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Romao RLP, Aldrink JH, Renfro LA, Mullen EA, Murphy AJ, Brzezinski J, Malek MM, Benedetti DJ, Cost NG, Smith E, Dome JS, Davidoff AM, Treece A, Parsons LN, Fernandez CV, Tornwall B, Shamberger RC, Paulino A, Kalapurakal JA, Geller JI, Ehrlich PF. Bilateral Wilms tumor with anaplasia: A report from the Children's Oncology Group Study AREN0534. Pediatr Blood Cancer 2024:e30981. [PMID: 38637871 DOI: 10.1002/pbc.30981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION The purpose of this study is to examine the outcomes in children with anaplastic bilateral Wilms tumor (BWT) from study AREN0534 in order to define potential prognostic factors and areas to target in future clinical trials. METHODS Demographic and clinical data from AREN0534 study patients with anaplasia (focal anaplasia [FA], or diffuse anaplasia [DA]) were compared. Event-free survival (EFS) and overall survival (OS) were reported using Kaplan-Meier estimation with 95% confidence bands, and differences in outcomes between FA and DA compared using log-rank tests. The impact of margin status was analyzed. RESULTS Twenty-seven children who enrolled on AREN0534 had evidence of anaplasia (17 DA, 10 FA) in at least one kidney and were included in this analysis. Twenty-six (96%) had BWT. Nineteen percent had anaplastic histology in both kidneys (four of 17 DA, and one of 10 FA). Forty-six percent with BWT had bilateral nephron-sparing surgery (NSS); one child who went off protocol therapy, eventually required bilateral completion nephrectomies. Median follow-up for EFS and OS was 8.6 and 8.7 years from enrollment. Four- and 8-year EFS was 53% [95% confidence interval (CI): 34%-83%] for DA; 4-year EFS was 80% [95% CI: 59%-100%], and 8-year EFS 70% [95% CI: 47%-100%] for FA. Three out of 10 children with FA and eight out of 17 children with DA had events. EFS did not differ statistically by margin status (p = .79; HR = 0.88). Among the six children who died (five DA, one FA), all experienced prior relapse or progression within 18 months. CONCLUSION Events in children with DA/FA in the setting of BWT occurred early. Caution should be taken about interpreting the impact of margin status outcomes in the context of contemporary multimodal therapy. Future targeted investigations in children with BWT and DA/FA are needed.
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Affiliation(s)
- Rodrigo L P Romao
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer H Aldrink
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California and Children's Oncology Group, Los Angeles, California, USA
| | - Elizabeth A Mullen
- Boston Children's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Andrew J Murphy
- St Jude's Children's Research Hospital, Memphis, Tennessee, USA
| | - Jack Brzezinski
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Marcus M Malek
- Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel J Benedetti
- Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicholas G Cost
- The Surgical Oncology Program at the Children's Hospital of Colorado, University of Colorado, Denver, Colorado, USA
| | - Ethan Smith
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey S Dome
- Children National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | | | - Amy Treece
- Children's Hospital of Alabama, Birmingham, Alabama, USA
| | | | | | - Brett Tornwall
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Robert C Shamberger
- Boston Children's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | | | | | - James I Geller
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Peter F Ehrlich
- Section of Pediatric Surgery, C.S. Mott Children's Hospital University of Michigan, Ann Arbor, Michigan, USA
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Pichavaram P, Jablonowski CM, Fang J, Fleming AM, Gil HJ, Boghossian AS, Rees MG, Ronan MM, Roth JA, Morton CL, Zambetti GP, Davidoff AM, Yang J, Murphy AJ. Oncogenic Cells of Renal Embryonic Lineage Sensitive to the Small-Molecule Inhibitor QC6352 Display Depletion of KDM4 Levels and Disruption of Ribosome Biogenesis. Mol Cancer Ther 2024; 23:478-491. [PMID: 37988559 PMCID: PMC10987284 DOI: 10.1158/1535-7163.mct-23-0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
The histone lysine demethylases KDM4A-C are involved in physiologic processes including stem cell identity and self-renewal during development, DNA damage repair, and cell-cycle progression. KDM4A-C are overexpressed and associated with malignant cell behavior in multiple human cancers and are therefore potential therapeutic targets. Given the role of KDM4A-C in development and cancer, we aimed to test the potent, selective KDM4A-C inhibitor QC6352 on oncogenic cells of renal embryonic lineage. The anaplastic Wilms tumor cell line WiT49 and the tumor-forming human embryonic kidney cell line HEK293 demonstrated low nanomolar QC6352 sensitivity. The cytostatic response to QC6352 in WiT49 and HEK293 cells was marked by induction of DNA damage, a DNA repair-associated protein checkpoint response, S-phase cell-cycle arrest, profound reduction of ribosomal protein gene and rRNA transcription, and blockade of newly synthesized proteins. QC6352 caused reduction of KDM4A-C levels by a proteasome-associated mechanism. The cellular phenotype caused by QC6352 treatment of reduced migration, proliferation, tumor spheroid growth, DNA damage, and S-phase cell-cycle arrest was most closely mirrored by knockdown of KDM4A as determined by siRNA knockdown of KDM4A-C. QC6352 sensitivity correlated with high basal levels of ribosomal gene transcription in more than 900 human cancer cell lines. Targeting KDM4A may be of future therapeutic interest in oncogenic cells of embryonic renal lineage or cells with high basal expression of ribosomal protein genes.
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Affiliation(s)
| | | | - Jie Fang
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Andrew M. Fleming
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Hyea Jin Gil
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | | | - Matthew G. Rees
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Melissa M. Ronan
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Jennifer A. Roth
- Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA
| | - Christopher L. Morton
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Gerard P. Zambetti
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jun Yang
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrew J. Murphy
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Lovvorn HN, Renfro LA, Benedetti DJ, Kotagal M, Phelps HM, Ehrlich PF, Lo AC, Sandberg JK, Treece AL, Gow KW, Glick RD, Davidoff AM, Cost NG, Dix DB, Fernandez CV, Dome JS, Geller JI, Mullen EA. Race and Ethnic Group Enrollment and Outcomes for Wilms Tumor: Analysis of the Current Era Children's Oncology Group Study, AREN03B2. J Am Coll Surg 2024; 238:733-749. [PMID: 38251681 DOI: 10.1097/xcs.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND To review race and ethnic group enrollment and outcomes for Wilms tumor (WT) across all 4 risk-assigned therapeutic trials from the current era Children's Oncology Group Renal Tumor Biology and Risk Stratification Protocol, AREN03B2. STUDY DESIGN For patients with WT enrolled in AREN03B2 (2006 to 2019), disease and biologic features, therapeutic study-specific enrollment, and event-free (EFS) and overall (OS) 4-year survival were compared between institutionally reported race and ethnic groups. RESULTS Among 5,146 patients with WT, no statistically significant differences were detected between race and ethnic groups regarding subsequent risk-assigned therapeutic study enrollment, disease stage, histology, biologic factors, or overall EFS or OS, except the following variables: Black children were older and had larger tumors at enrollment, whereas Hispanic children had lower rates of diffuse anaplasia WT and loss of heterozygosity at 1p. The only significant difference in EFS or OS between race and ethnic groups was observed among the few children treated for diffuse anaplasia WT with regimen UH-1 and -2 on high-risk protocol, AREN0321. On this therapeutic arm only, Black children showed worse EFS (hazard ratio = 3.18) and OS (hazard ratio = 3.42). However, this finding was not replicated for patients treated with regimen UH-1 and -2 under AREN03B2 but not on AREN0321. CONCLUSIONS Race and ethnic group enrollment appeared constant across AREN03B2 risk-assigned therapeutic trials. EFS and OS on these therapeutic trials when analyzed together were comparable regarding race and ethnicity. Black children may have experienced worse stage-specific survival when treated with regimen UH-1 and -2 on AREN0321, but this survival gap was not confirmed when analyzing additional high-risk AREN03B2 patients.
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Affiliation(s)
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California, and Children's Oncology Group, Los Angeles, CA (Renfro)
| | - Daniel J Benedetti
- Division of Pediatric Hematology/Oncology, Department of Pediatrics (Benedetti), Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN
| | - Meera Kotagal
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (Kotagal)
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH (Kotagal)
| | - Hannah M Phelps
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO (Phelps)
| | - Peter F Ehrlich
- Section of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI (Ehrlich)
| | - Andrea C Lo
- Department of Radiation on Oncology, BC Cancer, Vancouver, British Columbia, Canada (Lo)
| | - Jesse K Sandberg
- Division of Pediatric Radiology, Lucille Packard Children's Hospital, Stanford University, Palo Alto, CA (Sandberg)
| | - Amanda L Treece
- Department of Pathology and Laboratory Medicine, Children's Hospital of Alabama, Birmingham, AL (Treece)
| | - Kenneth W Gow
- Division of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA (Gow)
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY (Glick)
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN (Davidoff)
| | - Nicholas G Cost
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Surgical Oncology Program, Children's Hospital Colorado, Aurora, CO (Cost)
| | - David B Dix
- Division of Hematology and Oncology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada (Dix)
| | - Conrad V Fernandez
- Division of Paediatric Haematology Oncology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia (Fernandez)
| | - Jeffrey S Dome
- Center for Cancer and Blood Disorders, Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC (Dome)
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH (Geller)
| | - Elizabeth A Mullen
- Division of Pediatric Hematology and Oncology, Dana-Farber Cancer Institute, Boston, MA (Mullen)
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Brimble MA, Morton CL, Winston SM, Reeves IL, Spence Y, Cheng PH, Zhou J, Nathwani AC, Thomas PG, Souquette A, Davidoff AM. Pre-Existing Immunity to a Nucleic Acid Contaminant-Derived Antigen Mediates Transaminitis and Resultant Diminished Transgene Expression in a Mouse Model of Hepatic Recombinant Adeno-Associated Virus-Mediated Gene Transfer. Hum Gene Ther 2024. [PMID: 38420654 DOI: 10.1089/hum.2023.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Liver injury with concomitant loss of therapeutic transgene expression can be a clinical sequela of systemic administration of recombinant adeno-associated virus (rAAV) when used for gene therapy, and a significant barrier to treatment efficacy. Despite this, it has been difficult to replicate this phenotype in preclinical models, thereby limiting the field's ability to systematically investigate underlying biological mechanisms and develop interventions. Prior animal models have focused on capsid and transgene-related immunogenicity, but the impact of concurrently present nontransgene or vector antigens on therapeutic efficacy, such as those derived from contaminating nucleic acids within rAAV preps, has yet to be investigated. In this study, using Ad5-CMV_GFP-immunized immunocompetent BALB/cJ mice, and a coagulation factor VIII expressing rAAV preparation that contains green flourescent protein (GFP) cDNA packaged as P5-associated contaminants, we establish a model to induce transaminitis and observe concomitant therapeutic efficacy reduction after rAAV administration. We observed strong epitope-specific anti-GFP responses in splenic CD8+ T cells when GFP cDNA was delivered as a P5-associated contaminant of rAAV, which coincided and correlated with alanine and aspartate aminotransferase elevations. Furthermore, we report a significant reduction in detectable circulating FVIII protein, as compared with control mice. Lastly, we observed an elevation in the detection of AAV8 capsid-specific T cells when GFP was delivered either as a contaminant or transgene to Ad5-CMV_GFP-immunized mice. We present this model as a potential tool to study the underlying biology of post-AAV hepatotoxicity and demonstrate the potential for T cell responses against proteins produced from AAV encapsidated nontherapeutic nucleic acids, to interfere with efficacious gene transfer.
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Affiliation(s)
- Mark A Brimble
- Departments of, Host Microbe Interactions, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christopher L Morton
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephen M Winston
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Isaiah L Reeves
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yunyu Spence
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Pei-Hsin Cheng
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Junfang Zhou
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amit C Nathwani
- Research Department of Haematology, UCL Cancer Institute, University College London, London, United Kingdom
| | - Paul G Thomas
- Departments of, Host Microbe Interactions, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Aisha Souquette
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew M Davidoff
- Departments of, Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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5
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Singh S, Fang J, Jin H, Van de Velde LA, Wu Q, Cortes A, Morton CL, Woolard MA, Quarni W, Steele JA, Connelly JP, He L, Thorne R, Turner G, Confer T, Johnson M, Caufield WV, Freeman BB, Lockey T, Pruett-Miller SM, Wang R, Davidoff AM, Thomas PG, Yang J. RBM39 degrader invigorates natural killer cells to eradicate neuroblastoma despite cancer cell plasticity. bioRxiv 2024:2024.03.21.586157. [PMID: 38585889 PMCID: PMC10996557 DOI: 10.1101/2024.03.21.586157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The cellular plasticity of neuroblastoma is defined by a mixture of two major cell states, adrenergic (ADRN) and mesenchymal (MES), which may contribute to therapy resistance. However, how neuroblastoma cells switch cellular states during therapy remains largely unknown and how to eradicate neuroblastoma regardless of their cell states is a clinical challenge. To better understand the lineage switch of neuroblastoma in chemoresistance, we comprehensively defined the transcriptomic and epigenetic map of ADRN and MES types of neuroblastomas using human and murine models treated with indisulam, a selective RBM39 degrader. We showed that cancer cells not only undergo a bidirectional switch between ADRN and MES states, but also acquire additional cellular states, reminiscent of the developmental pliancy of neural crest cells. The lineage alterations are coupled with epigenetic reprogramming and dependency switch of lineage-specific transcription factors, epigenetic modifiers and targetable kinases. Through targeting RNA splicing, indisulam induces an inflammatory tumor microenvironment and enhances anticancer activity of natural killer cells. The combination of indisulam with anti-GD2 immunotherapy results in a durable, complete response in high-risk transgenic neuroblastoma models, providing an innovative, rational therapeutic approach to eradicate tumor cells regardless of their potential to switch cell states.
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6
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Abu-Zaid A, Fang J, Jin H, Singh S, Pichavaram P, Wu Q, Tillman H, Janke L, Rosikiewicz W, Xu B, Van De Velde LA, Guo Y, Li Y, Shendy NAM, Delahunty IM, Rankovic Z, Chen T, Chen X, Freeman KW, Hatley ME, Durbin AD, Murray PJ, Murphy AJ, Thomas PG, Davidoff AM, Yang J. Histone lysine demethylase 4 family proteins maintain the transcriptional program and adrenergic cellular state of MYCN-amplified neuroblastoma. Cell Rep Med 2024; 5:101468. [PMID: 38508144 PMCID: PMC10983111 DOI: 10.1016/j.xcrm.2024.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/21/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
Neuroblastoma with MYCN amplification (MNA) is a high-risk disease that has a poor survival rate. Neuroblastoma displays cellular heterogeneity, including more differentiated (adrenergic) and more primitive (mesenchymal) cellular states. Here, we demonstrate that MYCN oncoprotein promotes a cellular state switch in mesenchymal cells to an adrenergic state, accompanied by induction of histone lysine demethylase 4 family members (KDM4A-C) that act in concert to control the expression of MYCN and adrenergic core regulatory circulatory (CRC) transcription factors. Pharmacologic inhibition of KDM4 blocks expression of MYCN and the adrenergic CRC transcriptome with genome-wide induction of transcriptionally repressive H3K9me3, resulting in potent anticancer activity against neuroblastomas with MNA by inducing neuroblastic differentiation and apoptosis. Furthermore, a short-term KDM4 inhibition in combination with conventional, cytotoxic chemotherapy results in complete tumor responses of xenografts with MNA. Thus, KDM4 blockade may serve as a transformative strategy to target the adrenergic CRC dependencies in MNA neuroblastomas.
