1
|
Ashurov JA, Musa G, Kumirova EV, Margaryan SN, Livshitz MI, Ozerov SS, Reyes Soto G, Ramirez MDJE, Chmutin GE. Use of Neuroendoscopy in Combination Treatment of a Three-Year-Old Patient With Primary Disseminated Medulloblastoma: A Case Report. Cureus 2024; 16:e68239. [PMID: 39347241 PMCID: PMC11439456 DOI: 10.7759/cureus.68239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2024] [Indexed: 10/01/2024] Open
Abstract
A three-year-four-month-old boy with primary disseminated medulloblastoma M3 stage and secondary occlusive hydrocephalus underwent an endoscopic triventriculocisternostomy (ETVC) and tumor biopsy, followed by ventriculoperitoneal shunt (VPS) placement due to ETVC failure. The treatment regimen, which included intensive induction chemotherapy, proton beam therapy (PBT), and maintenance chemotherapy, led to significant clinical improvement and a complete radiological response. Four years post-treatment, the child remains in remission, illustrating the effectiveness of a multimodal approach in managing complex cases of medulloblastoma in pediatric patients.
Collapse
Affiliation(s)
- Jalolboy A Ashurov
- Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia, Moscow, RUS
- Neurosurgery, Morozovskaya Children's City Clinical Hospital, Moscow, RUS
| | - Gerald Musa
- Neurosurgery, Livingstone Central Hospital, Livingstone, ZMB
- Neurological Diseases and Neurosurgery, Peoples' Friendship University of Russia, Moscow, RUS
| | - Ella V Kumirova
- Pediatric Oncology, Morozovskaya Children's City Clinical Hospital, Moscow, RUS
| | - Sirak N Margaryan
- Oncology, Morozovskaya Children's City Clinical Hospital, Moscow, RUS
| | - Matvey I Livshitz
- Neurosurgery, Morozovskaya Children's City Clinical Hospital, Moscow, RUS
| | - Sergei S Ozerov
- Neurosurgery, Morozovskaya Children's City Clinical Hospital, Moscow, RUS
| | | | - Manuel De Jesus Encarnacion Ramirez
- Neurosurgery, Peoples' Friendship University of Russia, Moscow, RUS
- Neurosurgery, Morozovskaya Children's City Clinical Hospital, Moscow, RUS
| | - Gennady E Chmutin
- Neurosurgery, Peoples' Friendship University of Russia, Moscow, RUS
- Neurosurgery, Morozovskaya Children's City Clinical Hospital, Moscow, RUS
| |
Collapse
|
2
|
Adolph JE, Fleischhack G, Tschirner S, Rink L, Dittes C, Mikasch R, Dammann P, Mynarek M, Obrecht-Sturm D, Rutkowski S, Bison B, Warmuth-Metz M, Pietsch T, Pfister SM, Pajtler KW, Milde T, Kortmann RD, Dietzsch S, Timmermann B, Tippelt S. Radiotherapy for Recurrent Medulloblastoma in Children and Adolescents: Survival after Re-Irradiation and First-Time Irradiation. Cancers (Basel) 2024; 16:1955. [PMID: 38893076 PMCID: PMC11171022 DOI: 10.3390/cancers16111955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/18/2024] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Radiotherapy (RT) involving craniospinal irradiation (CSI) is important in the initial treatment of medulloblastoma. At recurrence, the re-irradiation options are limited and associated with severe side-effects. METHODS For pre-irradiated patients, patients with re-irradiation (RT2) were matched by sex, histology, time to recurrence, disease status and treatment at recurrence to patients without RT2. RESULTS A total of 42 pre-irradiated patients with RT2 were matched to 42 pre-irradiated controls without RT2. RT2 improved the median PFS [21.0 (CI: 15.7-28.7) vs. 12.0 (CI: 8.1-21.0) months] and OS [31.5 (CI: 27.6-64.8) vs. 20.0 (CI: 14.0-36.7) months]. Concerning long-term survival after ten years, RT2 only lead to small improvements in OS [8% (CI: 1.4-45.3) vs. 0%]. RT2 improved survival most without (re)-resection [PFS: 17.5 (CI: 9.7-41.5) vs. 8.0 (CI: 6.6-12.2)/OS: 31.5 (CI: 27.6-NA) vs. 13.3 (CI: 8.1-20.1) months]. In the RT-naïve patients, CSI at recurrence improved their median PFS [25.0 (CI: 16.8-60.6) vs. 6.6 (CI: 1.5-NA) months] and OS [40.2 (CI: 18.7-NA) vs. 12.4 (CI: 4.4-NA) months]. CONCLUSIONS RT2 could improve the median survival in a matched cohort but offered little benefit regarding long-term survival. In RT-naïve patients, CSI greatly improved their median and long-term survival.
