Endoglin Expression and Microvessel Density as Prognostic Factors in Pediatric Rhabdomyosarcoma

(1) Background: The study proposed to analyze microvessel density (MVD) in rhabdomyosarcoma (RMS) based on the expression of angiogenesis markers and define its prognostic role in this group of patients. (2) Methods: The study included forty-nine pediatric patients diagnosed with RMS. Tumor tissue expression of CD31, CD34, and CD105 was analyzed. MVD was calculated and correlated with clinical RMS prognostic parameters. (3) Results: CD31, CD34, and CD105 are expressed in all RMS cases. MVD/CD105 was significantly higher in the RMS group than in the control group. The mean and median values of MVD/CD105 in RMS were lower than MVD/CD31 and MVD/CD34. MVD/CD105 was significantly higher in patients with alveolar RMS and those with metastatic disease. Patients with higher levels of MVD/CD105 had a higher risk of death (HR = 1.009). (4) Conclusion: CD105 is a relevant angiogenesis marker in pediatric RMS, and MVD/CD105 is an independent risk factor of short overall survival in children with RMS.

Tumor expression of survivin, p53, cyclin D1, osteopontin and fibronectin in predicting the response to neo-adjuvant chemotherapy in children with advanced malignant peripheral nerve sheath tumor

PURPOSE

Selected cell-cycle regulators and extracellular matrix proteins were found to play roles in malignant peripheral nerve sheath tumor (MPNST) biology. We aimed to analyze whether initial tumor tissue expressions of survivin, p53, cyclin D1, osteopontin (OPN) and fibronectin (FN) correlate with the response to neo-adjuvant CHT (naCHT) in children with advanced inoperable MPNST.

METHODS

The study included 26 children with MPNST (M/F 14/12, median age 130 months) treated in Polish centers of pediatric oncology between 1992 and 2013. Tissue expression of markers was studied immunohistochemically in the manually performed tissue microarrays and assessed semi-quantitatively as low and high, based on the rate of positive cells and staining intensity.

RESULTS

Good response to naCHT was noted in 47.6%, while poor-in 52.4% of patients. The response to naCHT was influenced negatively by the presence of neurofibromatosis NF1 and high initial tumor tissue expression of OPN, survivin, p53 and cyclin D1. Patients with high tumor expression of either OPN, survivin or p53 and those with simultaneous high expression of ≥ 3 of the markers, responded significantly worse to naCHT, than patients, in whom expression of ≤ 2 markers were detected at diagnosis. Nearly, 85% of patients expressing ≥ 3 markers, responded poor to CHT; while 87.5% of children, expressing ≤ 2 markers, were good responders.

CONCLUSION

The initial tumor tissue expression of OPN, survivin, p53 and cyclin D1 may serve as markers to predict response to naCHT in pediatric advanced MPNST. Future studies in more numerous group of patients are needed to confirm these preliminary results.

Failure rate of standard rescue with leucovorin for high-dose methotrexate (HDMTX) in osteosarcoma

11028

Background: HDMTX followed by leucovorin rescue is well established as part of MAP chemotherapy for osteosarcoma. However, leucovorin rescue is not always effective as rescue, resulting in delays to subsequent courses of chemotherapy. Methods: This retrospective observational study involved patients ≥2 years of age with osteosarcoma treated with MAP during 2009 - 2014. Data was extracted from medical records from five clinics in Poland, Hungary, Norway and Sweden. The study objective was to determine to what extent patients treated with MAP encountered treatment delays due to MTX-related toxicity or delayed MTX elimination. Results: All patients fulfilling the inclusion criteria were included. Of 116 patients (ages 5-39 with a mean of 14 years; 59% males), 97% completed their first MAP cycle while only 48% completed six treatment cycles. The analysis of the primary endpoint included 114 evaluable patients. At least one treatment delay due to MTX toxicity or delayed MTX elimination was reported for 89 patients (78%) and only six patients (5%) completed the entire MAP treatment according to plan. Delay in subsequent treatment was observed following 183 of 369 evaluated MAP cycles (50%). About three quarters of the delays were found to be due to MTX-related toxicity while only a small number were related to delayed MTX elimination. The treatment related issues most commonly registered were increased liver enzymes, hematological disturbances, increased bilirubin and mucositis. Conclusions: We found at least one treatment delay due to MTX toxicity or delayed MTX elimination in 78% of all MAP-treated patients and that 50% of the administered MAP cycles resulted in a delay in subsequent treatment, mostly due to MTX toxicity. Only six patients (5%) completed the entire MAP treatment according to plan. The retrospective methodology with broad inclusion criteria implies that the results can be extrapolated to the entire target population. Thus, there appears to be an unmet need for a more effective HDMTX rescue that could reduce MTX toxicity and be expected to enable more patients to maintain planned MAP treatment intensity and duration, thereby improving the overall efficacy of the MAP regimen.