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Affiliation(s)
- Ahmed Abu-Zaid
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA; College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jie Fang
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Hongjian Jin
- Center for Applied Bioinformatics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Shivendra Singh
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | | | - Qiong Wu
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Heather Tillman
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Laura Janke
- Department of Pathology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Wojciech Rosikiewicz
- Center for Applied Bioinformatics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Beisi Xu
- Center for Applied Bioinformatics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Lee-Ann Van De Velde
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yian Guo
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Yimei Li
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Noha A M Shendy
- Department of Molecular Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Ian M Delahunty
- Department of Molecular Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Zoran Rankovic
- Department of Chemical Biology and Therapeutics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Taosheng Chen
- Department of Chemical Biology and Therapeutics, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Xiang Chen
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kevin W Freeman
- Genetics, Genomics & Informatics, The University of Tennessee Health Science Center, Memphis, TN 38103, USA
| | - Mark E Hatley
- Department of Molecular Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Adam D Durbin
- Department of Molecular Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Peter J Murray
- Max Planck Institute of Biochemistry, Am Klopferspitz 18, 82152 Martinsried, Germany
| | - Andrew J Murphy
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Paul G Thomas
- Department of Immunology, St Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA; St Jude Graduate School of Biomedical Sciences, St Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Pathology and Laboratory Medicine, College of Medicine, The University of Tennessee Health Science Center, 930 Madison Avenue, Suite 500, Memphis, TN 38163, USA
| | - Jun Yang
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN 38105, USA; St Jude Graduate School of Biomedical Sciences, St Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Pathology and Laboratory Medicine, College of Medicine, The University of Tennessee Health Science Center, 930 Madison Avenue, Suite 500, Memphis, TN 38163, USA; College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA.
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7
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Jablonowski CM, Quarni W, Singh S, Tan H, Bostanthirige DH, Jin H, Fang J, Chang TC, Finkelstein D, Cho JH, Hu D, Pagala V, Sakurada SM, Pruett-Miller SM, Wang R, Murphy A, Freeman K, Peng J, Davidoff AM, Wu G, Yang J. Metabolic reprogramming of cancer cells by JMJD6-mediated pre-mRNA splicing associated with therapeutic response to splicing inhibitor. eLife 2024; 12:RP90993. [PMID: 38488852 PMCID: PMC10942784 DOI: 10.7554/elife.90993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Dysregulated pre-mRNA splicing and metabolism are two hallmarks of MYC-driven cancers. Pharmacological inhibition of both processes has been extensively investigated as potential therapeutic avenues in preclinical and clinical studies. However, how pre-mRNA splicing and metabolism are orchestrated in response to oncogenic stress and therapies is poorly understood. Here, we demonstrate that jumonji domain containing 6, arginine demethylase, and lysine hydroxylase, JMJD6, acts as a hub connecting splicing and metabolism in MYC-driven human neuroblastoma. JMJD6 cooperates with MYC in cellular transformation of murine neural crest cells by physically interacting with RNA binding proteins involved in pre-mRNA splicing and protein homeostasis. Notably, JMJD6 controls the alternative splicing of two isoforms of glutaminase (GLS), namely kidney-type glutaminase (KGA) and glutaminase C (GAC), which are rate-limiting enzymes of glutaminolysis in the central carbon metabolism in neuroblastoma. Further, we show that JMJD6 is correlated with the anti-cancer activity of indisulam, a 'molecular glue' that degrades splicing factor RBM39, which complexes with JMJD6. The indisulam-mediated cancer cell killing is at least partly dependent on the glutamine-related metabolic pathway mediated by JMJD6. Our findings reveal a cancer-promoting metabolic program is associated with alternative pre-mRNA splicing through JMJD6, providing a rationale to target JMJD6 as a therapeutic avenue for treating MYC-driven cancers.
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Affiliation(s)
| | - Waise Quarni
- Department of Surgery, St Jude Children’s Research HospitalMemphisUnited States
| | - Shivendra Singh
- Department of Surgery, St Jude Children’s Research HospitalMemphisUnited States
| | - Haiyan Tan
- Center for Proteomics and Metabolomics, St Jude Children's Research HospitalMemphisUnited States
| | | | - Hongjian Jin
- Center for Applied Bioinformatics, St Jude Children’s Research HospitalMemphisUnited States
| | - Jie Fang
- Department of Surgery, St Jude Children’s Research HospitalMemphisUnited States
| | - Ti-Cheng Chang
- Center for Applied Bioinformatics, St Jude Children’s Research HospitalMemphisUnited States
| | - David Finkelstein
- Center for Applied Bioinformatics, St Jude Children’s Research HospitalMemphisUnited States
| | - Ji-Hoon Cho
- Center for Proteomics and Metabolomics, St Jude Children's Research HospitalMemphisUnited States
| | - Dongli Hu
- Department of Surgery, St Jude Children’s Research HospitalMemphisUnited States
| | - Vishwajeeth Pagala
- Center for Proteomics and Metabolomics, St Jude Children's Research HospitalMemphisUnited States
| | - Sadie Miki Sakurada
- Department of Cell and Molecular Biology, St Jude Children's Research HospitalMemphisUnited States
| | - Shondra M Pruett-Miller
- Department of Cell and Molecular Biology, St Jude Children's Research HospitalMemphisUnited States
| | - Ruoning Wang
- Center for Childhood Cancer and Blood Disease, Abigail Wexner Research Institute, Nationwide Children’s HospitalColumbusUnited States
| | - Andrew Murphy
- Department of Surgery, St Jude Children’s Research HospitalMemphisUnited States
| | - Kevin Freeman
- Genetics, Genomics & Informatics, The University of Tennessee Health Science Center (UTHSC)MemphisUnited States
| | - Junmin Peng
- Department of Structural Biology, St Jude Children’s Research HospitalMemphisUnited States
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children’s Research HospitalMemphisUnited States
- St Jude Graduate School of Biomedical Sciences, St Jude Children’s Research HospitalMemphisUnited States
- Department of Pathology and Laboratory Medicine, College of Medicine, The University of Tennessee Health Science CenterMemphisUnited States
| | - Gang Wu
- Center for Applied Bioinformatics, St Jude Children’s Research HospitalMemphisUnited States
| | - Jun Yang
- Department of Surgery, St Jude Children’s Research HospitalMemphisUnited States
- St Jude Graduate School of Biomedical Sciences, St Jude Children’s Research HospitalMemphisUnited States
- Department of Pathology and Laboratory Medicine, College of Medicine, The University of Tennessee Health Science CenterMemphisUnited States
- College of Graduate Health Sciences, University of Tennessee Health Science CenterMemphisUnited States
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8
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Wang T, Liu L, Fang J, Jin H, Natarajan S, Sheppard H, Lu M, Turner G, Confer T, Johnson M, Steinberg J, Ha L, Yadak N, Jain R, Picketts DJ, Ma X, Murphy A, Davidoff AM, Glazer ES, Easton J, Chen X, Wang R, Yang J. Conditional c-MYC activation in catecholaminergic cells drives distinct neuroendocrine tumors: neuroblastoma vs somatostatinoma. bioRxiv 2024:2024.03.12.584622. [PMID: 38559042 PMCID: PMC10980015 DOI: 10.1101/2024.03.12.584622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The MYC proto-oncogenes (c-MYC, MYCN , MYCL ) are among the most deregulated oncogenic drivers in human malignancies including high-risk neuroblastoma, 50% of which are MYCN -amplified. Genetically engineered mouse models (GEMMs) based on the MYCN transgene have greatly expanded the understanding of neuroblastoma biology and are powerful tools for testing new therapies. However, a lack of c-MYC-driven GEMMs has hampered the ability to better understand mechanisms of neuroblastoma oncogenesis and therapy development given that c-MYC is also an important driver of many high-risk neuroblastomas. In this study, we report two transgenic murine neuroendocrine models driven by conditional c-MYC induction in tyrosine hydroxylase (Th) and dopamine β-hydroxylase (Dbh)-expressing cells. c-MYC induction in Th-expressing cells leads to a preponderance of Pdx1 + somatostatinomas, a type of pancreatic neuroendocrine tumor (PNET), resembling human somatostatinoma with highly expressed gene signatures of δ cells and potassium channels. In contrast, c-MYC induction in Dbh-expressing cells leads to onset of neuroblastomas, showing a better transforming capacity than MYCN in a comparable C57BL/6 genetic background. The c-MYC murine neuroblastoma tumors recapitulate the pathologic and genetic features of human neuroblastoma, express GD2, and respond to anti-GD2 immunotherapy. This model also responds to DFMO, an FDA-approved inhibitor targeting ODC1, which is a known MYC transcriptional target. Thus, establishing c-MYC-overexpressing GEMMs resulted in different but related tumor types depending on the targeted cell and provide useful tools for testing immunotherapies and targeted therapies for these diseases.
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9
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Sutthatarn P, Davidoff AM, Bahrami A, Richard C, Shalini B, Santiago TC, Shulkin BL, Pappo AS, Abdelhafeez A. Regional lymph node evaluation in pediatric conventional melanoma subtype: a single-center 10-year review. Pediatr Surg Int 2024; 40:68. [PMID: 38441654 PMCID: PMC10914839 DOI: 10.1007/s00383-024-05646-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE To assess the prognostic and therapeutic significance of sentinel lymph node biopsy (SLNB) and completion lymph node dissection (CLND) in pediatric conventional melanoma (CM), while evaluating potential predictive factors for outcomes. METHODS We conducted a retrospective analysis of medical records spanning 2009-2020, focusing on patients aged 18 or younger with localized cutaneous conventional melanoma. RESULTS Among the 33 patients, SLNB detected metastasis in 57.6% of cases, with 52.6% undergoing CLND. Positive SLN patients had higher relapse risk (HR 5.92; 95% CI 1.27-27.7; P = 0.024) but similar overall survival (HR 3.19; 95% CI 0.31-33.1, P = 0.33). No significant differences in disease-free survival (DFS) and OS were found between patients who underwent CLND and those who did not (HR 1.91; 95% CI 0.49-7.43, P = 0.35, and HR 0.52; 95% CI 0.03-8.32, P = 0.64, respectively). Univariate analysis showed age at diagnosis (P = 0.02) correlated with higher recurrence risk, with a 21% hazard increase per additional year of age. CONCLUSIONS Positive SLN status and age at diagnosis were associated with worse DFS in CM patients. Our study did not find any prognostic or therapeutic value in CLND for pediatric melanoma. Further multicenter trials are needed to confirm our single-institution experience. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Pattamon Sutthatarn
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, 38105, USA
| | - Armita Bahrami
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Celine Richard
- Department of Otolaryngology, University of Tennessee Health Science Center College of Medicine, Memphis, USA.
- Division of Otolaryngology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
| | - Bhatia Shalini
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Teresa C Santiago
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, 38105, United States
| | - Alberto S Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, 38105, United States
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10
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Abramson ZR, Davidoff AM. Comment on: COG Diagnostic Imaging Committee/SPR Oncology Committee White Papers. Pediatr Blood Cancer 2024; 71:e30840. [PMID: 38173085 DOI: 10.1002/pbc.30840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Zachary R Abramson
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew M Davidoff
- Surgery Department, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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11
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Fleming AM, Hendrick LE, Yakoub D, Abdelhafeez H, Deneve JL, Langham MR, Glazer ES, Davidoff AM, Merchant NB, Dickson PV, Murphy AJ. ASO Visual Abstract: Malignant Solid Pseudopapillary Neoplasm of the Pancreas-An Orthogonal Analysis. Ann Surg Oncol 2024; 31:1946. [PMID: 37962743 DOI: 10.1245/s10434-023-14542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Andrew M Fleming
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Leah E Hendrick
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Danny Yakoub
- Department of Surgery, Augusta University Medical Center, Augusta, GA, USA
| | - Hafeez Abdelhafeez
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Max R Langham
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nipun B Merchant
- Department of Surgery, University of Miami Health System, Miami, FL, USA
| | - Paxton V Dickson
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew J Murphy
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
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12
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Gow KW, Lautz TB, Malek MM, Cost NG, Newman EA, Dasgupta R, Christison-Lagay ER, Tiao GM, Davidoff AM. Children's Oncology Group's 2023 blueprint for research: Surgery. Pediatr Blood Cancer 2024; 71:e30766. [PMID: 37950538 PMCID: PMC10872730 DOI: 10.1002/pbc.30766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
Surgery plays a crucial role in the treatment of children with solid malignancies. A well-conducted operation is often essential for cure. Collaboration with the primary care team is important for determining if and when surgery should be performed, and if performed, an operation must be done in accordance with well-established standards. The long-term consequences of surgery also need to be considered. Indications and objectives for a procedure vary. Providing education and developing and analyzing new research protocols that include aims relevant to surgery are key objectives of the Surgery Discipline of the Children's Oncology Group. The critical evaluation of emerging technologies to ensure safe, effective procedures is another key objective. Through research, education, and advancing technologies, the role of the pediatric surgeon in the multidisciplinary care of children with solid malignancies will continue to evolve.
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Affiliation(s)
- Kenneth W. Gow
- Division of General & Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Timothy B. Lautz
- Department of Pediatric Surgery, Lurie Children’s Hospital of Chicago, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Marcus M. Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicholas G. Cost
- Department of Surgery, Division of Urology and the Surgical Oncology Program, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Erika A. Newman
- Department of Surgery, Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Roshni Dasgupta
- Division of Pediatric General and Thoracic Surgery, Cincinnati Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Emily R. Christison-Lagay
- Division of Pediatric Surgery, Yale School of Medicine, Yale-New Haven Children’s Hospital, New Haven, Connecticut, USA
| | - Gregory M. Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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13
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Abramson Z, Thompson D, Goode C, Morin CE, Daniels S, Choudhri AF, Davidoff AM. Current and emerging 3D visualization technologies in radiology. Pediatr Radiol 2024:10.1007/s00247-024-05875-y. [PMID: 38332355 DOI: 10.1007/s00247-024-05875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
As the field of three-dimensional (3D) visualization rapidly advances, how healthcare professionals perceive and interact with real and virtual objects becomes increasingly complex. Lack of clear vocabulary to navigate the changing landscape of 3D visualization hinders clinical and scientific advancement, particularly within the field of radiology. In this article, we provide foundational definitions and illustrative examples for 3D visualization in clinical care, with a focus on the pediatric patient population. We also describe how understanding 3D visualization tools enables better alignment of hardware and software products with intended use-cases, thereby maximizing impact for patients, families, and healthcare professionals.