Collapse
Affiliation(s)
- Jonas E. Adolph
- Department of Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen, 45122 Essen, Germany; (G.F.); (S.T.); (L.R.); (C.D.); (S.T.)
| | - Gudrun Fleischhack
- Department of Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen, 45122 Essen, Germany; (G.F.); (S.T.); (L.R.); (C.D.); (S.T.)
| | - Sebastian Tschirner
- Department of Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen, 45122 Essen, Germany; (G.F.); (S.T.); (L.R.); (C.D.); (S.T.)
| | - Lydia Rink
- Department of Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen, 45122 Essen, Germany; (G.F.); (S.T.); (L.R.); (C.D.); (S.T.)
| | - Christine Dittes
- Department of Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen, 45122 Essen, Germany; (G.F.); (S.T.); (L.R.); (C.D.); (S.T.)
| | - Ruth Mikasch
- Department of Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen, 45122 Essen, Germany; (G.F.); (S.T.); (L.R.); (C.D.); (S.T.)
| | - Philipp Dammann
- Department of Neurosurgery and Spine Surgery, University Hospital Essen, 45122 Essen, Germany;
| | - Martin Mynarek
- Department of Pediatric Hematology and Oncology, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (M.M.); (D.O.-S.); (S.R.)
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Denise Obrecht-Sturm
- Department of Pediatric Hematology and Oncology, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (M.M.); (D.O.-S.); (S.R.)
| | - Stefan Rutkowski
- Department of Pediatric Hematology and Oncology, Center for Obstetrics and Pediatrics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (M.M.); (D.O.-S.); (S.R.)
| | - Brigitte Bison
- Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany;
| | - Monika Warmuth-Metz
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Wuerzburg, 97080 Wuerzburg, Germany;
| | - Torsten Pietsch
- Institute of Neuropathology, DGNN Brain Tumor Reference Center, University Hospital of Bonn, 53105 Bonn, Germany;
| | - Stefan M. Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.M.P.); (K.W.P.)
- Department of Pediatric Oncology and Hematology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
- Hopp Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Kristian W. Pajtler
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany; (S.M.P.); (K.W.P.)
- Department of Pediatric Oncology and Hematology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
- Hopp Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
| | - Till Milde
- Department of Pediatric Oncology and Hematology, University Hospital Heidelberg, 69120 Heidelberg, Germany;
- Hopp Children’s Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- Clinical Cooperation Unit (CCU) Pediatric Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Consortium for Translational Cancer Research (DKTK), 69120 Heidelberg, Germany
| | - Rolf-Dieter Kortmann
- Department of Radio-Oncology, University Leipzig, 04129 Leipzig, Germany; (R.-D.K.); (S.D.)
| | - Stefan Dietzsch
- Department of Radio-Oncology, University Leipzig, 04129 Leipzig, Germany; (R.-D.K.); (S.D.)
