumor-specific methylated. As DRD4 is involved in early brain development and may thus be involved in developmentally dependent tumors of the CNS in children epigenetic deregulation of DRD4 and its functional consequences were analyzed in vitro. CpG methylation of DRD4 was detected in 18/24 medulloblastomas, 23/29 ependymomas, 6/6 high-grade gliomas, 7/10 CNS PNET and 8/8 cell lines by qCOBRA and bisulfite sequencing. Real-time RT-PCR demonstrated a significantly inferior expression of DRD4 in primary tumors compared to cell lines and non-malignant control tissues. Epigenetic deregulation of DRD4 was analyzed in reexpression experiments and restoration of DRD4 was observed in medulloblastoma (MB) cells treated with 5-Aza-CdR. Reexpression was not accompanied by demethylation of the DRD4 promoter but by a significant decrease of H3K27me3 and of bound enhancer of zeste homologue 2 (EZH2). Knockdown of EZH2 demonstrated DRD4 as a direct target for inhibition by EZH2. Stimulation of reexpressed DRD4 resulted in an activation of ERK1/2. Our analyses thus disclose that DRD4 is epigenetically repressed in CNS tumors of childhood. DRD4 is a direct target of EZH2 in MB cell lines. EZH2 appears to dominate over aberrant DNA methylation in the epigenetic inhibition of DRD4, which eventually leads to inhibition of a DRD4-mediated stimulation of the ERK1/2 kinase pathway.
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Detection of irreversible changes in susceptibility-weighted images after whole-brain irradiation of children. Neuroradiology 2013; 55:853-9. [PMID: 23588615 DOI: 10.1007/s00234-013-1185-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 03/29/2013] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Whole-brain irradiation is part of the therapy protocol for patients with medulloblastomas. Side effects and complications of radiation can be detected by follow-up magnetic resonance imaging (MRI). Susceptibility-weighted images (SWI) can detect even very small amounts of residual blood that cannot be shown with conventional MRI. The purpose of this study was to determine when and where SWI lesions appear after whole-brain irradiation. METHODS MRI follow-up of seven patients with medulloblastoma who were treated with whole-brain irradiation were analyzed retrospectively. SWI were part of the initial and follow-up MRI protocol. De novo SWI lesions, localization, and development over time were documented. RESULTS At time of irradiation, mean age of the patients was 13 years (±4 years). Earliest SWI lesions were detected 4 months after radiation treatment. In all patients, SWI lesions accumulated over time, although the individual number of SWI lesions varied. No specific dissemination of SWI lesions was observed. CONCLUSION Whole-brain irradiation can cause relatively early dot-like SWI lesions. The lesions are irreversible and accumulate over time. Histopathological correlation and clinical impact of these SWI lesions should be investigated.
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