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Affiliation(s)
- Zachary Abramson
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
| | - Dylan Thompson
- Department of Biomedical Engineering, The University of Memphis, 3806 Norriswood Avenue, Memphis, TN, USA
| | - Chris Goode
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, USA
| | - Sarah Daniels
- Child Life Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, USA
| | - Asim F Choudhri
- Department of Radiology, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 50 N. Dunlap St., Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, USA
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14
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Ates O, Pirlepesov F, Uh J, Hua CH, Merchant TE, Boria A, Davidoff AM, Graetz DE, Krasin MJ. Evaluating the Impact of Bowel Gas Variations for Wilms' Tumor in Pediatric Proton Therapy. Cancers (Basel) 2024; 16:642. [PMID: 38339393 PMCID: PMC10854738 DOI: 10.3390/cancers16030642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Proton therapy, a precise form of radiation treatment, can be significantly affected by variations in bowel content. The purpose was to identify the most beneficial gantry angles that minimize deviations from the treatment plan quality, thus enhancing the safety and efficacy of proton therapy for Wilms' tumor patients. (2) Methods: Thirteen patients with Wilms' tumor, enrolled in the SJWT21 clinical trial, underwent proton therapy. The variations in bowel gas were systematically monitored using daily Cone Beam Computed Tomography (CBCT) imaging. Air cavities identified in daily CBCT images were analyzed to construct daily verification plans and measure water equivalent path length (WEPL) changes. A worst-case scenario simulation was conducted to identify the safest beam angles. (3) Results: The study revealed a maximum decrease in target dose (ΔD100%) of 8.0%, which corresponded to a WEPL variation (ΔWEPL) of 11.3 mm. The average reduction in target dose, denoted as mean ΔD100%, was found to be 2.8%, with a standard deviation (SD) of 3.2%. The mean ΔWEPL was observed as 3.3 mm, with an SD of 2.7 mm. The worst-case scenario analysis suggested that gantry beam angles oriented toward the patient's right and posterior aspects from 110° to 310° were associated with minimized WEPL discrepancies. (4) Conclusions: This study comprehensively evaluated the influence of bowel gas variability on treatment plan accuracy and proton range uncertainties in pediatric proton therapy for Wilms' tumor.
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Affiliation(s)
- Ozgur Ates
- St. Jude Children’s Research Hospital, Memphis, TN 38105, USA; (F.P.); (J.U.); (C.-h.H.); (T.E.M.); (A.B.); (A.M.D.); (D.E.G.); (M.J.K.)
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15
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Fleming AM, Mansfield SA, Jancelewicz T, Gosain A, Eubanks JW, Davidoff AM, Langham MR, Murphy AJ. Hepatic Metastasectomy in Pediatric Patients: An Observational Study. J Pediatr Surg 2024; 59:247-253. [PMID: 37980196 DOI: 10.1016/j.jpedsurg.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND The role of hepatectomy for metastatic disease in children is controversial. Rationales include potential cure, obtaining a diagnosis, and guiding chemotherapy decisions. This study examines the safety and utility of hepatic metastasectomy for children at a single institution. METHODS After IRB approval (#22-1258), medical records were reviewed from 1995 to 2022 for children undergoing hepatic metastasectomy. En-bloc hepatectomies during primary tumor resection were excluded. RESULTS Hepatic metastasectomy was performed in 16 patients for a variety of histologies. Median patient age was 12.2 years [IQR 6.9-22.6], and 13/16 patients were female (81 %). Number of hepatic metastases ranged from 1 to 23 and involved between 1 and 8 Couinaud segments. Anatomic resections included 4 hemihepatectomies and 1 sectionectomy. All other resections were nonanatomic. 3/6 resections for germ cell tumor (GCT) revealed only mature teratoma, driving adjuvant therapy decisions. When indicated, median time to adjuvant chemotherapy was 19 days [IQR 11-22]. No patients had Clavien-Dindo Class III or higher perioperative morbidity. Three patients (1 GCT, 1 adrenocortical carcinoma (ACC), and 1 gastric neuroendocrine tumor (GNET) experienced hepatic relapse. The patients with relapsed GCT and GNET are alive with disease at 17 and 135 months, respectively. The patient with ACC died of disease progression and liver failure. One patient with Wilms tumor experienced extrahepatic, retroperitoneal recurrence and died. With a median follow-up of 38 months, 10-year disease-specific and disease-free survival were 77 % and 61 %, respectively. CONCLUSIONS Hepatic metastasectomy can be accomplished safely in children, may guide adjuvant therapy decisions, and is associated with long-term survival in selected patients. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Treatment Study, Case series with no comparison group.
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Affiliation(s)
- Andrew M Fleming
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Sara A Mansfield
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Tim Jancelewicz
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Ankush Gosain
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - James W Eubanks
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Andrew M Davidoff
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Max R Langham
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA
| | - Andrew J Murphy
- St. Jude Children's Research Hospital, Department of Surgery, Memphis, TN, USA; The University of Tennessee Health Science Center, Department of Surgery, Memphis, TN, USA.
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16
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Pio L, Brisse HJ, Alaggio R, Zambaiti E, Stenman J, Giuliani S, Montano V, Hinojosa AS, Hoel AT, Pevere A, Abu-Zaid A, Franchi-Abella S, Abdelhafeez AH, Davidoff AM, Losty PD. Image-guided core-needle or surgical biopsy for neuroblastoma diagnosis in children: A systematic review and meta-analysis from the International Society of Pediatric Surgical Oncology (IPSO). Pediatr Blood Cancer 2024; 71:e30789. [PMID: 38015091 DOI: 10.1002/pbc.30789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Image-guided core-needle biopsy (IGCNB) is a widely used and valuable clinical tool for tissue diagnosis of pediatric neuroblastoma. However, open surgical biopsy remains common practice even if children undergo more invasive and painful procedures. This review aims to determine the diagnostic accuracy and safety of IGCNBs in pediatric patients with neuroblastoma. METHODS We conducted a systematic review of peer-reviewed original articles published between 1980 and 2023, by searching "pediatric oncology," "biopsy," "interventional radiology," and "neuroblastoma." Exclusion criteria were patients older than 18 years, studies concerning non-neurogenic tumors, case reports, and language other than English. Both the systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 533 abstracts articles were analyzed. Of these, eight retrospective studies met inclusion criteria (490 infants, 270 surgical biopsies [SB], 220 image-guided biopsies). Tissue adequacy for primary diagnosis (SB: n = 265, 98%; IGCNB: n = 199, 90%; p = .1) and biological characterization (SB: n = 186, 95%; IGCNB: n = 109, 89%; p = .15) was similar with both biopsy techniques, while intraoperative transfusion rate (SB: n = 51, 22%; IGCNB: n = 12, 6%; p = .0002) and complications (%) (SB: n = 58, 21%; IGCNB: n = 14, 6%; p = .005) were higher with surgical biopsy. Length of stay was similar in both groups; however, no additional data about concurrent diagnostic or treatment procedures were available in the analyzed studies. CONCLUSIONS IGCNB is a safe and effective strategic approach for diagnostic workup of NB and should be considered in preferance to SB wherever possible.
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Affiliation(s)
- Luca Pio
- Departments of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Rita Alaggio
- Department of Laboratories, Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elisa Zambaiti
- UOC Chirurgia Pediatrica, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Jacob Stenman
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Stefano Giuliani
- Cancer Section, Developmental Biology and Cancer Programme, UCL, Great Ormond Street Institute of Child Health, London, UK
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Valentina Montano
- UOC Chirurgia Pediatrica, Ospedale Filippo Del Ponte di Varese, ASST Settelaghi, Varese, Italy
| | - Alexander Siles Hinojosa
- Department of Pediatric Surgery, Maternity and Children's Hospital, Regional University Hospital of Malaga, Malaga, Spain
| | - Anders Toel Hoel
- Department of Pediatric Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Andrea Pevere
- Department of Pediatric Anesthesiology, Hôpital Armand-Trousseau, AP-HP, UPMC, Paris, France
| | - Ahmed Abu-Zaid
- Departments of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Stephanie Franchi-Abella
- Department of Pediatric Imaging, Bicêtre Hospital-Assistance Publique Hôpitaux de Paris-F, Le Kremlin-Bicêtre, France
| | - Abdelhafeez H Abdelhafeez
- Departments of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrew M Davidoff
- Departments of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Paul D Losty
- Institute of Systems, Molecular And Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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17
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Robertson DJ, Abramson ZR, Davidoff AM, Bramlet MT. Virtual reality applications in pediatric surgery. Semin Pediatr Surg 2024; 33:151387. [PMID: 38262206 DOI: 10.1016/j.sempedsurg.2024.151387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Virtual reality modeling (VRM) is a 3-dimensional (3D) simulation. It is a powerful tool and has multiple uses and applications in pediatric surgery. Patient-specific 2-dimensional imaging can be used to generate a virtual reality model, which can improve anatomical perception and understanding, and can aid in preoperative planning for complex operations. VRM can also be used for realistic training and simulation. It has also proven effective in distraction for pediatric patients experiencing pain and/or anxiety. We detail the technical requirements and process required for VRM generation, the applications, and future directions.
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Affiliation(s)
- Daniel J Robertson
- Division of Pediatric Surgery, Children's Hospital of Illinois, OSF Healthcare, Peoria, Illinois; University of Illinois College of Medicine, Peoria, Illinois; Jump Simulation Center, Peoria, Illinois.
| | - Zachary R Abramson
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Matthew T Bramlet
- University of Illinois College of Medicine, Peoria, Illinois; Jump Simulation Center, Peoria, Illinois; Division of Pediatric Cardiology, Children's Hospital of Illinois, Peoria, Illinois
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18
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Fleming AM, Hendrick LE, Yakoub D, Abdelhafeez H, Deneve JL, Langham MR, Glazer ES, Davidoff AM, Merchant NB, Dickson PV, Murphy AJ. Malignant Solid Pseudopapillary Neoplasm of the Pancreas: An Orthogonal Analysis. Ann Surg Oncol 2024; 31:475-487. [PMID: 37768414 DOI: 10.1245/s10434-023-14343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Pancreatic solid pseudopapillary neoplasms (SPN) are generally indolent; however, some patients present with "malignant" SPN. An orthogonal analysis of multiple datasets was performed to investigate the utility of complete surgical resection (CSR) for malignant SPN. METHODS A systematic review was performed for cases of malignant SPN, defined as T4, N1, and/or M1. Malignant SPN was analyzed within the National Cancer Database (NCDB) and compared with T1-3N0M0 SPN. Predictors of malignant SPN were assessed, and treatments were analyzed by using survival analysis. RESULTS The systematic review yielded 164 cases of malignant SPN. Of 31 children, only one died due to malignant SPN. Among adults, CSR was associated with improved disease-specific survival (DSS) (P = 0.0002). Chemotherapy did not improve malignant SPN DSS, whether resected (P = 0.8485) or not (P = 0.2219). Of 692 adults with SPN within the NCDB, 93 (13.4%) had malignant SPN. Pancreatic head location (odds ratio [OR] 2.174; 95% confidence interval [CI] 1.136-4.166; P = 0.0186) and tumor size (OR 1.154; 95% CI 1.079-1.235; P < 0.0001) associated with the malignant phenotype. Malignant SPN predicted decreased overall survival (OS) compared with T1-3N0M0 disease (P < 0.0001). Resected malignant SPN demonstrated improved OS (P < 0.0001), including resected stage IV malignant SPN (P = 0.0003). Chemotherapy did not improve OS for malignant SPN, whether resected (P = 0.8633) or not (P = 0.5734). Within a multivariable model, resection was associated with decreased hazard of death (hazard ratio 0.090; 95% CI 0.030-0.261; P < 0.0001). CONCLUSIONS Approximately 13% of patients with SPN present with a malignant phenotype. Pediatric cases may be less aggressive. Resection may improve survival for malignant SPN, which does not appear chemosensitive.
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Affiliation(s)
- Andrew M Fleming
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Leah E Hendrick
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Danny Yakoub
- Department of Surgery, Augusta University Medical Center, Augusta, GA, USA
| | - Hafeez Abdelhafeez
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Max R Langham
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nipun B Merchant
- Department of Surgery, University of Miami Health System, Miami, FL, USA
| | - Paxton V Dickson
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew J Murphy
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
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Murphy AJ, Cheng C, Williams J, Shaw TI, Pinto EM, Dieseldorff-Jones K, Brzezinski J, Renfro LA, Tornwall B, Huff V, Hong AL, Mullen EA, Crompton B, Dome JS, Fernandez CV, Geller JI, Ehrlich PF, Mulder H, Oak N, Maciezsek J, Jablonowski CM, Fleming AM, Pichavaram P, Morton CL, Easton J, Nichols KE, Clay MR, Santiago T, Zhang J, Yang J, Zambetti GP, Wang Z, Davidoff AM, Chen X. Genetic and epigenetic features of bilateral Wilms tumor predisposition in patients from the Children's Oncology Group AREN18B5-Q. Nat Commun 2023; 14:8006. [PMID: 38110397 PMCID: PMC10728430 DOI: 10.1038/s41467-023-43730-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Developing synchronous bilateral Wilms tumor suggests an underlying (epi)genetic predisposition. Here, we evaluate this predisposition in 68 patients using whole exome or genome sequencing (n = 85 tumors from 61 patients with matched germline blood DNA), RNA-seq (n = 99 tumors), and DNA methylation analysis (n = 61 peripheral blood, n = 29 non-diseased kidney, n = 99 tumors). We determine the predominant events for bilateral Wilms tumor predisposition: 1)pre-zygotic germline genetic variants readily detectable in blood DNA [WT1 (14.8%), NYNRIN (6.6%), TRIM28 (5%), and BRCA-related genes (5%)] or 2)post-zygotic epigenetic hypermethylation at 11p15.5 H19/ICR1 that may require analysis of multiple tissue types for diagnosis. Of 99 total tumor specimens, 16 (16.1%) have 11p15.5 normal retention of imprinting, 25 (25.2%) have 11p15.5 copy neutral loss of heterozygosity, and 58 (58.6%) have 11p15.5 H19/ICR1 epigenetic hypermethylation (loss of imprinting). Here, we ascertain the epigenetic and genetic modes of bilateral Wilms tumor predisposition.
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Affiliation(s)
- Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, 38105, USA.
| | - Changde Cheng
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Justin Williams
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Timothy I Shaw
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Emilia M Pinto
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | | | - Jack Brzezinski
- Department of Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lindsay A Renfro
- Children's Oncology Group and Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Brett Tornwall
- Children's Oncology Group Statistics and Data Center, Monrovia, CA, USA
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew L Hong
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth A Mullen
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA, 02215, USA
| | - Brian Crompton
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA, 02215, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Jeffrey S Dome
- Center for Cancer and Blood Disorders, Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Peter F Ehrlich
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Heather Mulder
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Ninad Oak
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jamie Maciezsek
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Carolyn M Jablonowski
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Andrew M Fleming
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, 38105, USA
| | | | - Christopher L Morton
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - John Easton
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael R Clay
- Department of Pathology, University of Colorado Anschutz, Aurora, CO, USA
| | - Teresa Santiago
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Jun Yang
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Gerard P Zambetti
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Zhaoming Wang
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, 38105, USA
| | - Xiang Chen
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA.