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, 45122 Essen, Germany;
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, 45122 Essen, Germany;
| | - Stephan Tippelt
- Department of Pediatrics III, Center for Translational Neuro- and Behavioral Sciences (CTNBS), University Hospital of Essen, 45122 Essen, Germany; (G.F.); (S.T.); (L.R.); (C.D.); (S.T.)
| |
Collapse
|
3
|
Luo Y, Zhuang Y, Zhang S, Wang J, Teng S, Zeng H. Multiparametric MRI-Based Radiomics Signature with Machine Learning for Preoperative Prediction of Prognosis Stratification in Pediatric Medulloblastoma. Acad Radiol 2024; 31:1629-1642. [PMID: 37643930 DOI: 10.1016/j.acra.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/24/2023] [Accepted: 06/24/2023] [Indexed: 08/31/2023]
Abstract
RATIONALE AND OBJECTIVES Despite advances in risk-stratified treatment strategies for children with medulloblastoma (MB), the prognosis for MB with short-term recurrence is extremely poor, and there is still a lack of evaluation of short-term recurrence risk or short-term survival. This study aimed to construct and validate a radiomics model for predicting the outcome of MB based on preoperative multiparametric magnetic resonance images (MRIs) and to provide an objective for clinical decision-making. MATERIALS AND METHODS The clinical and imaging data of 64 patients with MB admitted to Shenzhen Children's Hospital from December 2012 to December 2021 and confirmed by pathology were retrospectively collected. According to the 18-month progression-free survival, the cases were classified into a good prognosis group and a poor prognosis group, and all cases were divided into training group (70%) and validation group (30%) randomly. Radiomics features were extracted from MRI of each child. The consistency test, t-test, and the least absolute shrinkage and selection operator were used for feature selection. The support vector machine (SVM) and receiver operator characteristic were used to evaluate the distinguishing ability of the selected features to the prognostic groups. RAD score was calculated based on the selected features. The clinical characteristics and RAD score were included in the multivariate logistic regression, and prediction models were constructed by screening out independent influences. The radiomics nomogram was constructed, and its clinical significance was evaluated. RESULTS A total of 1930 radiomic features were extracted from the images of each patient, and 11 features were included in the construction of radiomics score after selected. The area under the curve (AUC) values of the SVM model in the training and validation groups were 0.946 and 0.797, respectively. The radiomics nomogram was constructed based on the training cohort, and the AUC values in the training group and the validation group were 0.926 and 0.835, respectively. The results of clinical decision curve analysis showed that a good net benefit could be obtained from the nomogram. CONCLUSION The radiomics nomogram established based on MRI can be used as a noninvasive predictive tool to evaluate the prognosis of children with MB, which is expected to help neurosurgeons better conduct preoperative planning and patient follow-up management.
Collapse
Affiliation(s)
- Yi Luo
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, China (Y.L., Y.Z., S.Z., H.Z.); Shantou University Medical College, Shantou 515041, China (Y.L., S.Z.)
| | - Yijiang Zhuang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, China (Y.L., Y.Z., S.Z., H.Z.)
| | - Siqi Zhang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, China (Y.L., Y.Z., S.Z., H.Z.); Shantou University Medical College, Shantou 515041, China (Y.L., S.Z.)
| | - Jingsheng Wang
- Department of Neurosurgery, Shenzhen Children's Hospital, Shenzhen 518038, China (J.W.)
| | - Songyu Teng
- Shenzhen Children's Hospital of China Medical University, Shenzhen 518038, China (S.T.)
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen 518038, China (Y.L., Y.Z., S.Z., H.Z.).
| |
Collapse
|
4
|
Mushtaq N, Ul Ain R, Hamid SA, Bouffet E. Evolution of Systemic Therapy in Medulloblastoma Including Irradiation-Sparing Approaches. Diagnostics (Basel) 2023; 13:3680. [PMID: 38132264 PMCID: PMC10743079 DOI: 10.3390/diagnostics13243680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
The management of medulloblastoma in children has dramatically changed over the past four decades, with the development of chemotherapy protocols aiming at improving survival and reducing long-term toxicities of high-dose craniospinal radiotherapy. While the staging and treatment of medulloblastoma were until recently based on the modified Chang's system, recent advances in the molecular biology of medulloblastoma have revolutionized approaches in the management of this increasingly complex disease. The evolution of systemic therapies is described in this review.
