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Furtwängler R, Kager L, Melchior P, Rübe C, Ebinger M, Nourkami-Tutdibi N, Niggli F, Warmann S, Hubertus J, Amman G, Leuschner I, Vokuhl C, Graf N, Frühwald MC. High-dose treatment for malignant rhabdoid tumor of the kidney: No evidence for improved survival-The Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) experience. Pediatr Blood Cancer 2018; 65. [PMID: 28843054 DOI: 10.1002/pbc.26746] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 02/23/2017] [Revised: 06/19/2017] [Accepted: 07/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Malignant rhabdoid tumor of the kidney (MRTK) is the most aggressive childhood renal tumor with overall survival (OS) rates ranging from 22% to 42%. Whether high-dose chemotherapy with autologous stem-cell transplantation (HDSCT) in an intensive first-line treatment offers additional benefit is an ongoing discussion. METHODS A retrospective analysis of all 58 patients with MRTK from Austria, Switzerland, and Germany treated in the framework of consecutive, prospective renal/rhabdoid tumor studies SIOP9/GPO, SIOP93-01/GPOH (where SIOP is International Society of Pediatric Oncology and GPOH is German Society of Pediatric Oncology and Hematology), SIOP2001/GPOH, and European Rhabdoid Tumor Registry from 1991 to 2014. RESULTS Median age at diagnosis was 11 months. Fifty percent of patients had metastases or multifocal disease at diagnosis (Stage IV). Local stage distribution was as follows: not done/I/II/III-1/6/11/40. Fifteen (26%) patients underwent upfront surgery. Thirty-seven (64%) patients achieved a complete remission, 17 (29%) relapsed, 34 (59%) died of disease progression, and two (3%) died of treatment-related complication. Mean time to the first event was 3.5 months. Two-year EFS/OS (where EFS is event-free survival) for the whole group was 37 ± 6%/38 ± 6%. Metastases/multifocal disease, younger age, and local stage III were associated with significantly inferior survival. Eleven (19%) patients underwent HDSCT (carboplatin + thiotepa, n = 6; carboplatin + etoposide + melphalan, n = 4; others, n = 1); 2-year OS in this group was 60 ± 15% compared to 34 ± 8% in the non-HDSCT group (P = 0.064). However, the time needed from radiologic to histologic diagnosis, stem-cell harvest, and HDSCT must also be taken into account to avoid selection bias by excluding the highest risk group with early progression (<90 days). Thus, 2-year EFS only for patients without progression until day 90 was 60 ± 16% consolidated by HDSCT compared to 62 ± 11% without (P = 0.8). CONCLUSION Our retrospective analysis suggests comparable outcomes for patients with and without HDSCT, if adjusted for early disease progression.
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Affiliation(s)
- Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Leo Kager
- Department of Pediatrics, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Patrick Melchior
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Hospital, Homburg, Germany
| | - Martin Ebinger
- Department of Pediatric Hematology and Oncology, Tübingen University Hospital, Tübingen, Germany
| | - Nasenien Nourkami-Tutdibi
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Felix Niggli
- Department of Pediatric Oncology, Children's Hospital, Zurich University, Switzerland
| | - Steven Warmann
- Department of Pediatric Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Jochen Hubertus
- Department of Pediatric Surgery, von Haunersches Kinderspital, Ludwigs-Maximilian-University, Munich, Germany
| | - Gabriele Amman
- Department of Clinical Pathology, Medical University Vienna, Vienna, Austria
| | - Ivo Leuschner
- Department of Paidopathology, Schleswig-Holstein-University Hospital, Campus Kiel, Kiel, Germany
| | - Christian Vokuhl
- Department of Paidopathology, Schleswig-Holstein-University Hospital, Campus Kiel, Kiel, Germany
| | - Norbert Graf
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg/Saar, Germany
| | - Michael C Frühwald
- Swabian Children's Center, Children's Hospital Augsburg, Augsburg, Germany