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Fleming AM, Herb J, Stiles ZE, Burkbauer L, Dickson PV, Glazer ES, Shibata D, Murphy AJ, Davidoff AM, Gleeson E, Kim HJ, Meyers MO, Stitzenberg K, Ollila DW, Deneve JL. Lymph node metastases in young patients with gastrointestinal stromal tumor: A nationwide analysis. J Surg Oncol 2023; 128:1268-1277. [PMID: 37650827 DOI: 10.1002/jso.27431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Children, adolescents, and young adults (CAYA) (age ≤39 years) with GIST have high rates of LNM, but their clinical relevance is undefined. This study analyzed the impact of LNM on overall survival (OS) for CAYA with GIST. METHODS The National Cancer Database was queried for patients with resected GIST and pathologic nodal staging data from 2004-2019. Factors associated with LNM were identified. Survival was assessed stratified by presence of LNM. RESULTS Of 4420 patients with GIST, 238 were CAYA (5.4%). When compared to older adults, CAYA more often had small intestine primaries (51.8% vs. 36.6%, p < 0.0001), T4 tumors (30.7% vs. 24.5%, p = 0.0275) and pN1 disease (11.3% vs. 4.7%, p < 0.0001). Within a multivariable Cox proportional hazards regression model adjusting for age, comorbid disease, mitotic rate, tumor size, and primary site, LNM were associated with increased hazard of death for older adults (hazard ratio [HR]: 1.83; confidence interval [CI]: 1.35-2.42; p < 0.0001), but not CAYA (HR: 3.38; CI: 0.50-14.08; p = 0.13). For CAYA, only high mitotic rate predicted mortality (HR: 4.68; CI: 1.41-18.37: p = 0.02). CONCLUSIONS LNM are more commonly identified among CAYA with resected GIST who undergo lymph node evaluations, but do not appear to impact OS as observed in older adults. High mitotic rate remains a predictor of poor outcomes for CAYA with GIST.
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Affiliation(s)
- Andrew M Fleming
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Joshua Herb
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Zachary E Stiles
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Laura Burkbauer
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paxton V Dickson
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Evan S Glazer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrew J Murphy
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Andrew M Davidoff
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Elizabeth Gleeson
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hong J Kim
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael O Meyers
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karyn Stitzenberg
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David W Ollila
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Jablonowski C, Quarni W, Singh S, Tan H, Bostanthirige DH, Jin H, Fang J, Chang TC, Finkelstein D, Cho JH, Hu D, Pagala V, Sakurada SM, Pruett-Miller SM, Wang R, Murphy A, Freeman K, Peng J, Davidoff AM, Wu G, Yang J. Metabolic reprogramming of cancer cells by JMJD6-mediated pre-mRNA splicing is associated with therapeutic response to splicing inhibitor. bioRxiv 2023:2023.06.26.546606. [PMID: 37425900 PMCID: PMC10327027 DOI: 10.1101/2023.06.26.546606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Dysregulated pre-mRNA splicing and metabolism are two hallmarks of MYC-driven cancers. Pharmacological inhibition of both processes has been extensively investigated as potential therapeutic avenues in preclinical and clinical studies. However, how pre-mRNA splicing and metabolism are orchestrated in response to oncogenic stress and therapies is poorly understood. Here, we demonstrate that Jumonji Domain Containing 6, Arginine Demethylase and Lysine Hydroxylase, JMJD6, acts as a hub connecting splicing and metabolism in MYC-driven neuroblastoma. JMJD6 cooperates with MYC in cellular transformation by physically interacting with RNA binding proteins involved in pre-mRNA splicing and protein homeostasis. Notably, JMJD6 controls the alternative splicing of two isoforms of glutaminase (GLS), namely kidney-type glutaminase (KGA) and glutaminase C (GAC), which are rate-limiting enzymes of glutaminolysis in the central carbon metabolism in neuroblastoma. Further, we show that JMJD6 is correlated with the anti-cancer activity of indisulam, a "molecular glue" that degrades splicing factor RBM39, which complexes with JMJD6. The indisulam-mediated cancer cell killing is at least partly dependent on the glutamine-related metabolic pathway mediated by JMJD6. Our findings reveal a cancer-promoting metabolic program is associated with alternative pre-mRNA splicing through JMJD6, providing a rationale to target JMJD6 as a therapeutic avenue for treating MYC-driven cancers.
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22
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Pio L, Melero Pardo AL, Zaghloul T, Murphy AJ, Talbot L, Mothi SS, Davidoff AM, Abdelhafeez AH. Retroperitoneoscopic or Transperitoneal Approach for Neurogenic and Adrenal Tumors in Children? A Comparison on the Way to Enhanced Recovery in Pediatric Surgical Oncology. J Pediatr Surg 2023; 58:2135-2140. [PMID: 37385908 DOI: 10.1016/j.jpedsurg.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Minimally invasive surgery is increasingly utilized for resection of neurogenic tumors in children. The minimally invasive retroperitoneoscopic approach was recently reported in children, but transperitoneal laparoscopy still remains the most common technique. The aim of this study is to compare a novel single-port retroperitoneoscopy (SPR) approach for pediatric neurogenic tumor resection with transperitoneal laparoscopic (TPL). METHODS Patients undergoing minimally invasive resection of abdominal neurogenic tumors over 5 years at a single institution (from 2018 to 2022) were retrospectively reviewed. Tumor volume, stage, presence of image-defined risk factors (IDRFs), neoadjuvant chemotherapy, operative time, estimated blood loss (EBL), length of stay (LOS), complications, oral morphine equivalents per kilogram (OME/Kg), and time to chemotherapy were assessed and compared with SPR and TPL approaches. RESULTS Eighteen and fifteen patients underwent TPL and SPR, respectively. No significant differences were found between the TPL and SPR approaches in terms of tumor characteristics and IDRFs. Patients who underwent SPR had a significantly faster recovery (p = 0.008) and less postoperative opioid use compared to those in TPL (p = 0.02), thus allowing an enhanced recovery after surgery (ERAS) protocol application. TPL and SPR approaches were performed in presence of IDRFs, respectively in 2 (11%) and 4 patients (27%), with a IDRFs-related conversion in one TPL procedure. Both approaches had one < Grade 3 Clavien Dindo complication, but not requiring further surgery. DISCUSSION SPR approach can be considered as a safe and feasible minimally invasive approach for the resection of pediatric primary adrenal and neurogenic tumors. The retroperitoneoscopic approach performed using a single port technique represents a promising new frontier of ERAS application in pediatric surgical oncology. CONCLUSION SPR is a viable surgical alternative in selected neurogenic abdominal tumors with limited IDRFs, thus allowing for the application of ERAS protocols in these patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Luca Pio
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Ana L Melero Pardo
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Tarek Zaghloul
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Andrew J Murphy
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Lindsay Talbot
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Suraj Sarvode Mothi
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, 38163, USA
| | - Andrew M Davidoff
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA.
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23
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Pio L, Wijnen MHWA, Giuliani S, Sarnacki S, Davidoff AM, Abdelhafeez AH. Identification of Pediatric Tumors Intraoperatively Using Indocyanine Green (ICG). Ann Surg Oncol 2023; 30:7789-7798. [PMID: 37543553 DOI: 10.1245/s10434-023-13953-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Fluorescence-guided surgery (FGS) with indocyanine green (ICG) is increasingly applied in pediatric surgical oncology. However, FGS has been mostly reported in case studies of liver or renal tumors. Applying novel technologies in pediatric surgical oncology is more challenging than in adult surgical oncology due to differences in tumor histology, biology, and fewer cases. No consensus exists on ICG-guided FGS for surgically managing pediatric solid tumors. Therefore, we reviewed the literature and discuss the limitations and prospects of FGS. METHODS Using PRISMA guidelines, we analyzed articles on ICG-guided FGS for childhood solid tumors. Case reports, opinion articles, and narrative reviews were excluded. RESULTS Of the 108 articles analyzed, 17 (14 retrospective and 3 prospective) met the inclusion criteria. Most (70.6%) studies used ICG to identify liver tumors, but the timing and dose of ICG administered varied. Intraoperative outcomes, sensitivity and specificity, were reported in 23.5% of studies. Fluorescence-guided liver resections resulted in negative margins in 90-100% of cases; lung metastasis was detected in 33% of the studies. In otolaryngologic malignancies, positive margins without fluorescence signal were reported in 25% of cases. Overall, ICG appeared effective and safe for lymph node sampling and nephron-sparing procedures. CONCLUSIONS Despite promising results from FGS, ICG use varies across the international pediatric surgical oncology community. Underreported intraoperative imaging outcomes and the diversity and rarity of childhood solid tumors hinder conclusive scientific evidence supporting adoption of ICG in pediatric surgical oncology. Further international collaborations are needed to study the applications and limitations of ICG in pediatric surgical oncology.
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Affiliation(s)
- Luca Pio
- Department of Surgery, MS133, St. Jude Children's Researsch Hospital, Memphis, TN, USA
- Learning Planet Institute, Université de Paris, Paris, France
| | - Marc H W A Wijnen
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Stefano Giuliani
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Cancer Section, Developmental Biology and Cancer Programme, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Urology and Transplantation, Necker-Enfants Malades Hospital, GH Centre, APHP, Paris, France
- Université de Paris Cité, Paris, France
| | - Andrew M Davidoff
- Department of Surgery, MS133, St. Jude Children's Researsch Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, MS133, St. Jude Children's Researsch Hospital, Memphis, TN, USA.
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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Pio L, Wijnen MHWA, Giuliani S, Sarnacki S, Davidoff AM, Abdelhafeez AH. ASO Visual Abstract: Identification of Pediatric Tumors Intraoperatively Using Indocyanine Green. Ann Surg Oncol 2023; 30:7801-7802. [PMID: 37589799 DOI: 10.1245/s10434-023-14113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Luca Pio
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Learning Planet Institute, Université de Paris, Paris, France
| | - Marc H W A Wijnen
- Department of Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Stefano Giuliani
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Cancer Section, Developmental Biology and Cancer Programme, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Urology and Transplantation, Necker-Enfants Malades Hospital, GH Centre, APHP, Paris, France
- Université de Paris Cité, Paris, France
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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25
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Pio L, Wijnen MHWA, Giuliani S, Sarnacki S, Davidoff AM, Abdelhafeez AH. ASO Author Reflections: Identification of Pediatric Tumors Intraoperatively Using Indocyanine Green (ICG). Ann Surg Oncol 2023; 30:7799-7800. [PMID: 37573285 DOI: 10.1245/s10434-023-14116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Luca Pio
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, Memphis, TN, USA
- Learning Planet Institute, Université de Paris, Paris, France
| | - Marc H W A Wijnen
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Stefano Giuliani
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
- Cancer Section, Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Urology and Transplantation, Necker-Enfants Malades Hospital, GH Centre, APHP, Paris, France
- Université de Paris Cité, Paris, France
| | - Andrew M Davidoff
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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Brimble MA, Winston SM, Davidoff AM. Stowaways in the cargo: Contaminating nucleic acids in rAAV preparations for gene therapy. Mol Ther 2023; 31:2826-2838. [PMID: 37533254 PMCID: PMC10556190 DOI: 10.1016/j.ymthe.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023] Open
Abstract
Recombinant AAV (rAAV) is the most used delivery vector for clinical gene therapy. However, many issues must be addressed before safer and more widespread implementation can be achieved. At present, efficacies are highly variable across trials and patients, and immune responses after treatment are widely reported. Although rAAV is capable of directly delivering gene-encoded therapeutic sequences, increased scrutiny of viral preparations for translational use have revealed contaminating nucleic acid species packaged within rAAV preparations. The introduction of non-therapeutic nucleic acids into a recipient patient adds to the risk burden, immunogenic or otherwise, of rAAV therapies. DNA from incomplete expression cassettes, portions of plasmids or vectors used to facilitate viral replication, and production cell line genomes all have the potential to be packaged within rAAV. Here, we review what is currently known about the profile, abundance, and post-treatment consequences of nucleic acid impurities within rAAV and cover strategies that have been developed to improve rAAV purity. Furthering our understanding of these aberrantly packaged DNA species will help to ensure the continued safe implementation of rAAV therapies as the number of patients treated with this modality increases.
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Affiliation(s)
- Mark A Brimble
- Department of Immunology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.
| | - Stephen M Winston
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; St. Jude Children's Research Hospital Graduate School of Biomedical Sciences, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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27
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Pio L, Abu-Zaid A, Zaghloul T, Halepota HF, Davidoff AM, Losty PD, Abdelhafeez HH. Ovarian-sparing surgery for ovarian tumors in children: A systematic review and meta-analysis. Eur J Surg Oncol 2023; 49:106923. [PMID: 37211469 DOI: 10.1016/j.ejso.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/28/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION An increased number of children and adolescents with ovarian tumors have been managed with ovarian-sparing surgery in the last few years. However, comprehensive data on fertility outcomes and local relapse are scarce. In this study, we systematically describe the contemporary outcomes of ovarian-sparing surgery, as reported in the literature. MATERIALS AND METHODS Using PRISMA guidelines, we analyzed studies reporting ovarian-sparing techniques for ovarian tumors in children and adolescents. from 1980 to 2022. Reports with fewer than three patients, narrative reviews, and opinion articles were excluded. Statistical analysis was performed for dichotomous and continuous variables. RESULTS Of 283 articles screened, 16 papers (3057 patients) met inclusion criteria (15 retrospective/1 prospective) and were analyzed. The vast majority of studies had no long-term fertility follow-up data and direct comparison between ovarian-sparing surgery vs oophorectomy was reported in only a few studies. Ovarian sparing surgery was not associated with worse oncologic outcomes in terms of (i) tumour spillage or (ii) recurrence rates, and of key importance allowed a higher ovarian reserve at long term follow-up. CONCLUSIONS Ovarian-sparing surgery is a safe and feasible technique for benign tumors. Long-term outcome studies are needed to show efficacy and fertility preservation.
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Affiliation(s)
- Luca Pio
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
| | - Ahmed Abu-Zaid
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Tarek Zaghloul
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Huma F Halepota
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
| | - Paul D Losty
- University of Liverpool, Institute of Life Course and Medical Sciences, Liverpool, L69 3BX, UK; Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hafeez H Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN, 38163, USA
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28
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Shaffiey SA, Le HD, Christison-Lagay E, Fialkowski EA, Aldrink JH, Grant CN, Honeyman JN, Janek KC, Madonna MB, Rhee DS, Nuchtern JG, Newman EA, LaQuaglia MP, Davidoff AM, Shamberger RC, Malek MM. Critical elements of pediatric neuroblastoma surgery. Semin Pediatr Surg 2023; 32:151338. [PMID: 38042090 DOI: 10.1016/j.sempedsurg.2023.151338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2023]
Abstract
Neuroblastoma (NB) is the most common solid extracranial malignancy of childhood with an incidence of 1 per 100,000 in the United States compromising approximately 10 % of childhood cancer. Unfortunately, patients with high-risk NG continue to have long-term survival less than 50 %. Both Children's Oncology Group and the International Society of Paediatric Oncology have demonstrated the important role of surgery in the treatment of high-risk NB. Herein, we compose the results of an extensive literature review as well as expert opinion from leaders in pediatric surgical oncology, to present the critical elements of effective surgery for high-risk neuroblastoma.