Collapse
Affiliation(s)
- Naureen Mushtaq
- Division of Pediatric Oncology, Department of Oncology, Aga Khan University, Karachi 74800, Pakistan;
| | - Rahat Ul Ain
- Department of Pediatric Hematology/Oncology & Bone Marrow Transplant, University of Child Health Sciences, Children’s Hospital, Lahore 54600, Pakistan;
| | - Syed Ahmer Hamid
- Department of Pediatric Hematology and Oncology, Indus Hospital & Health Network, Karachi 74800, Pakistan;
| | - Eric Bouffet
- Global Neuro-Oncology Program, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, St. Jude Global, Memphis, TN 38105, USA
| |
Collapse
|
5
|
Peyrl A, Chocholous M, Sabel M, Lassaletta A, Sterba J, Leblond P, Nysom K, Torsvik I, Chi SN, Perwein T, Jones N, Holm S, Nyman P, Mörse H, Öberg A, Weiler-Wichtl L, Leiss U, Haberler C, Schmook MT, Mayr L, Dieckmann K, Kool M, Gojo J, Azizi AA, André N, Kieran M, Slavc I. Sustained Survival Benefit in Recurrent Medulloblastoma by a Metronomic Antiangiogenic Regimen: A Nonrandomized Controlled Trial. JAMA Oncol 2023; 9:1688-1695. [PMID: 37883081 PMCID: PMC10603581 DOI: 10.1001/jamaoncol.2023.4437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/27/2023] [Indexed: 10/27/2023]
Abstract
Importance Medulloblastoma recurrence in patients who have previously received irradiation has a dismal prognosis and lacks a standard salvage regimen. Objective To evaluate the response rate of pediatric patients with medulloblastoma recurrence using an antiangiogenic metronomic combinatorial approach (Medulloblastoma European Multitarget Metronomic Anti-Angiogenic Trial [MEMMAT]). Design, Setting, and Participants This phase 2, investigator-initiated, multicenter nonrandomized controlled trial assessed 40 patients with relapsed or refractory medulloblastoma without a ventriculoperitoneal shunt who were younger than 20 years at original diagnosis. Patients were enrolled between April 1, 2014, and March 31, 2021. Interventions Treatment consisted of daily oral thalidomide, fenofibrate, celecoxib, and alternating 21-day cycles of low-dose (metronomic) oral etoposide and cyclophosphamide, supplemented by intravenous bevacizumab and intraventricular therapy consisting of alternating etoposide and cytarabine. Main Outcomes and Measures The primary end point was response after 6 months of antiangiogenic metronomic therapy. Secondary end points included progression-free survival (PFS), overall survival (OS), and quality of life. Adverse events were monitored to assess safety. Results Of the 40 patients (median [range] age at treatment start, 10 [4-17] years; 25 [62.5%] male) prospectively enrolled, 23 (57.5%) achieved disease control after 6 months of treatment, with a response detected in 18 patients (45.0%). Median OS was 25.5 months (range, 10.9-40.0 months), and median PFS was 8.5 months (range, 1.7-15.4 months). Mean (SD) PFS at both 3 and 5 years was 24.6% (7.9%), while mean (SD) OS at 3 and 5 years was 43.6% (8.5%) and 22.6% (8.8%), respectively. No significant differences in PFS or OS were evident based on molecular subgroup analysis or the number of prior recurrences. In patients demonstrating a response, mean (SD) overall 5-year PFS was 49.7% (14.3%), and for patients who remained progression free for the first 12 months of treatment, mean (SD) 5-year PFS was 66.7% (16.1%). Treatment was generally well tolerated. Grade 3 to 4 treatment-related adverse events included myelosuppression, infections, seizures, and headaches. One heavily pretreated patient with a third recurrence died of secondary acute myeloid leukemia. Conclusions and Relevance This feasible and well-tolerated MEMMAT combination regimen demonstrated promising activity in patients with previously irradiated recurrent medulloblastoma. Given these results, this predominantly oral, well-tolerated, and outpatient treatment warrants further evaluation. Trial Registration ClinicalTrials.gov Identifier: NCT01356290.