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Modritz D, Ladenstein R, Pötschger U, Amman G, Dieckmann K, Horcher E, Urban C, Meister B, Schmitt K, Jones R, Kaulfersch W, Haas H, Moser R, Stöllinger O, Peham M, Gadner H, Koscielniak E, Treuner J. Treatment for soft tissue sarcoma in childhood and adolescence. Wien Klin Wochenschr 2005; 117:196-209. [PMID: 15875759 DOI: 10.1007/s00508-004-5-0285-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the CWS 96 Study was to achieve an optimal treatment in children and adolescents with soft tissue sarcoma (STS) implementing a further refinement of risk-adapted allocation to chemotherapy, surgery and radiotherapy. METHODS Treatment stratification was based on tumour histology, TNM status, postsurgical stage, localisation and age. Local tumour control was ensured by surgery and risk-adapted radiotherapy. RESULTS From 1995 to 2002, 89 patients were registered in Austria. The 3-year event-free survival (EFS) and overall survival rates (OS) were 63% +/- 6% and 71% +/- 6%, respectively. 59/89 patients had localised RMS-like (rhabdomayosarcoma) STS (EFS 73% +/- 7%), 14 had localised NON-RMS STS (EFS 54% +/- 16%) and 15 patients had metastatic disease at diagnosis (EFS 33% +/- 12%), 1 patient had fibromatosis. The EFS rates at 3 years in patients with localised RMS-like tumours according to risk group were 92% +/- 8% for low and standard risk (12 patients) and 67% +/- 8% for high risk (47 patients). Favourable primary tumour sites of nonmetastatic RMS-like STS i.e. orbit, head/neck nonparameningeal or genitourinary non-bladder/prostate were diagnosed in 15 patients (1/15 patients died). In 44 patients with unfavourable localisation such as parameningeal, genitourinary bladder/prostate, extremity and others, 7 deceased. The 3 year EFS according to histology in patients with RMS-like STS was 61% +/- 11% for RME (embryonal RMS ) (28 patients) and 71% +/- 15% for RMA (alveolar RMS) (10 patients). The most common treatment failure was local relapse occurring in 21% of patients in the high-risk group. CONCLUSION Risk-adapted individualisation of treatment led to a reduction of chemotherapy in the low and standard risk group without compromising survival. The outcome of RME and RMA was similar in this cohort of patients. These preliminary results after a median observation time of 2.5 years confirm the CWS 96 strategy.
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Affiliation(s)
- Ditha Modritz
- CCRI Children's Cancer Research Institute--St. Anna Kinderspital, Wien/Osterreichische Studienzentrale, Vienna, Austria
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Pinker K, Dominkus M, Amman G, Trattnig S, Kainberger F. Lokales Wachstum maligner Extremitätenweichteiltumoren: magnetresonanztomographische Erfassung. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Berger A, Haschke N, Kohlhauser C, Amman G, Unterberger U, Weninger M. Neonatal cholestasis and focal medullary dysplasia of the kidneys in a case of microcephalic osteodysplastic primordial dwarfism. J Med Genet 1998; 35:61-4. [PMID: 9475098 PMCID: PMC1051190 DOI: 10.1136/jmg.35.1.61] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report on a male infant who presented with intrauterine growth retardation, severe postnatal failure to thrive, microcephaly, facial dysmorphism, and skeletal dysplasia. The clinical and radiological findings are consistent with former descriptions of microcephalic osteodysplastic primordial dwarfism (MOPD) type I/III. In addition to previously published features, multiple fractures of the long bones, severe neonatal cholestasis, and histological dysplasia of the kidneys were found. The boy died at the age of 8 months. The new finding of focal renal medullary dysplasia further supports the hypothesis of a basic defect in tissue differentiation in the pathogenesis of this rare condition.
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Affiliation(s)
- A Berger
- University Children's Hospital Vienna, AKH, Department of Neonatology, Austria
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Brodowicz T, Wiltschka C, Krainer M, Dobrowsky W, Pötter R, Amman G, Lang S, Salzer-Kuntschik M, Kotz R, Zlelinski C. Cooperative study of soft tissue sarcoma: First results. Eur J Cancer 1997. [DOI: 10.1016/s0959-8049(97)85017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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