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Liu APY, Zhen Z, Yang Q, Yuan X, Ma X, Chen J, Wang J, Yang L, Guo H, Jiang L, Weng W, Huang L, Liu W, Wang J, Wu S, Zeng J, Jiang M, He K, Ge M, Cheng KKF, Ho WWS, Li C, Yu L, Zhu S, Ng HK, Chan GCF, Sun X. Treatment barriers and clinical outcome of children with medulloblastoma in China: a report from the Chinese Children's Cancer Group (CCCG). Neurooncol Adv 2021; 3:vdab134. [PMID: 34693286 PMCID: PMC8528264 DOI: 10.1093/noajnl/vdab134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Medulloblastoma (MB) is the most common malignant central nervous system tumor of childhood. Management requires interdisciplinary care and is associated with unique challenges in developing regions. Here, we report the characteristics, clinical outcome and treatment barriers for Chinese children with MB based on a multi-institutional cohort from the Chinese Children’s Cancer Group (CCCG). Methods Retrospective cohort study among 12 Chinese pediatric oncology units from the CCCG Brain Tumor Workgroup on patients aged <18 years diagnosed with MB from 2016 to 2019. Results 221 patients (male:female = 138:83) were included, 175 (79%) were ≥3 years of age, and 46 (21%) <3 years. 177 patients (80%) were completely staged, among which 50 (28%) had metastasis and 70 (40%) were considered to have high-risk (HR) disease. Gross/near-total resection was achieved in 203 patients (92%). In patients where molecular grouping could be assigned, 19 (16%), 35 (29%), and 65 (54%), respectively had WNT-activated, SHH-activated, and Group 3/4 MB. The median duration between resection and initiation of adjuvant therapy was 36 days. Respective 2-year PFS and OS rates were 76.0 ± 3.0% and 88.0 ± 2.3%. PFS was significantly associated with age, metastatic status and clinical risk grouping. Chemotherapy use during CSI or alkylator choice were not significant predictors for patient outcome. Conclusions We reported the clinical profiles and outcome from the largest cohort of Chinese children with MB after multi-modal therapy. Strengths and limitations on the local provision of neuro-oncology service are identified.
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Affiliation(s)
- Anthony Pak-Yin Liu
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Zijun Zhen
- State Key Laboratory of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qunying Yang
- State Key Laboratory of Oncology in South China, Department of Neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaojun Yuan
- Department of Pediatric Hematology and Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaoli Ma
- Medical Oncology Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Jianliang Chen
- Department of Paediatrics and Adolescent Medicine, HKU-Shenzhen Hospital, Shenzhen, China
| | - Jingsheng Wang
- Department of Neurosurgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Lihua Yang
- Pediatric Center of Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Haixia Guo
- Department of Pediatrics, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Lian Jiang
- Department of Pediatrics, Hebei Medical University the Fourth Hospital, Shijiazhuang, Hebei, China
| | - Wenjun Weng
- Department of Pediatrics, Sun Yat-sen University Memorial Hospital, Guangzhou, China
| | - Libin Huang
- Department of Pediatrics, Sun Yat-sen University the First Affiliated Hospital, Guangzhou, China
| | - Wei Liu
- Department of Hematology and Oncology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jian Wang
- State Key Laboratory of Oncology in South China, Department of Neurosurgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shaoxiong Wu
- State Key Laboratory of Oncology in South China, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jing Zeng
- State Key Laboratory of Oncology in South China, Department of Pathology, Sun Yat-sen University Cancer Center, GuangzhouChina
| | - Mawei Jiang
- Department of Radiation Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Kejun He
- Department of Pediatric Hematology and Oncology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ming Ge
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | | | - Wilson Wai-Shing Ho
- Department of Neurosurgery, HKU-Shenzhen Hospital, Shenzhen, China.,Department of Neurosurgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Chunyu Li
- Department of Paediatrics and Adolescent Medicine, HKU-Shenzhen Hospital, Shenzhen, China
| | - Lihua Yu
- Pediatric Center of Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuai Zhu
- Medical Oncology Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing, China
| | - Ho-Keung Ng
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Godfrey Chi-Fung Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.,Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Xiaofei Sun