Collapse
Affiliation(s)
- Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Monika Chocholous
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Magnus Sabel
- Childhood Cancer Centre, Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alvaro Lassaletta
- Department of Pediatric Neuro-Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Jaroslav Sterba
- Pediatric Oncology Department, University Hospital Brno, Brno, Czech Republic
| | - Pierre Leblond
- Pediatric Oncology Unit, Oscar Lambret Comprehensive Cancer Center, Lille, France
- Centre Léon Bérard, Institut d’Hématologie et d’Oncologie Pediatrique, Lyon, France
| | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Ingrid Torsvik
- Department of Paediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
| | - Susan N. Chi
- Department of Pediatric Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Thomas Perwein
- Division of Pediatric Hemato-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Neil Jones
- Kinderonkologie, Salzburger Universitätsklinikum, Salzburg, Austria
| | - Stefan Holm
- Department of Pediatric Hematology and Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Nyman
- Department of Paediatrics, Linköping University Hospital, Linköping, Sweden
| | - Helena Mörse
- Pediatric Cancer Center, Skane University Hospital, Lund, Sweden
| | - Anders Öberg
- Department of Pediatrics, Uppsala University, Uppsala, Sweden
| | - Liesa Weiler-Wichtl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Ulrike Leiss
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | | | - Maresa T. Schmook
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Lisa Mayr
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radio-Oncology, Medical University of Vienna, Vienna, Austria
| | - Marcel Kool
- Hopp Children’s Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Johannes Gojo
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Amedeo A. Azizi
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Nicolas André
- Départment of Pediatric Oncology, Assistance Publique-Hopitaux de Marseille, Marseille, France
- Aix Marseille University, Cancer Research Center of Marseille, Marseille, France
| | - Mark Kieran
- Department of Pediatric Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
6
|
Massimino M, Vennarini S, Buttarelli FR, Antonelli M, Colombo F, Minasi S, Pecori E, Ferroli P, Giussani C, Schiariti M, Schiavello E, Biassoni V, Erbetta A, Chiapparini L, Nigro O, Boschetti L, Gianno F, Miele E, Modena P, De Cecco L, Pollo B, Barretta F. Optimizing reirradiation for relapsed medulloblastoma: identifying the ideal patient and tumor profiles. J Neurooncol 2023; 163:577-586. [PMID: 37326761 DOI: 10.1007/s11060-023-04361-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND First-line therapies for medulloblastoma(MBL) are obtaining higher survival-rates while decreasing late-effects, but treatment at relapse is not standardized. We report here the experience with MBL re-irradiation(re-RT), its timing and outcome in different clinical settings and tumor groups. METHODS Patient's staging/treatment at diagnosis, histotypes/molecular subgroups, relapse site/s, re-treatments outcome are reported. RESULTS 25 patients were included, with a median age of 11.4 years; 8 had metastases. According to 2016-2021 WHO-classification, 14 had SHH subgroup tumors(six TP53 mutated,one + MYC,one + NMYC amplification), 11 non-WNT/non-SHH (two with MYC/MYCN amplification).Thirteen had received HART-CSI, 11 standard-CSI, one HFRT; all post-radiation chemotherapy(CT), 16 also pre-RT. Median time to relapse (local-LR in nine, distant-DR in 14, LR + DR in two) was 26 months. Fourteen patients were re-operated, in five cases excising single DR-sites, thereafter three received CT, two after re-RT; out of 11 patients not re-operated, four had re-RT as first treatment and seven after CT. Re-RT was administered at median 32 months after first RT: focally in 20 cases, craniospinal-CSI in five. Median post-relapse-PFS/after re-RT was 16.7/8.2 months, while overall survival-OS was 35.1/23.9 months, respectively. Metastatic status both at diagnosis/relapse negatively affected outcome and re-surgery was prognostically favorable. PD after re-RT was however significantly more frequent in SHH (with a suggestive association with TP53 mutation, p = 0.050). We did not observe any influence of biological subgroups on PFS from recurrence while SHH showed apparently worse OS compared to non-WNT/non-SHH group. CONCLUSIONS Re-surgery + reRT can prolong survival; a substantial fraction of patients with worse outcome belongs to the SHH-subgroup.