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Affiliation(s)
| | - Hau D Le
- University of Wisconsin-Madison, Madison WI 53705, USA
| | | | | | - Jennifer H Aldrink
- Nationwide Children's Hospital OSU College of Medicine, Columbus, OH 43205, USA
| | - Christa N Grant
- Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY 10595, USA
| | | | - Kevin C Janek
- Children's Hospital of Michigan, Detroit, MI 48201, USA
| | | | | | - Jed G Nuchtern
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX 77030, USA
| | | | | | | | | | - Marcus M Malek
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
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29
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Abdelhafeez AH, Mothi SS, Pio L, Mori M, Santiago TC, McCarville MB, Kaste SC, Pappo AS, Talbot LJ, Murphy AJ, Davidoff AM. Feasibility of indocyanine green-guided localization of pulmonary nodules in children with solid tumors. Pediatr Blood Cancer 2023; 70:e30437. [PMID: 37194488 PMCID: PMC10685698 DOI: 10.1002/pbc.30437] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Clearing all pulmonary metastases is essential for curing pediatric solid tumors. However, intraoperative localization of such pulmonary nodules can be challenging. Therefore, an intraoperative tool that localizes pulmonary metastases is needed to improve diagnostic and therapeutic resections. Indocyanine green (ICG) real-time fluorescence imaging is used for this purpose in adult solid tumors, but its utility in pediatric solid tumors has not been determined. METHODS A single-center, open-label, nonrandomized, prospective clinical trial (NCT04084067) was conducted to assess the ability of ICG to localize pulmonary metastases of pediatric solid tumors. Patients with pulmonary lesions who required resection, either for therapeutic or diagnostic intent, were included. Patients received a 15-minute intravenous infusion of ICG (1.5 mg/kg), and pulmonary metastasectomy was performed the following day. A near-infrared spectroscopy iridium system was optimized to detect ICG, and all procedures were photo-documented and recorded. RESULTS ICG-guided pulmonary metastasectomies were performed in 12 patients (median age: 10.5 years). A total of 79 nodules were visualized, 13 of which were not detected by preoperative imaging. Histologic examination confirmed the following histologies: hepatoblastoma (n = 3), osteosarcoma (n = 2), and one each of rhabdomyosarcoma, Ewing sarcoma, inflammatory myofibroblastic tumor, atypical cartilaginous tumor, neuroblastoma, adrenocortical carcinoma, and papillary thyroid carcinoma. ICG guidance failed to localize pulmonary metastases in five (42%) patients who had inflammatory myofibroblastic tumor, atypical cartilaginous tumor, neuroblastoma, adrenocortical carcinoma, or papillary thyroid carcinoma. CONCLUSIONS ICG-guided identification of pulmonary nodules is not feasible for all pediatric solid tumors. However, it may localize most metastatic hepatic tumors and high-grade sarcomas in children.
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Affiliation(s)
- Abdelhafeez H. Abdelhafeez
- Departments of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Suraj Sarvode Mothi
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Luca Pio
- Departments of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Motomi Mori
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Teresa C. Santiago
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - M. Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sue C. Kaste
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Alberto S. Pappo
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Lindsay J. Talbot
- Departments of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew J. Murphy
- Departments of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew M. Davidoff
- Departments of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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30
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Fang J, Singh S, Cheng C, Natarajan S, Sheppard H, Abu-Zaid A, Durbin AD, Lee HW, Wu Q, Steele J, Connelly JP, Jin H, Chen W, Fan Y, Pruett-Miller SM, Rehg JE, Koo SC, Santiago T, Emmons J, Cairo S, Wang R, Glazer ES, Murphy AJ, Chen T, Davidoff AM, Armengol C, Easton J, Chen X, Yang J. Genome-wide mapping of cancer dependency genes and genetic modifiers of chemotherapy in high-risk hepatoblastoma. Nat Commun 2023; 14:4003. [PMID: 37414763 PMCID: PMC10326052 DOI: 10.1038/s41467-023-39717-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/27/2023] [Indexed: 07/08/2023] Open
Abstract
A lack of relevant genetic models and cell lines hampers our understanding of hepatoblastoma pathogenesis and the development of new therapies for this neoplasm. Here, we report an improved MYC-driven hepatoblastoma-like murine model that recapitulates the pathological features of embryonal type of hepatoblastoma, with transcriptomics resembling the high-risk gene signatures of the human disease. Single-cell RNA-sequencing and spatial transcriptomics identify distinct subpopulations of hepatoblastoma cells. After deriving cell lines from the mouse model, we map cancer dependency genes using CRISPR-Cas9 screening and identify druggable targets shared with human hepatoblastoma (e.g., CDK7, CDK9, PRMT1, PRMT5). Our screen also reveals oncogenes and tumor suppressor genes in hepatoblastoma that engage multiple, druggable cancer signaling pathways. Chemotherapy is critical for human hepatoblastoma treatment. A genetic mapping of doxorubicin response by CRISPR-Cas9 screening identifies modifiers whose loss-of-function synergizes with (e.g., PRKDC) or antagonizes (e.g., apoptosis genes) the effect of chemotherapy. The combination of PRKDC inhibition and doxorubicin-based chemotherapy greatly enhances therapeutic efficacy. These studies provide a set of resources including disease models suitable for identifying and validating potential therapeutic targets in human high-risk hepatoblastoma.
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Affiliation(s)
- Jie Fang
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shivendra Singh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Changde Cheng
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sivaraman Natarajan
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Heather Sheppard
- Comparative Pathology Core, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ahmed Abu-Zaid
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Adam D Durbin
- Division of Molecular Oncology, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ha Won Lee
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Qiong Wu
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jacob Steele
- Center for Advanced Genome Engineering (CAGE), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jon P Connelly
- Center for Advanced Genome Engineering (CAGE), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Hongjian Jin
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Wenan Chen
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yiping Fan
- Center for Applied Bioinformatics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shondra M Pruett-Miller
- Center for Advanced Genome Engineering (CAGE), St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jerold E Rehg
- Comparative Pathology Core, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Selene C Koo
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Teresa Santiago
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph Emmons
- VPC Diagnostic Laboratory, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Stefano Cairo
- Champions Oncology, 1330 Piccard dr, Rockville, MD, USA
| | - Ruoning Wang
- Center for Childhood Cancer and Blood Disease, Hematology/Oncology & BMT, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Evan S Glazer
- Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, 910 Madison Ave., Suite 325, Memphis, TN, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, 910 Madison Ave., Suite 325, Memphis, TN, USA
| | - Taosheng Chen
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, 910 Madison Ave., Suite 325, Memphis, TN, USA
- St Jude Graduate School of Biomedical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA
- Department of Pathology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Carolina Armengol
- Childhood Liver Oncology Group, Germans Trias i Pujol Research Institute (IGTP), Translational Program in Cancer Research (CARE), Badalona, Spain
- CIBER, Hepatic and Digestive Diseases, Barcelona, Spain
- CIBERehd, Madrid, Spain
| | - John Easton
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Xiang Chen
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA.
- St Jude Graduate School of Biomedical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA.
| | - Jun Yang
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
- St Jude Graduate School of Biomedical Sciences, St Jude Children's Research Hospital, Memphis, TN, USA.
- Department of Pathology, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA.
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31
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Murphy AJ, Cheng C, Williams J, Shaw TI, Pinto EM, Dieseldorff-Jones K, Brzezinski J, Renfro LA, Tornwall B, Huff V, Hong AL, Mullen EA, Crompton B, Dome JS, Fernandez CV, Geller JI, Ehrlich PF, Mulder H, Oak N, Maciezsek J, Jablonowski C, Fleming AM, Pichavaram P, Morton CL, Easton J, Nichols KE, Clay MR, Santiago T, Zhang J, Yang J, Zambetti GP, Wang Z, Davidoff AM, Chen X. The Genetic and Epigenetic Features of Bilateral Wilms Tumor Predisposition: A Report from the Children's Oncology Group AREN18B5-Q Study. Res Sq 2023:rs.3.rs-2675436. [PMID: 36993649 PMCID: PMC10055651 DOI: 10.21203/rs.3.rs-2675436/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
This study comprehensively evaluated the landscape of genetic and epigenetic events that predispose to synchronous bilateral Wilms tumor (BWT). We performed whole exome or whole genome sequencing, total-strand RNA-seq, and DNA methylation analysis using germline and/or tumor samples from 68 patients with BWT from St. Jude Children's Research Hospital and the Children's Oncology Group. We found that 25/61 (41%) of patients evaluated harbored pathogenic or likely pathogenic germline variants, with WT1 (14.8%), NYNRIN (6.6%), TRIM28 (5%) and the BRCA-related genes (5%) BRCA1, BRCA2, and PALB2 being most common. Germline WT1 variants were strongly associated with somatic paternal uniparental disomy encompassing the 11p15.5 and 11p13/WT1 loci and subsequent acquired pathogenic CTNNB1 variants. Somatic coding variants or genome-wide copy number alterations were almost never shared between paired synchronous BWT, suggesting that the acquisition of independent somatic variants leads to tumor formation in the context of germline or early embryonic, post-zygotic initiating events. In contrast, 11p15.5 status (loss of heterozygosity, loss or retention of imprinting) was shared among paired synchronous BWT in all but one case. The predominant molecular events for BWT predisposition include pathogenic germline variants or post-zygotic epigenetic hypermethylation at the 11p15.5 H19/ICR1 locus (loss of imprinting). This study demonstrates that post-zygotic somatic mosaicism for 11p15.5 hypermethylation/loss of imprinting is the single most common initiating molecular event predisposing to BWT. Evidence of somatic mosaicism for 11p15.5 loss of imprinting was detected in leukocytes of a cohort of BWT patients and long-term survivors, but not in unilateral Wilms tumor patients and long-term survivors or controls, further supporting the hypothesis that post-zygotic 11p15.5 alterations occurred in the mesoderm of patients who go on to develop BWT. Due to the preponderance of BWT patients with demonstrable germline or early embryonic tumor predisposition, BWT exhibits a unique biology when compared to unilateral Wilms tumor and therefore warrants continued refinement of its own treatment-relevant biomarkers which in turn may inform directed treatment strategies in the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Brian Crompton
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center
| | | | | | | | | | | | - Ninad Oak
- St. Jude Children's Research Hospital
| | | | | | | | | | | | | | | | | | | | | | - Jun Yang
- St. Jude Children's Research Hospital
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32
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Mansfield SA, Staszak J, Murphy AJ, Talbot L, Abdelhafeez A, Prajapati H, Gold R, Maller V, Proctor K, Davidoff AM, Williams RF. Impact of insertion site on complications in central venous access devices. Pediatr Surg Int 2023; 39:118. [PMID: 36773111 DOI: 10.1007/s00383-023-05399-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE There is still debate over the safest route for the placement of long-term central venous access devices. The aim of this study was to review a large, single-institution experience to determine the impact of access location on peri-operative complications. METHODS The records of patients undergoing subcutaneous port (SQP) and tunneled catheter insertion over a seven-year period were reviewed. Vein cannulated (subclavian (SCV) versus internal jugular (IJ) vein), and 30-day complications were assessed. Surgical complications included pneumothorax, hemothorax, infections, arrhythmia or malpositioning requiring intervention. RESULTS A total of 1,309 patients were included (618 SQP, 691 tunneled catheters). The location for insertion was SCV (909, 69.4%) and IJ (400, 30.6%). There were 69 complications (5.2%) (41, 4.5% SCV, 28, 7.0% IJV) including: malpositioning/malfunctioning (SCV 13, 1.4% and IJV 14, 3.0%), pneumothorax (SCV 4, 0.4% and IJV 1, 0.3%), hemothorax (SCV 0 and IJV 1, 0.3%), arrhythmia (SCV 1, 0.1%, and IJV 0), and infection within 30 days of placement (SCV 20, 2.2% and IJ 11, 2.8%). The complication rates were not significantly different based on site (p = 0.080). CONCLUSION There was no significant difference in complication rates when using the subclavian versus the internal jugular vein as the site for long-term central venous access. LEVEL OF EVIDENCE III, retrospective comparative study.
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Affiliation(s)
- Sara A Mansfield
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
| | - Jessica Staszak
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Lindsay Talbot
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Abdelhafeez Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Hasmukh Prajapati
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN, 38105, USA
| | - Robert Gold
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN, 38105, USA
| | - Vinod Maller
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN, 38105, USA
| | - Kimberly Proctor
- Division of Pediatric Interventional Radiology, Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN, 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
| | - Regan F Williams
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.,Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 N. Dunlap St, Memphis, TN, 38105, USA
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33
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Murphy AJ, Davidoff AM. Nephron-sparing surgery for Wilms tumor. Front Pediatr 2023; 11:1122390. [PMID: 36743884 PMCID: PMC9895406 DOI: 10.3389/fped.2023.1122390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
The algorithm that has been used successfully in the surgical management of unilateral Wilms tumor, radical nephroureterectomy, cannot be used in children who present with synchronous bilateral renal masses. Instead, a surgical approach that removes all tumor masses while preserving as much normal renal parenchyma as possible is encouraged to avoid acute and long-term renal insufficiency. We will review technical aspects of the conduct of nephron-sparing surgery for synchronous bilateral Wilms tumor, including the more recent advances in the use of imaging adjuncts such as pre-operative 3D imaging and fluorescence-guided surgery. The potential role of nephron-sparing surgery for unilateral Wilms tumor will also be discussed.
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Affiliation(s)
- Andrew J. Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, United States
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, United States
- Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
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34
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Abdelhafeez AH, Davidoff AM, Murphy AJ, Arul GS, Pachl MJ. Fluorescence-guided lymph node sampling is feasible during up-front or delayed nephrectomy for Wilms tumor. J Pediatr Surg 2022; 57:920-925. [PMID: 35794043 DOI: 10.1016/j.jpedsurg.2022.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/23/2022] [Accepted: 06/05/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lymph node sampling is critical to surgical staging in Wilms tumor; failure to sample lymph nodes is associated with under-staging and an increased incidence of local relapse. However, no standard lymphatic mapping method is currently being utilized for Wilms tumor to aid identification of regional draining lymph nodes. Herein, we describe the use of fluorescence-guided lymphatic mapping for Wilms tumor. MATERIALS AND METHODS Two tertiary level referral centers independently began indocyanine green (ICG) fluorescence-guided nodal mapping. In one center, this was achieved with ipsilateral intra-parenchymal (IP) injection of ICG during minimally invasive tumor nephrectomy (MIN) following neoadjuvant chemotherapy and in the other, with Peri‑Hilar (PH) injection during upfront, open tumor nephrectomy (ON). Successful lymph node mapping was defined as the presence of fluorescence signal in draining lymph nodes. RESULTS Eight patients (median age of 2.5 years) underwent fluorescence-guided lymphatic mapping (four IP and four PH injection). Lymphatic mapping was successful in seven patients (88%) including each of the four patients with IP injection. CONCLUSIONS Fluorescence-guided lymphatic mapping of Wilms tumor drainage is feasible by both IP injection and PH injection techniques. However, whether lymphatic mapping improves the precision of lymph node sampling is unknown and should be studied in prospective trials.
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Affiliation(s)
- Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, MS 133, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38163, USA.