- State Key Laboratory of Oncology in South China, Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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Amayiri N, Swaidan M, Ibrahimi A, Hirmas N, Musharbash A, Bouffet E, Al-Hussaini M, Ramaswamy V. Molecular Subgroup Is the Strongest Predictor of Medulloblastoma Outcome in a Resource-Limited Country. JCO Glob Oncol 2021; 7:1442-1453. [PMID: 34609903 PMCID: PMC8492378 DOI: 10.1200/go.21.00127] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Medulloblastoma is composed of four clinically and prognostically distinct molecular subgroups (WNT, SHH, group 3, and group 4). However, the clinical implications of these subgroups in the context of the unique challenges of low- to middle-income countries are rarely reported. METHODS We assembled an institutional cohort of children (3-18 years) diagnosed with medulloblastoma and treated in Jordan between 2003 and 2016. Tumors were subgrouped by NanoString and correlated with clinical and radiologic characteristics. RESULTS Eighty-eight patients were identified (63% male); median age was 6.9 years (interquartile range 4.8-9.2) and median symptom duration was 6 weeks (interquartile range 4-11). Radiotherapy was implemented as standard-risk in 41 patients (47%) and high-risk in 47 patients (53%). Subgrouping revealed 17 WNT (19%), 22 SHH (25%), 21 group 3 (24%), and 28 group 4 tumors (32%). Median time between craniotomy and radiotherapy was 45 days (17-155); 44% of them > 49 days. Median duration of radiotherapy was 44 days (36-74). Seventy-two patients (82%) received chemotherapy afterward. With a median follow-up of 4.6 years (0.2-14.9), 5-year progression-free survival (PFS) and overall survival were 73.5% and 69.4%, respectively, with no statistically significant survival difference between standard-risk and high-risk patients. Metastasis was significant for overall survival (P = .011). Patients with SHH and group 4 tumors had very good PFS (83.4% and 87.0%, respectively) and those with group 3 tumors had dismal outcomes (PFS 44.9%), whereas WNT tumors had less-than expected PFS (70.5%). PFS was statistically significant in patients with nonmetastatic tumors receiving radiotherapy ≤ 49 days (P = .011), particularly group 3 tumors. CONCLUSION Patients with SHH and group 4 medulloblastoma had excellent survival comparable with high-income countries. Compliance with treatment protocols and avoiding radiotherapy delays are important in achieving adequate survival in low- to middle-income country settings. Subgroup-driven treatment protocols should be considered in countries with limited resources.
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Affiliation(s)
- Nisreen Amayiri
- Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Maisa Swaidan
- Division of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Ahmed Ibrahimi
- Division of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Nader Hirmas
- Research and Grants Office, King Hussein Cancer Center, Amman, Jordan
| | - Awni Musharbash
- Division of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Eric Bouffet
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada
| | | | - Vijay Ramaswamy
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Canada
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Epigenetic-Based Therapy-A Prospective Chance for Medulloblastoma Patients' Recovery. Int J Mol Sci 2021; 22:ijms22094925. [PMID: 34066495 PMCID: PMC8124462 DOI: 10.3390/ijms22094925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
Medulloblastoma (MB) is one of the most frequent and malignant brain tumors in children. The prognosis depends on the advancement of the disease and the patient's age. Current therapies, which include surgery, chemotherapy, and irradiation, despite being quite effective, cause significant side effects that influence the central nervous system's function and cause neurocognitive deficits. Therefore, they substantially lower the quality of life, which is especially severe in a developing organism. Thus, there is a need for new therapies that are less toxic and even more effective. Recently, knowledge about the epigenetic mechanisms that are responsible for medulloblastoma development has increased. Epigenetics is a phenomenon that influences gene expression but can be easily modified by external factors. The best known epigenetic mechanisms are histone modifications, DNA methylation, or noncoding RNAs actions. Epigenetic mechanisms comprehensively explain the complex phenomena of carcinogenesis. At the same time, they seem to be a potential key to treating medulloblastoma with fewer complications than past therapies. This review presents the currently known epigenetic mechanisms that are involved in medulloblastoma pathogenesis and the potential therapies that use epigenetic traits to cure medulloblastoma while maintaining a good quality of life and ensuring a higher median overall survival rate.