Effective treatment of cytomegalovirus retinitis and neuritis with retrobulbar ganciclovir after treosulfan-based autologous bone marrow transplant

We describe the case of a 16-month-old girl with neuroblastoma and chronic lymphocytopenia due to chemotherapy and treosulfan-containing megatherapy who developed cytomegalovirus retinitis and neuritis. Intravenous ganciclovir and anti-cytomegalovirus immunoglobulin were used with a transient benefit; however, retrobulbar gancyclovir resulted in a complete remission. This report emphasizes the need for close monitoring of viral infections in patients undergoing treosulfan-containing megatherapy, highlighting the immunosuppressive effects of this agent, and indicates the potential use of retrobulbar ganciclovir as the alternative method of drug delivery.

Internal hemipelvectomy in the management of pelvic Ewing sarcoma - are outcomes better than with radiation therapy?

BACKGROUND

Pelvic Ewing sarcoma (ES) is commonly associated with a worse prognosis. Large size and location limit local control options to radiation therapy, and local recurrences are common. We evaluated the impact of hemipelvectomy and radiation on outcomes, including function.

MATERIALS AND METHODS

Thirty-nine patients (median age 13.5years) with ES of the pelvis and sacral bones were treated during the period 2000-2012. Fifteen were treated with definitive radiotherapy (RT), 9 patients underwent hemipelvectomy alone, and 15 were treated with combined hemipelvectomy and RT.

RESULTS

Twenty patients (51.2%) are alive with a median follow-up 3.2years from diagnosis. Median time from diagnosis to relapse was 1.3years. Three-year estimates of EFS and OS were 47% and 61%, respectively. Patients treated with surgery or surgery with RT had better outcome than patients treated with RT only (3-year OS 78% or 81% vs. 36%, respectively, p=0.00083). The outcome of patients with pelvic ES treated with hemipelvectomy was not significantly different from the outcome of all patients with Ewing sarcoma treated on the national Polish protocol.

CONCLUSIONS

Internal hemipelvectomy offers good chances of cure for patients with pelvic ES, with a reasonable rate of complications and good function.

[Markers of bone formation in children with osteosarcoma]

Among biochemical markers, which reflect bone remodeling and can be measured in blood, there are formation markers such as serum bone alkaline phosphatase (BALP) and osteocalcin (OC). Formation markers are considered to be useful in diagnosis and anticancer treatment of many metastatic bone diseases, but the clinical value of these markers in primary osseous tumours such as osteosarcoma is not yet recognized.

AIM

The aim of this study was the investigation of BALP activity and OC level in patients with osteosarcoma during clinical treatment.

SUBJECTS AND METHODS

We studied 22 patients (aged 11-19 years) with osteosarcoma, at diagnosis, during preoperative and postoperative chemotherapy and at the end of treatment. The control group consisted of 30 healthy age-matched children. The activity of BALP and the level of OC were measured in serum using ELISA kits.

RESULTS

Our results indicated that both tested parameters were lower during preoperative and postoperative chemotherapy (BALP, p<0.05; OC, p<0.01,p<0.001), in patients group than in controls. However we found higher value of BALP and OC also at diagnosis and during chemotherapy in same patients before occurrence of metastases. Moreover, we observed markedly higher activity of BALP (5:fold) and level of OC (2-fold) in patients with progression in comparison to the group with favourable prognosis, who responded to chemotherapy.

CONCLUSIONS

Our studies suggest, that investigation of formation markers, especially BALP could be useful in monitoring of osteosarcoma therapy and may be a valuable indicator of the progression of this disease. Further studies with long-term observation of investigated patients are necessary.