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, MS 133, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38163, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, MS 133, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, 800 Madison Ave, Memphis, TN 38163, USA
| | - G Suren Arul
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Max J Pachl
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
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35
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Abdelhafeez AH, Reljic T, Kumar A, Banu T, Cox S, Davidoff AM, Elgendy A, Ghandour K, Gerstle JT, Karpelowsky J, Kaste SC, Kechiche N, Esiashvili N, Nasir A, Ngongola A, Marollano J, Moreno AA, Muzira A, Parkes J, Saldaña LJ, Shalkow J, Vujanić GM, Velasquez T, Lakhoo K, Mukkada S, Abib S. Evidence-based surgical guidelines for treating children with Wilms tumor in low-resource settings. Pediatr Blood Cancer 2022; 69:e29906. [PMID: 35929184 DOI: 10.1002/pbc.29906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Survival of Wilms tumor (WT) is > 90% in high-resource settings but < 30% in low-resource settings. Adapting a standardized surgical approach to WT is challenging in low-resource settings, but a local control strategy is crucial to improving outcomes. OBJECTIVE Provide resource-sensitive recommendations for the surgical management of WT. METHODS We performed a systematic review of PubMed and EMBASE through July 7, 2020, and used the GRADE approach to assess evidence and recommendations. RECOMMENDATIONS Initiation of treatment should be expedited, and surgery should be done in a high-volume setting. Cross-sectional imaging should be done to optimize preoperative planning. For patients with typical clinical features of WT, biopsy should not be done before chemotherapy, and neoadjuvant chemotherapy should precede surgical resection. Also, resection should include a large transperitoneal laparotomy, adequate lymph node sampling, and documentation of staging findings. For WT with tumor thrombus in the inferior vena cava, neoadjuvant chemotherapy should be given before en bloc resection of the tumor and thrombus and evaluation for viable tumor thrombus. For those with bilateral WT, neoadjuvant chemotherapy should be given for 6-12 weeks. Neither routine use of complex hilar control techniques during nephron-sparing surgery nor nephron-sparing resection for unilateral WT with a normal contralateral kidney is recommended. When indicated, postoperative radiotherapy should be administered within 14 days of surgery. Post-chemotherapy pulmonary oligometastasis should be resected when feasible, if local protocols allow omission of whole-lung irradiation in patients with nonanaplastic histology stage IV WT with pulmonary metastasis without evidence of extrapulmonary metastasis. CONCLUSION We provide evidence-based recommendations for the surgical management of WT, considering the benefits/risks associated with limited-resource settings.
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Affiliation(s)
- Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.,University of Tennessee Health Science Center, Memphis, Tennessee
| | - Tea Reljic
- Office of Research Conduct and Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Ambuj Kumar
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Tahmina Banu
- Chittagong Research Institute for Children Surgery, Chattogram, Bangladesh
| | - Sharon Cox
- Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.,University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ahmed Elgendy
- Surgical Oncology Unit, Tanta University & Department of Pediatric Surgery, Children's Cancer Hospital - Egypt, Tanta, Gharbia, Egypt
| | - Khalil Ghandour
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - J Ted Gerstle
- Pediatric Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Karpelowsky
- The Children's Hospital at Westmead, Division of Child & Adolescent Health, The University of Sydney, Children's Cancer Research Unit -Kids Research Institute, Sydney, Australia
| | - Sue C Kaste
- University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Radiaology and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Nahla Kechiche
- Department of Pediatric Surgery, University Hospital Monastir, LR12SP13, University of Monastir, Monastir, Tunisia
| | - Natia Esiashvili
- Department of Radiation Oncology, Emory Winship Cancer Institute, Atlanta, Georgia
| | - Abdulrasheed Nasir
- Department of Surgery, University of Ilorin Teaching Hospital/University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Amon Ngongola
- Department of Pediatric Surgery, University Teaching Hospital, Lusaka, Zambia
| | | | - Amabelle A Moreno
- Division of Pediatric Surgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Arlene Muzira
- Department of Paediatric Surgery, Uganda Cancer Institute, Kampala, Uganda
| | - Jeannette Parkes
- Department of Radiation Oncology, University of Cape Town, Cape Town, South Africa
| | - Lily J Saldaña
- Pediatric Surgery Service, Instituto Nacional de Salud del Niño de San Borja, Lima, Peru
| | - Jaime Shalkow
- Pediatric Surgery, National Institute of Paediatrics and ABC Cancer Centre, Mexico City, Mexico
| | - Gordan M Vujanić
- Department of Pediatric Pathology, Sidra Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Thelma Velasquez
- Department of Oncology, Unidad Nacional de Oncologia Pediatrica, Guatemala City, Guatemala
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, Oxford University, Oxford, UK
| | - Sheena Mukkada
- University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Simone Abib
- Department of Pediatric Surgery, Pediatric Oncology Institute - GRAACC - Federal University of São Paulo, São Paulo, Brazil
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Foster KL, Salehabadi SM, Green DM, Xing M, Ness KK, Krull KR, Brinkman TM, Ehrhardt MJ, Chemaitilly W, Dixon SB, Bhakta N, Brennan RC, Krasin MJ, Davidoff AM, Robison LL, Hudson MM, Mulrooney DA. Clinical Assessment of Late Health Outcomes in Survivors of Wilms Tumor. Pediatrics 2022; 150:e2022056918. [PMID: 36300342 PMCID: PMC9812640 DOI: 10.1542/peds.2022-056918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We aimed to clinically characterize the health, neurocognitive, and physical function outcomes of curative treatment of Wilms tumor. METHODS Survivors of Wilms tumor (n = 280) participating in the St. Jude Lifetime Cohort, a retrospective study with prospective follow-up of individuals treated for childhood cancer at St. Jude Children's Research Hospital, were clinically evaluated and compared to age and sex-matched controls (n = 625). Health conditions were graded per a modified version of the National Cancer Institute's Common Terminology Criteria for Adverse Events. Standardized neurocognitive testing was graded by using age-adjusted z-scores. Impaired physical function was defined by age- and sex-matched z-scores >1.5 SD below controls. Modified Poisson regression was used to compare the prevalence of conditions and multivariable logistic regression to examine treatment associations. RESULTS Median age at evaluation was similar between survivors and controls (30.5 years [9.0-58.0] and 31.0 [12.0-70.0]). Therapies included nephrectomy (100%), vincristine (99.3%), dactinomycin (97.9%), doxorubicin (66.8%), and abdominal (59.3%) and/or chest radiation (25.0%). By age 40 years, survivors averaged 12.7 (95% confidence interval [CI] 11.7-13.8) grade 1-4 and 7.5 (CI: 6.7-8.2) grade 2 to 4 health conditions, compared to 4.2 (CI: 3.9-4.6) and 2.3 (CI: 2.1-2.5), respectively, among controls. Grade 2 to 4 endocrine (53.9%), cardiovascular (26.4%), pulmonary (18.2%), neurologic (8.6%), neoplastic (7.9%), and kidney (7.2%) conditions were most prevalent. Survivors exhibited neurocognitive and physical performance impairments. CONCLUSIONS Wilms tumor survivors experience a threefold higher burden of chronic health conditions compared to controls and late neurocognitive and physical function deficits. Individualized clinical management, counseling, and surveillance may improve long-term health maintenance.
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Affiliation(s)
- Kayla L. Foster
- Department of Pediatrics, Texas Children’s Hospital, Section of Hematology-Oncology Baylor College of Medicine, Houston, Texas
| | | | - Daniel M. Green
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Mengqi Xing
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kevin R. Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Tara M. Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew J. Ehrhardt
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Wassim Chemaitilly
- Division of Pediatric Endocrinology, Children’s Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie B. Dixon
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Nickhill Bhakta
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Rachel C. Brennan
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
| | - Matthew J. Krasin
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Melissa M. Hudson
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
- Department of Psychology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Daniel A. Mulrooney
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennesseee
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
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Bolous NS, Bhatt N, Bhakta N, Neufeld EJ, Davidoff AM, Reiss UM. Gene Therapy and Hemophilia: Where Do We Go from Here? J Blood Med 2022; 13:559-580. [PMID: 36226233 PMCID: PMC9550170 DOI: 10.2147/jbm.s371438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Gene therapy for hemophilia using adeno-associated virus (AAV) derived vectors can reduce or eliminate patients' disease-related complications and improve their quality of life. Broad implementation globally will lead to societal gains and foster health equity. Several vector products each for factor IX (FIX) or factor VIII (FVIII) deficiency are in advanced clinical development. Safety data are reassuring. Efficacy data for up to 8 and 5 years, respectively, vary considerably among vector types and among individuals, but indicate significant reduction in bleeds and factor use. Products will soon be approved for marketing. This review highlights the relevant considerations for implementation of hemophilia gene therapy, specifically across a broad range of socioeconomic backgrounds globally, based on recent publications and our own experience. We address the current efficacy and safety data and relevant aspects of vector immunology. We then discuss pertinent implementation steps including pre-implementation and readiness assessments, considerations on cost, cost-effectiveness and payment models, approaches to education and informed consent, and the operational needs as well as the need for monitoring of health outcomes and implementation outcomes. To prevent a lag or complete lack of establishing access to this life-changing therapy option for all patients with hemophilia worldwide, adaptable pathways supported by collaborative and international efforts of all stakeholders are needed.
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Affiliation(s)
- Nancy S Bolous
- Department of Global Pediatric Medicine – St. Jude Children’s Research Hospital, Memphis, TN, USA,Correspondence: Nancy S Bolous, Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 721, Memphis, TN, 38105, USA, Tel +1 901 595 1968, Fax +1 901 595 5319, Email
| | - Nidhi Bhatt
- Department of Hematology – St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine – St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ellis J Neufeld
- Department of Hematology – St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery – St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ulrike M Reiss
- Department of Hematology – St. Jude Children’s Research Hospital, Memphis, TN, USA
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Abdelhafeez AH, Murphy AJ, Brennan R, Santiago TC, Lu Z, Krasin MJ, Bissler JJ, Gleason JM, Davidoff AM. Indocyanine green-guided nephron-sparing surgery for pediatric renal tumors. J Pediatr Surg 2022; 57:174-178. [PMID: 34518021 DOI: 10.1016/j.jpedsurg.2021.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/10/2021] [Accepted: 08/15/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Indocyanine green (ICG), a water-soluble tricarbocyanine fluorophore, is being increasingly used for tumor localization based on its passive intra-tumoral accumulation due to enhanced permeability and retention in tumor tissue. Therefore, we hypothesized that ICG can provide contrast to facilitate accurate, real-time recognition of renal tumors at the time of nephron-sparing surgery in children. METHODS This retrospective study examined the feasibility of ICG in guiding nephron-sparing surgery for pediatric renal tumors. RESULTS We reviewed the medical records of 8 pediatric patients with renal tumors in 12 kidneys. Intraoperative localization of tumor with near infrared guidance was successful in all 12 kidneys. However, we consistently found an inverse pattern of near infrared signal in which the normal kidney demonstrated increased fluorescent signal relative to the kidney tumor. CONCLUSIONS Fluorescence-guided renal tumor delineation is unique because it has an inverse pattern of near infrared signal in which the normal kidney demonstrates increased signal relative to the adjacent tumor. Nevertheless fluorescence-guided distinguishing of renal tumor from surrounding normal kidney is feasible.
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Affiliation(s)
- Abdelhafeez H Abdelhafeez
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Division of Pediatric Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA.
| | - Andrew J Murphy
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Division of Pediatric Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA
| | - Rachel Brennan
- Department of Oncology, MS 260, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Teresa C Santiago
- Department of Pathology, MS 250, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Zhaohua Lu
- Department of Biostatistics, MS 768, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Matthew J Krasin
- Department of Radiation Oncology, MS 210, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - John J Bissler
- Division of Pediatric Nephrology, Le Bonheur Children's Hospital and St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph M Gleason
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Urology, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA
| | - Andrew M Davidoff
- Department of Surgery, MS 133, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Division of Pediatric Surgery, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163, USA
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Sutthatarn P, Gomez Quevedo O, Gleason J, Davidoff AM, Murphy AJ. Management of intravascular thrombus in cases of bilateral Wilms tumor or horseshoe kidney. J Pediatr Surg 2022; 57:166-173. [PMID: 34452755 DOI: 10.1016/j.jpedsurg.2021.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 07/28/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE To describe the oncologic and surgical management of bilateral Wilms tumor or Wilms tumor arising in a horseshoe kidney with intravenous tumor thrombus to help pediatric surgeons negotiate this rare and difficult anatomic circumstance. METHODS A single-institution, retrospective medical record review identified 4 cases of bilateral WT and one case of WT arising in a horseshoe kidney with intravenous tumor thrombus between 2009 and 2021. The presentation, imaging, chemotherapy regimen, intraoperative approach, and surgical and oncologic outcomes were reviewed for each of these patients. RESULTS All patients received a total of 12 weeks of neoadjuvant chemotherapy. In two patients, a staged approach to the bilateral tumors was undertaken with the first side being operated on after six weeks of therapy and the other side undergoing surgery after an additional six weeks of therapy. Of five patients, four underwent nephron-sparing surgery of all tumors and one underwent unilateral radical nephroureterectomy with contralateral nephron-sparing surgery. Tumor thrombectomy was performed in four of five cases; one patient demonstrated a complete response of the intravenous tumor thrombus to neoadjuvant chemotherapy and did not require thrombectomy. Three patients received adjuvant flank radiotherapy. Three patients developed medically managed stage II or III chronic kidney disease and no patient required renal replacement therapy or kidney transplant to date. CONCLUSION Nephron-sparing surgery is feasible and safe to perform in selected cases of bilateral Wilms tumor with intravascular thrombus by utilizing three-drug neoadjuvant chemotherapy, staged approaches to each kidney when appropriate, and detailed preoperative and/or intraoperative mapping of renal venous anatomy. Successful nephron-sparing surgery with tumor thrombectomy is dependent on a branched renal venous system or the presence of accessory renal veins. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Pattamon Sutthatarn
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States; Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Oswaldo Gomez Quevedo
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States
| | - Joesph Gleason
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States; Department of Urology, University of Tennessee Health Science Center, Memphis, TN 38105, United States
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, United States
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 133, Memphis, TN 38105, United States; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, United States.
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Crook JL, Lu Z, Wang X, Henderson N, Proctor KE, Maller VG, Prajapati HJ, Gold RE, Abdelhafeez AH, Talbot LJ, Pui CH, Davidoff AM, Hoffman JM, Murphy AJ. Why do subcutaneous ports get stuck? A case-control study. J Pediatr Surg 2022; 57:229-233. [PMID: 34456040 DOI: 10.1016/j.jpedsurg.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/20/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We sought to identify clinical features associated with difficult subcutaneous port removals in children. METHODS Ports placed between April 2014 and September 2017 at our institution were prospectively tracked for difficult removals. A case-control analysis was performed. Patients with ports that were difficult to remove (stuck; cases) were compared to biological sex and age-matched controls in a ratio of 1:3. Logistic regression determined the association between case/control status and clinical features adjusting for biological sex and age as covariates. A multivariable analysis was performed to identify independent associations. RESULTS 57 stuck ports (28 extreme [10 endovascular intervention] and 29 moderate) and 171 controls were analyzed. Stuck ports were associated with a diagnosis of acute lymphoblastic leukemia (86% cases versus 22.2% controls; p < 0.001) and a longer placement duration (median 2.6 years [interquartile range (IQR) 2.5-2.6] versus 0.8 years [IQR 0.5-1.4]; p < 0.001). On univariate analysis, procedural and device features associated with stuck ports included subclavian access (71.9% cases versus 48.5% controls; p = 0.0126), a polyurethane versus silicone catheter (96.5% cases versus 79.9% controls; p = 0.001), and a rough catheter appearance at removal (92.6% cases versus 9.4% controls; p < 0.0001). A diagnosis of ALL and duration of line placement were associated with having a stuck port on multivariate analysis. CONCLUSION Polyurethane central venous catheters placed for the two-year treatment of acute lymphoblastic leukemia may become difficult to remove. This constellation of factors warrants more extensive preoperative discussion of risk, endovascular backup availability, and scheduling for longer operating room time.