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Li Q, Dai Z, Cao Y, Wang L. Comparing children and adults with medulloblastoma: a SEER based analysis. Oncotarget 2018; 9:30189-30198. [PMID: 30046397 PMCID: PMC6059016 DOI: 10.18632/oncotarget.23773] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/26/2017] [Indexed: 11/25/2022] Open
Abstract
Medulloblastoma (MB) is a brain malignancy, which commonly occurs in children, but is rare in adults. The Surveillance, Epidemiology, and End Results (SEER) database was used to compare survival, clinical features, and prognostic factors of children and adults with MB from 1992 to 2013. Overall survival estimates were compared using the Kaplan-Meier method, and Cox Proportion Hazard Regression modeling was used to evaluate prognostic variables. We identified 616 children (63.8%) and 349 adults (36.2%) with diagnosis of MB. The estimated survival rates for children diagnosed with MB for 2, 5, and 10 years were 85.6%, 75.5%, and 67.9%, respectively; the corresponding estimates for adults were 84.9%, 74.2%, and 67.3%. Radiotherapy was the only identical prognostic factor observed in the two groups. Children MB patients were more likely to experience distal metastases that was associated with increased hazard of mortality, and be diagnosed after 2003. Among adult MB patients, gross total resection (GTR) was a favorable prognostic factor, while large cell/anaplastic (LC/A) histology was correlated with decreased survival. Our analysis highlighted that both groups had similar overall survival time, but the prognostic factors were not comparable, except radiotherapy which was associated with better survival.
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Affiliation(s)
- Qian Li
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Zhenguo Dai
- Department of Cardiology, The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Yuze Cao
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Harbin 150081, Heilongjiang, China
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6
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Aldaregia J, Odriozola A, Matheu A, Garcia I. Targeting mTOR as a Therapeutic Approach in Medulloblastoma. Int J Mol Sci 2018; 19:ijms19071838. [PMID: 29932116 PMCID: PMC6073374 DOI: 10.3390/ijms19071838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/12/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022] Open
Abstract
Mechanistic target of rapamycin (mTOR) is a master signaling pathway that regulates organismal growth and homeostasis, because of its implication in protein and lipid synthesis, and in the control of the cell cycle and the cellular metabolism. Moreover, it is necessary in cerebellar development and stem cell pluripotency maintenance. Its deregulation has been implicated in the medulloblastoma and in medulloblastoma stem cells (MBSCs). Medulloblastoma is the most common malignant solid tumor in childhood. The current therapies have improved the overall survival but they carry serious side effects, such as permanent neurological sequelae and disability. Recent studies have given rise to a new molecular classification of the subgroups of medulloblastoma, specifying 12 different subtypes containing novel potential therapeutic targets. In this review we propose the targeting of mTOR, in combination with current therapies, as a promising novel therapeutic approach.
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Affiliation(s)
- Juncal Aldaregia
- Cellular Oncology Group, Biodonostia Research Institute, 20014 Donostia-San Sebastián, Spain.
| | - Ainitze Odriozola
- Cellular Oncology Group, Biodonostia Research Institute, 20014 Donostia-San Sebastián, Spain.
| | - Ander Matheu
- Cellular Oncology Group, Biodonostia Research Institute, 20014 Donostia-San Sebastián, Spain.
- IKERBASQUE, Basque Foundation for Science, 48013 Bilbao, Spain.
- CIBER de fragilidad y envejecimiento saludable (CIBERfes), 28029 Madrid, Spain.
| | - Idoia Garcia
- Cellular Oncology Group, Biodonostia Research Institute, 20014 Donostia-San Sebastián, Spain.
- IKERBASQUE, Basque Foundation for Science, 48013 Bilbao, Spain.
- CIBER de fragilidad y envejecimiento saludable (CIBERfes), 28029 Madrid, Spain.
- Physiology Department, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain.
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Liu W, Tang J, Van Halm-Lutterodt N, Luo S, Li C. History and current state of pediatric neurosurgery at Beijing Tiantan Hospital Neurosurgery Center. Childs Nerv Syst 2018. [PMID: 29520436 DOI: 10.1007/s00381-018-3755-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Wei Liu
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jie Tang
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China
| | - Nicholas Van Halm-Lutterodt
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China.,Department of Orthopedics and Neurosurgery, University of Southern California, Los Angeles, CA, 90089, USA
| | - Shiqi Luo
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China.
| | - Chunde Li
- Department of Neurosurgery, Beijing TianTan Hospital, Capital Medical University, Beijing, 100050, China.
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