Collapse
Affiliation(s)
- Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy.
| | - Sabina Vennarini
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Manila Antonelli
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
| | - Francesca Colombo
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Simone Minasi
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
| | - Emilia Pecori
- Pediatric Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Ferroli
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Carlo Giussani
- Neurosurgery, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Marco Schiariti
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Alessandra Erbetta
- Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Olga Nigro
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Luna Boschetti
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, 20133, Italy
| | - Francesca Gianno
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
| | - Evelina Miele
- Department of Pediatric Onco-Hematology and Transfusion Medicine (EM), Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | | | - Loris De Cecco
- Integrated Biology Platform, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Barretta
- Department of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| |
Collapse
|
7
|
Butler A, Meijer L, Liu JF, Chohan M, Jalloh I, Macarthur D, Parr M, Wilne S, Wilson S, Walker D, Grundy R, Dandapani M. Evaluating the efficacy and safety of single-agent etoposide intra-CSF chemotherapy in children and young people with relapsed/refractory central nervous system tumours. Childs Nerv Syst 2023; 39:1537-1544. [PMID: 36949251 DOI: 10.1007/s00381-023-05872-w] [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: 01/02/2023] [Accepted: 01/28/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE The aim of the project was to evaluate intra-CSF etoposide administration in a palliative setting for children and young people with relapsed/refractory central nervous system (CNS) tumours, with the primary endpoints being overall survival and progression-free survival time. A safety endpoint was to assess the side effect profile and complications of intra-CSF etoposide. METHODS Thirty-five patients under the age of 30 years (median age: 5.33 years) were enrolled onto the project. The cross-centre study was a service evaluation, with a data collection spreadsheet designed in Nottingham and completed by both Nottingham and Oxford centres. Data was analysed using SPSS, assessing the overall survival and progression-free survival times, as well as the 6-month and 1-year survival rates. RESULTS The median overall survival and progression-free survival times were 10.97 and 5.91 months, respectively. The 6-month and 1-year overall survival rates were 67% and 48%, and the progression-free survival rates were 50% and 22%. Age at the start of intra-CSF therapy was significantly associated with overall survival (P = 0.046), with the 6 + age group having improved overall survival. Treatment type was significantly associated with overall survival (P = 0.012), with etoposide intra-CSF treatment being associated with improved overall survival. Treatment duration was significantly associated with both overall survival (P < 0.001) and progression-free survival (P < 0.001). CONCLUSION Intra-CSF etoposide treatment has shown to increase both overall and progression-free survival significantly, whilst having few side effects and maintaining a good quality of life for patients, reflecting it as a beneficial therapy in the palliative setting.
Collapse
Affiliation(s)
- Anna Butler
- Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Lisethe Meijer
- Department of Neuro-Oncology, Princess Maxima Centre for Paediatric Oncology, Utrecht, The Netherlands
| | - Jo-Fen Liu
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, NG7 2RG, UK
| | - Manjit Chohan
- Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Ibrahim Jalloh
- Cambridge University Hospitals NHS Trust, Cambridge, CB2 0QQ, UK
| | - Donald Macarthur
- Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Margaret Parr
- Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Sophie Wilne
- Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Shaun Wilson
- Oxford University Hospitals NHS Trust, Oxford, OX3 7LE, UK
| | - David Walker
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, NG7 2RG, UK
| | - Richard Grundy
- Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, NG7 2RG, UK
| | - Madhumita Dandapani
- Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, NG7 2RG, UK.
| |
Collapse
|