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Affiliation(s)
- Jennifer L Crook
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Xiaoqing Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Nan Henderson
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Kimberly E Proctor
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Vinod G Maller
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN 38105, USA; Department of Radiology, Le Bonheur Children's Hospital, Memphis, TN 38105, USA
| | - Hasmukh J Prajapati
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN 38105, USA; Department of Radiology, Le Bonheur Children's Hospital, Memphis, TN 38105, USA
| | - Robert E Gold
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN 38105, USA; Department of Radiology, Le Bonheur Children's Hospital, Memphis, TN 38105, USA
| | - Abdelhafeez H Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Lindsay J Talbot
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Ching-Hon Pui
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - James M Hoffman
- Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 133, Memphis, TN 38105, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38105, USA.
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Im C, Yuan Y, Austin ED, Stokes DC, Krasin MJ, Davidoff AM, Sapkota Y, Wang Z, Ness KK, Wilson CL, Armstrong GT, Hudson MM, Robison LL, Mulrooney DA, Yasui Y. Leveraging Therapy-Specific Polygenic Risk Scores to Predict Restrictive Lung Defects in Childhood Cancer Survivors. Cancer Res 2022; 82:2940-2950. [PMID: 35713625 PMCID: PMC9388566 DOI: 10.1158/0008-5472.can-22-0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/30/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022]
Abstract
Therapy-related pulmonary complications are among the leading causes of morbidity among long-term survivors of childhood cancer. Restrictive ventilatory defects (RVD) are prevalent, with risks increasing after exposures to chest radiotherapy and radiomimetic chemotherapies. Using whole-genome sequencing data from 1,728 childhood cancer survivors in the St. Jude Lifetime Cohort Study, we developed and validated a composite RVD risk prediction model that integrates clinical profiles and polygenic risk scores (PRS), including both published lung phenotype PRSs and a novel survivor-specific pharmaco/radiogenomic PRS (surPRS) for RVD risk reflecting gene-by-treatment (GxT) interaction effects. Overall, this new therapy-specific polygenic risk prediction model showed multiple indicators for superior discriminatory accuracy in an independent data set. The surPRS was significantly associated with RVD risk in both training (OR = 1.60, P = 3.7 × 10-10) and validation (OR = 1.44, P = 8.5 × 10-4) data sets. The composite model featuring the surPRS showed the best discriminatory accuracy (AUC = 0.81; 95% CI, 0.76-0.87), a significant improvement (P = 9.0 × 10-3) over clinical risk scores only (AUC = 0.78; 95% CI: 0.72-0.83). The odds of RVD in survivors in the highest quintile of composite model-predicted risk was ∼20-fold higher than those with median predicted risk or less (OR = 20.01, P = 2.2 × 10-16), exceeding the comparable estimate considering nongenetic risk factors only (OR = 9.20, P = 7.4 × 10-11). Inclusion of genetic predictors also selectively improved risk stratification for pulmonary complications across at-risk primary cancer diagnoses (AUCclinical = 0.72; AUCcomposite = 0.80, P = 0.012). Overall, this PRS approach that leverages GxT interaction effects supports late effects risk prediction among childhood cancer survivors. SIGNIFICANCE This study develops a therapy-specific polygenic risk prediction model to more precisely identify childhood cancer survivors at high risk for pulmonary complications, which could help improve risk stratification for other late effects.
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Affiliation(s)
- Cindy Im
- School of Public Health, University of Alberta, Edmonton, AB, T6G 1C9, Canada,Corresponding authors: Cindy Im (), School of Public Health, University of Alberta, 3-250 Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada, Phone: +1-587-873-3904; Daniel A. Mulrooney (), Department of Oncology, Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105, USA, Phone: 901-595-5847; Yutaka Yasui (), Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105, USA, Phone: 901-500-6032
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, AB, T6G 1C9, Canada
| | - Eric D. Austin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dennis C. Stokes
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew J. Krasin
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA
| | - Yadav Sapkota
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA
| | - Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA
| | - Daniel A. Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA,Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA,Corresponding authors: Cindy Im (), School of Public Health, University of Alberta, 3-250 Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada, Phone: +1-587-873-3904; Daniel A. Mulrooney (), Department of Oncology, Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105, USA, Phone: 901-595-5847; Yutaka Yasui (), Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105, USA, Phone: 901-500-6032
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, AB, T6G 1C9, Canada,Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA,Corresponding authors: Cindy Im (), School of Public Health, University of Alberta, 3-250 Edmonton Clinic Health Academy, Edmonton, Alberta T6G 1C9, Canada, Phone: +1-587-873-3904; Daniel A. Mulrooney (), Department of Oncology, Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105, USA, Phone: 901-595-5847; Yutaka Yasui (), Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105, USA, Phone: 901-500-6032
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Mansfield SA, Davidoff AM. Reply to: Letter to the Editor: Reflection on "Impact of Neoadjuvant Chemotherapy on Image-Defined Risk Factors in High-Risk Neuroblastoma". Ann Surg Oncol 2022; 29:8694. [PMID: 35842537 DOI: 10.1245/s10434-022-12103-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Sara A Mansfield
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA. .,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.,Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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43
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Abstract
The histone lysine demethylase 4 (KDM4) family plays an important role in regulating gene transcription, DNA repair, and metabolism. The dysregulation of KDM4 functions is associated with many human disorders, including cancer, obesity, and cardiovascular diseases. Selective and potent KDM4 inhibitors may help not only to understand the role of KDM4 in these disorders but also to provide potential therapeutic opportunities. Here, we provide an overview of the field and discuss current status, challenges, and opportunities lying ahead in the development of KDM4-based anticancer therapeutics.
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Affiliation(s)
- Qiong Wu
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, United States
| | - Brandon Young
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, United States
| | - Yan Wang
- Department of Geriatrics and Occupational Disease, Qingdao Central Hospital, Qingdao 266044, China
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, United States
| | - Zoran Rankovic
- Department of Chemical Biology and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, United States
| | - Jun Yang
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, United States.,Department of Pathology and Laboratory Medicine, College of Medicine, The University of Tennessee Health Science Center, 930 Madison Avenue, Suite 500, Memphis, Tennessee 38163, United States
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44
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Singh S, Abu-Zaid A, Jin H, Fang J, Wu Q, Wang T, Feng H, Quarni W, Shao Y, Maxham L, Abdolvahabi A, Yun MK, Vaithiyalingam S, Tan H, Bowling J, Honnell V, Young B, Guo Y, Bajpai R, Pruett-Miller SM, Grosveld GC, Hatley M, Xu B, Fan Y, Wu G, Chen EY, Chen T, Lewis PW, Rankovic Z, Li Y, Murphy AJ, Easton J, Peng J, Chen X, Wang R, White SW, Davidoff AM, Yang J. Targeting KDM4 for treating PAX3-FOXO1-driven alveolar rhabdomyosarcoma. Sci Transl Med 2022; 14:eabq2096. [PMID: 35857643 PMCID: PMC9548378 DOI: 10.1126/scitranslmed.abq2096] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Chimeric transcription factors drive lineage-specific oncogenesis but are notoriously difficult to target. Alveolar rhabdomyosarcoma (RMS) is an aggressive childhood soft tissue sarcoma transformed by the pathognomonic Paired Box 3-Forkhead Box O1 (PAX3-FOXO1) fusion protein, which governs a core regulatory circuitry transcription factor network. Here, we show that the histone lysine demethylase 4B (KDM4B) is a therapeutic vulnerability for PAX3-FOXO1+ RMS. Genetic and pharmacologic inhibition of KDM4B substantially delayed tumor growth. Suppression of KDM4 proteins inhibited the expression of core oncogenic transcription factors and caused epigenetic alterations of PAX3-FOXO1-governed superenhancers. Combining KDM4 inhibition with cytotoxic chemotherapy led to tumor regression in preclinical PAX3-FOXO1+ RMS subcutaneous xenograft models. In summary, we identified a targetable mechanism required for maintenance of the PAX3-FOXO1-related transcription factor network, which may translate to a therapeutic approach for fusion-positive RMS.
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Affiliation(s)
- Shivendra Singh
- Department of Surgery, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Ahmed Abu-Zaid
- Department of Surgery, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Hongjian Jin
- Center for Applied Bioinformatics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Jie Fang
- Department of Surgery, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Qiong Wu
- Department of Surgery, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Tingting Wang
- Center for Childhood Cancer and Blood Disease, Abigail Wexner Research Institute, Nationwide Children’s Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Helin Feng
- Department of Orthopedics, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China
| | - Waise Quarni
- Department of Surgery, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Ying Shao
- Department of Computational Biology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Lily Maxham
- Department of Computational Biology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Alireza Abdolvahabi
- Department of Chemical Biology and Therapeutics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Mi-Kyung Yun
- Department of Structural Biology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Sivaraja Vaithiyalingam
- Department of Structural Biology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Protein Technologies Center, Molecular Interaction Analysis, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Haiyan Tan
- Department of Structural Biology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Center for Proteomics and Metabolomics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - John Bowling
- Department of Chemical Biology and Therapeutics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Victoria Honnell
- Graduate School of Biomedical Sciences, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Brandon Young
- Department of Chemical Biology and Therapeutics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Yian Guo
- Department of Biostatistics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Richa Bajpai
- Center for Advanced Genome Engineering, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Shondra M. Pruett-Miller
- Center for Advanced Genome Engineering, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Gerard C Grosveld
- Department of Genetics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Mark Hatley
- Department of Oncology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Beisi Xu
- Center for Applied Bioinformatics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Yiping Fan
- Center for Applied Bioinformatics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Gang Wu
- Center for Applied Bioinformatics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Eleanor Y. Chen
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA
| | - Taosheng Chen
- Department of Chemical Biology and Therapeutics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Peter W. Lewis
- Department of Biomolecular Chemistry, School of Medicine and Public Health, University of Wisconsin, USA
| | - Zoran Rankovic
- Department of Chemical Biology and Therapeutics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Yimei Li
- Department of Biostatistics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Andrew J. Murphy
- Department of Surgery, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - John Easton
- Department of Computational Biology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Junmin Peng
- Department of Structural Biology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Center for Proteomics and Metabolomics, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Xiang Chen
- Department of Computational Biology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Ruoning Wang
- Center for Childhood Cancer and Blood Disease, Abigail Wexner Research Institute, Nationwide Children’s Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Stephen W. White
- Department of Structural Biology, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Graduate School of Biomedical Sciences, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Andrew M. Davidoff
- Department of Surgery, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Jun Yang
- Department of Surgery, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Graduate School of Biomedical Sciences, St Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.,Department of Pathology, College of Medicine, The University of Tennessee Health Science Center, 930 Madison Ave, Suite 500, Memphis, TN 38163, USA
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45
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Morgan KM, Anderson KT, Johnston ME, Dasgupta R, Crowley JJ, Fahy AS, Lapidus-Krol E, Baertschiger RM, Lautz TB, Many BT, Marquart JP, Gainer H, Lal DR, Rich BS, Glick RD, MacArthur TA, Polites SF, Kastenberg ZJ, Short SS, Meyers RL, Talbot L, Abdelhafeez A, Prajapati H, Davidoff AM, Rubaclava N, Newman E, Ehrlich PF, Rothstein DH, Roach JP, Ladd P, Janek KC, Le HD, Leraas HJ, Tracy ET, Bisset L, Mora MC, Warren P, Aldrink JH, Malek MM. Interhospital variability in localization techniques for small pulmonary nodules in children: A pediatric surgical oncology research collaborative study. J Pediatr Surg 2022; 57:1013-1017. [PMID: 35307194 DOI: 10.1016/j.jpedsurg.2022.01.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pulmonary nodules that are deep within lung parenchyma and/or small in size can be challenging to localize for biopsy. This study describes current trends in performance of image-guided localization techniques for pulmonary nodules in pediatric patients. METHODS A retrospective review was performed on patients < 21 years of age undergoing localization of pulmonary nodules at 15 institutions. Localization and resection success, time in interventional radiology (IR), operating room (OR) and total anesthesia time, complications, and technical problems were compared between techniques. RESULTS 225 patients were included with an average of 1.3 lesions (range 1-5). Median nodule size and depth were 4 mm (range 0-30) and 5.4 mm (0-61), respectively. The most common localization techniques were: wire + methylene blue dye (MBD) (28%), MBD only (25%), wire only (14%), technetium-99 only (11%), coil + MBD (7%) and coil only (5%). Localization technique was associated with institution (p < 0.01); technique and institution were significantly associated with mean IR, OR, and anesthesia time (all p < 0.05). Comparing techniques, there was no difference in successful IR localization (range 92-100%, p = 0.75), successful resection (94-100%, p = 0.98), IR technical problems (p = 0.22), or operative complications (p = 0.16). CONCLUSIONS Many IR localization techniques for small pulmonary nodules in children can be successful, but there is wide variability in application by institution and in procedure time. LEVEL OF EVIDENCE Retrospective review, Level 3.
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Affiliation(s)
- Katrina M Morgan
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, United States
| | - K Tinsley Anderson
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th FL, Pittsburgh, PA, United States
| | - Michael E Johnston
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Roshni Dasgupta
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - John J Crowley
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th FL, Pittsburgh, PA, United States
| | | | | | | | - Timothy B Lautz
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Benjamin T Many
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - John P Marquart
- Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, United States
| | - Haley Gainer
- Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, United States
| | - Dave R Lal
- Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, United States
| | - Barrie S Rich
- Cohen Children's Medical Center, Queens, NY, United States
| | | | | | | | | | - Scott S Short
- University of Utah, Salt Lake City, UT, United States
| | | | | | | | | | | | | | - Erika Newman
- C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | | | | | | | - Patricia Ladd
- Children's Hospital Colorado, Aurora, CO, United States
| | - Kevin C Janek
- American Family Children's Hospital, Madison, WI, United States
| | - Hau D Le
- American Family Children's Hospital, Madison, WI, United States
| | | | | | - Logan Bisset
- Duke University Medical Center, Durham, NC, United States
| | - Maria C Mora
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Patrick Warren
- Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Marcus M Malek
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th FL, Pittsburgh, PA, United States.
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46
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Bishop MW, Li Y, Brennan RC, Federico SM, Stewart E, Hatley ME, Helmig S, Lucas JT, Tinkle CL, Davidoff AM, McCarville MB, Albritton KH, Indelicato DJ, Pappo AS, Krasin MJ. Risk-adapted local therapy and intensive chemotherapy in patients with high-risk rhabdomyosarcoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10031 Background: Outcomes for patients with metastatic RMS remain poor. Dose escalation of radiation may reduce risk of local failure, and maintenance therapy has prolonged survival in intermediate risk patients. We investigated a multimodal chemotherapeutic regimen with risk adapted local therapy and the addition of maintenance therapy following intensive chemotherapy to improve the outcome for patients with high-risk RMS. Methods: We conducted a phase 2 multi-center trial for patients with newly diagnosed high-risk (stage 4) RMS. Patients received 54 weeks of chemotherapy (vincristine/irinotecan, interval compressed vincristine/doxorubicin/cyclophosphamide and ifosfamide/etoposide, and vincristine/dactinomycin/cyclophosphamide) followed by 4 cycles of anti-angiogenic maintenance therapy (bevacizumab, sorafenib, cyclophosphamide). Primary tumor local control consisted of surgery and photon/proton radiation therapy (RT) dependent on the degree of resection (negative margin – no RT, positive margin – 36 GyRBE, unresected ≤5cm – 50.4 GyRBE, unresected > 5cm – 59.4 GyRBE). RT was administered at Week 4 or 20 based on size/location, and to radiographically visible (non-CR) sites of metastatic disease at end of treatment. Results: Thirty-nine eligible patients with high-risk RMS (64% FOXO1 fusion positive, 74% with nodal disease, 67% Oberlin score > 1) were enrolled. Two of 13 patients with Oberlin score ≤ 1 were FOXO1 fusion positive whereas 23 of 26 patients with Oberlin score > 1 were fusion positive. Seventeen patients received maintenance therapy as planned (progression, n = 12; received alternate maintenance regimen, n = 4; other, n = 6) with a median of 4 cycles (range 1-4). Common toxicities of maintenance included palmar-plantar erythrodysesthesia (n = 9), rash (n = 7), and cystitis (n = 6). At a median follow-up of 43.5 months for survivors, 3-year EFS was 29.5% (95% CI 15.4-45.1%). Fusion positive status significantly predicted EFS (negative, 60.6% vs. positive, 9.6%, p = 0.019), whereas low Oberlin score approached significance for EFS (≤1, 56.6% vs. > 1, 16.4%, p = 0.064). The cumulative incidence of local failure was 17.5% (95% CI 6.9-32.2%). Twenty-one patients achieved CR of all metastatic sites and did not receive metastatic site RT. Of those, 7 experienced disease recurrence in a pre-existing metastatic soft tissue site. Among 4 patients who received metastatic site RT at the end of treatment, one patient experienced disease recurrence in a pre-existing metastatic site. Conclusions: The addition of maintenance therapy to intensive chemotherapy and risk adapted radiotherapy did not improve EFS in this population. Consolidative radiation should be considered for soft tissue metastatic sites regardless of radiographic response. Clinical trial information: NCT01871766.
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Affiliation(s)
| | - Yimei Li
- St. Jude Children's Research Hospital, Memphis, TN
| | | | | | | | | | - Sara Helmig
- Cincinnati Children's Hospital and Medical Center, Cincinnati, OH
| | | | | | | | | | | | | | - Alberto S. Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
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47
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Singh G, Stefanelli G, Narkaj K, Brimble MA, Creighton SD, McLean TAB, Hall M, Mitchnick KA, Zakaria J, Phung T, Reda A, Leonetti AM, Monks A, Ianov L, Winters BD, Walters BJ, Davidoff AM, Mitchell JA, Zovkic IB. Author Correction: Histone macroH2A1 is a stronger regulator of hippocampal transcription and memory than macroH2A2 in mice. Commun Biol 2022; 5:531. [PMID: 35624301 PMCID: PMC9142576 DOI: 10.1038/s42003-022-03515-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gurdeep Singh
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, M5S 3G3, Canada
| | - Gilda Stefanelli
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Klotilda Narkaj
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, M5S 3G3, Canada
| | - Mark A Brimble
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Samantha D Creighton
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Timothy A B McLean
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, M5S 3G3, Canada
| | - Meaghan Hall
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | | | - Jacqueline Zakaria
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Thanh Phung
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, M5S 3G3, Canada
| | - Anas Reda
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, M5S 3G3, Canada
| | - Amanda M Leonetti
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, M5S 3G3, Canada
| | - Ashley Monks
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Lara Ianov
- Civitan International Research Center, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Boyer D Winters
- Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Brandon J Walters
- Department of Biology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Jennifer A Mitchell
- Department of Cell & Systems Biology, University of Toronto, Toronto, ON, M5S 3G3, Canada.
| | - Iva B Zovkic
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, L5L 1C6, Canada.
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48
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Rich BS, Fishbein J, Lautz T, Rubalcava NS, Kartal T, Newman E, Wok PE, Romao RL, Whitlock R, Naik-Mathuria B, Polites SF, Løfberg K, Lascano D, Kim E, Davidson J, Bütter A, Kastenberg ZJ, Short SS, Meyers RL, Mastropolo R, Malek MM, Weller J, Irfan A, Rhee DS, Utria AF, Rothstein DH, Riehle K, Commander SJ, Tracy E, Becktell K, Hallis B, Lal D, Li O, Dal-Soglio DB, Piché N, Gomez Quevedo O, Murphy AJ, Davidoff AM, Cooke Barber J, Watters E, Dasgupta R, Glick RD. Inflammatory Myofibroblastic Tumor: A Multi-Institutional Study from the Pediatric Surgical Oncology Research Collaborative. Int J Cancer 2022; 151:1059-1067. [PMID: 35604778 DOI: 10.1002/ijc.34132] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/03/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate malignancy. We describe the largest cohort of IMT patients to date, aiming to further characterize this rare, poorly understood tumor. This is a multi-institutional review of IMT patients ≤39 years, from 2000-2018, at 18 hospitals in the Pediatric Surgical Oncology Research Collaborative. 182 patients were identified with median age of 11 years. 33% of tumors were thoracic in origin. Presenting signs/symptoms included pain (29%), respiratory symptoms (25%), and constitutional symptoms (20%). Median tumor size was 3.9 cm. Anaplastic lymphoma kinase (ALK) overexpression was identified in 53% of patients. 7% of patients had distant disease at diagnosis. 91% of patients underwent resection: 14% received neoadjuvant treatment and 22% adjuvant treatment. 12% of patients received an ALK inhibitor. 66% of surgical patients had complete resection, with 20% positive microscopic margins, and 14% gross residual disease. Approximately 40% had en bloc resection of involved organs. Median follow-up time was 36 months. Overall 5-year survival (OS) was 95% and 5-year event-free survival (EFS) was 80%. Predictors of recurrence included respiratory symptoms, tumor size, and distant disease. Gross or microscopic margins were not associated with recurrence, suggesting that aggressive attempts at resection may not be warranted. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, NY
| | - Joanna Fishbein
- Biostatistics Unit, The Feinstein Institutes for Medical Research, Manhasset, NY
| | - Timothy Lautz
- Division of Pediatric Surgery, Lurie Children's Hospital, Northwestern University, Chicago, IL
| | - Nathan S Rubalcava
- Division of Pediatric Surgery, C.S. Mott Hospital, University of Michigan, Ann Arbor, MI
| | - Tanvi Kartal
- Division of Pediatric Surgery, C.S. Mott Hospital, University of Michigan, Ann Arbor, MI
| | - Erika Newman
- Division of Pediatric Surgery, C.S. Mott Hospital, University of Michigan, Ann Arbor, MI
| | - Pei En Wok
- Division of Pediatric Surgery, Department of Urology, IWK Health Centre, Halifax, NS
| | - Rodrigo Lp Romao
- Division of Pediatric Surgery, Department of Urology, IWK Health Centre, Halifax, NS
| | - Richard Whitlock
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Bindi Naik-Mathuria
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | - Katrine Løfberg
- Division of Pediatric Surgery, OHSU Doernbecher Children's Hospital, Portland, OR
| | - Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Eugene Kim
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jacob Davidson
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Andreana Bütter
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Scott S Short
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | | | - Marcus M Malek
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh
| | - Jennine Weller
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Ahmer Irfan
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Daniel S Rhee
- Division of Pediatric Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - Alan F Utria
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - David H Rothstein
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Kimberly Riehle
- Division of Pediatric Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | | | - Elisabeth Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, NC
| | - Kerri Becktell
- Division of Pediatric Surgery, Medical College of Wisconcon, Milwaukee, WI
| | - Brian Hallis
- Division of Pediatric Surgery, Medical College of Wisconcon, Milwaukee, WI
| | - Dave Lal
- Division of Pediatric Surgery, Medical College of Wisconcon, Milwaukee, WI
| | - Orville Li
- Faculty of Medicine, Université de Montréal
| | | | - Nelson Piché
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Ste-Justine
| | | | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Jo Cooke Barber
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Erin Watters
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Roshni Dasgupta
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, NY
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49
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Short SS, Kastenberg ZJ, Wei G, Bondoc A, Dasgupta R, Tiao GM, Watters E, Heaton TE, Lotakis D, La Quaglia MP, Murphy AJ, Davidoff AM, Mansfield SA, Langham MR, Lautz TB, Superina RA, Ott KC, Malek MM, Morgan KM, Kim ES, Zamora A, Lascano D, Roach J, Murphy JT, Rothstein DH, Vasudevan SA, Whitlock R, Lal DR, Hallis B, Bütter A, Baertschiger RM, Lapidus-Krol E, Putra J, Tracy ER, Aldrink JH, Apfeld J, Le HD, Park KY, Rich BS, Glick RD, Fialkowski EA, Utria AF, Meyers RL, Riehle KJ. Histologic type predicts disparate outcomes in pediatric hepatocellular neoplasms: A Pediatric Surgical Oncology Research Collaborative study. Cancer 2022; 128:2786-2795. [PMID: 35561331 DOI: 10.1002/cncr.34256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/06/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a rare cancer in children, with various histologic subtypes and a paucity of data to guide clinical management and predict prognosis. METHODS A multi-institutional review of children with hepatocellular neoplasms was performed, including demographic, staging, treatment, and outcomes data. Patients were categorized as having conventional HCC (cHCC) with or without underlying liver disease, fibrolamellar carcinoma (FLC), and hepatoblastoma with HCC features (HB-HCC). Univariate and multivariate analyses identified predictors of mortality and relapse. RESULTS In total, 262 children were identified; and an institutional histologic review revealed 110 cHCCs (42%; 69 normal background liver, 34 inflammatory/cirrhotic, 7 unknown), 119 FLCs (45%), and 33 HB-HCCs (12%). The authors observed notable differences in presentation and behavior among tumor subtypes, including increased lymph node involvement in FLC and higher stage in cHCC. Factors associated with mortality included cHCC (hazard ratio [HR], 1.63; P = .038), elevated α-fetoprotein (HR, 3.1; P = .014), multifocality (HR, 2.4; P < .001), and PRETEXT (pretreatment extent of disease) stage IV (HR, 5.76; P < .001). Multivariate analysis identified increased mortality in cHCC versus FLC (HR, 2.2; P = .004) and in unresectable tumors (HR, 3.4; P < .001). Disease-free status at any point predicted survival. CONCLUSIONS This multi-institutional, detailed data set allowed a comprehensive analysis of outcomes for children with these rare hepatocellular neoplasms. The current data demonstrated that pediatric HCC subtypes are not equivalent entities because FLC and cHCC have distinct anatomic patterns and outcomes in concert with their known molecular differences. This data set will be further used to elucidate the impact of histology on specific treatment responses, with the goal of designing risk-stratified algorithms for children with HCC. LAY SUMMARY This is the largest reported granular data set on children with hepatocellular carcinoma. The study evaluates different subtypes of hepatocellular carcinoma and identifies key differences between subtypes. This information is pivotal in improving understanding of these rare cancers and may be used to improve clinical management and subsequent outcome in children with these rare malignancies.
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Affiliation(s)
- Scott S Short
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Guo Wei
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Alex Bondoc
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roshni Dasgupta
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Greg M Tiao
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erin Watters
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd E Heaton
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dimitra Lotakis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael P La Quaglia
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Murphy
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Sara A Mansfield
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Max R Langham
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Timothy B Lautz
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Riccardo A Superina
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Katherine C Ott
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Marcus M Malek
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katrina M Morgan
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eugene S Kim
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Abigail Zamora
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan Roach
- Department of Pediatric Surgery, Children's Hospital of Colorado, Denver, Colorado
| | - Joseph T Murphy
- Division of Pediatric Surgery, Children's Medical Center, University of Texas Southwestern, Dallas, Texas
| | - David H Rothstein
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Richard Whitlock
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dave R Lal
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian Hallis
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andreana Bütter
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Reto M Baertschiger
- Department of General and Pediatric Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eveline Lapidus-Krol
- Department of General and Pediatric Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Juan Putra
- Division of Pediatric Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elisabeth R Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jordan Apfeld
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Hau D Le
- Division of Pediatric Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Keon Y Park
- Division of Pediatric Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, New York
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, New York
| | - Elizabeth A Fialkowski
- Division of Pediatric Surgery, Oregon Health and Science University Doernbecher Children's Hospital, Portland, Oregon
| | - Alan F Utria
- Division of Pediatric Surgery, Oregon Health and Science University Doernbecher Children's Hospital, Portland, Oregon
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Kimberly J Riehle
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
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50
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van der Perk MEM, Cost NG, Bos AME, Brannigan R, Chowdhury T, Davidoff AM, Daw NC, Dome JS, Ehrlich P, Graf N, Geller J, Kalapurakal J, Kieran K, Malek M, McAleer MF, Mullen E, Pater L, Polanco A, Romao R, Saltzman AF, Walz AL, Woods AD, van den Heuvel-Eibrink MM, Fernandez CV. White paper: Onco-fertility in pediatric patients with Wilms tumor. Int J Cancer 2022; 151:843-858. [PMID: 35342935 PMCID: PMC9541948 DOI: 10.1002/ijc.34006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
Abstract
The survival of childhood Wilms tumor is currently around 90%, with many survivors reaching reproductive age. Chemotherapy and radiotherapy are established risk factors for gonadal damage and are used in both COG and SIOP Wilms tumor treatment protocols. The risk of infertility in Wilms tumor patients is low but increases with intensification of treatment including the use of alkylating agents, whole abdominal radiation or radiotherapy to the pelvis. Both COG and SIOP protocols aim to limit the use of gonadotoxic treatment, but unfortunately this cannot be avoided in all patients. Infertility is considered one of the most important late effects of childhood cancer treatment by patients and their families. Thus, timely discussion of gonadal damage risk and fertility preservation options is important. Additionally, irrespective of the choice for preservation, consultation with a fertility preservation (FP) team is associated with decreased patient and family regret and better quality of life. Current guidelines recommend early discussion of the impact of therapy on potential fertility. Since most patients with Wilms tumors are prepubertal, potential FP methods for this group are still considered experimental. There are no proven methods for FP for prepubertal males (testicular biopsy for cryopreservation is experimental), and there is just a single option for prepubertal females (ovarian tissue cryopreservation), posing both technical and ethical challenges. Identification of genetic markers of susceptibility to gonadotoxic therapy may help to stratify patient risk of gonadal damage and identify patients most likely to benefit from FP methods.
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Affiliation(s)
| | - Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Surgical Oncology Program of the Children's Hospital Colorado, Aurora, CO, USA
| | - Annelies M E Bos
- University Medical Center Utrecht, Reproductive Medicine and Gynaecology, Utrecht, Netherlands
| | - Robert Brannigan
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Tanzina Chowdhury
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA
| | - Najat C Daw
- Department of Pediatrics - Patient Care, MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Dome
- Division of Oncology at Children's National Hospital, Washington, DC, USA
| | - Peter Ehrlich
- University of Michigan, C.S. Mott Children's Hospital Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Norbert Graf
- Department for Pediatric Oncology and Hematology, Saarland University Medical Center, Homburg, Germany
| | - James Geller
- Division of Pediatric Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - John Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA
| | - Kathleen Kieran
- Department of Urology, University of Washington, and Division of Urology, Seattle Children's Hospital, Seattle, USA
| | - Marcus Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Mullen
- Department of Pediatric Oncology, Children's Hospital Boston/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Angela Polanco
- National Cancer Research Institute Children's Group Consumer Representative, London, UK
| | - Rodrigo Romao
- Departments of Surgery and Urology, IWK Health Centre, Dalhousie University, Halifax, Canada
| | | | - Amy L Walz
- Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Andrew D Woods
- Children's Cancer Therapy Development Institute, Beaverton, Oregon, USA
| | | | - Conrad V Fernandez
- Department of Pediatric Hematology/Oncology, IWK Health Centre and Dalhousie University, Halifax, Canada
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