1
|
Ayad N, Gherbi M, Gacem O, Falek H, Labboun L, Amirat L, Chouli M, Abba K, Benmakhlouf H, Achir M, Ladj MS. 82 Juvenile dermatomyositis with early-onset anti-MDA 5 antibodies: a case report. Rheumatology (Oxford) 2022. [PMCID: PMC9538989 DOI: 10.1093/rheumatology/keac496.078] [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] [Indexed: 11/05/2022] Open
Abstract
Background Juvenile dermatomyositis (JDM) is a very rare inflammatory myopathy with an approximate incidence of 2–4 per million. The discovery of specific circulating autoantibodies present in about 60% of cases has allowed them to be classified according to their clinical and immunological expressions and their therapeutic response. Anti-Melanoma differentiation associated gene5 (MDA5) antibodies seem to be correlated with a particular clinical phenotype associating cutaneous, respiratory, and articular involvement and most often sparing the muscles. Observation We report the case of an early-onset anti-MDA 5 JDM in a 27-month-old girl. The first symptoms appeared at the age of 18 months and consisted of a skin rash and muscle weakness complicated 6 months later by generalized oedema. The child received symptomatic treatments without improvement. At 27 months of age, the child worsened and was admitted for respiratory distress. On clinical examination, she presented with fever and general deterioration, respiratory impairment with swallowing problems, skin damage with specific ulcerations, very significant generalized oedema, and severe muscle damage with axial hypotonia and myogenic EMG tracing. The inflammatory workup was positive and the autoimmune workup revealed 1/320 speckled antinuclear antibody (ANA) and positive anti-MDA5 anti bodies. Chest CT scan showed right interstitial lung disease. The diagnosis of anti-MDA5 JDM was retained and the child was treated with corticosteroids pulses associated with immunoglobulins and methotrexate (MTX) leading to a clear improvement. Corticosteroids and MTX were maintained on a long-term basis. Discussion The prevalence of anti-MDA5 anti bodies is variable and depends on ethnic origin (7% in an English cohort vs 38% in the Japanese cohort). These antibodies seem to be specific to a particular phenotype of DM associating skin involvement, interstitial lung disease with little or no muscle involvement. The originality of this observation lies in the early age of onset of JDM and in the fact that it expresses the anti-MDA5 antibodies. The skin and muscle involvement was prominent in our patient, while the pulmonary involvement, although not rapidly progressive, justified the combination of bolus methylprednisolone, MTX and immunoglobulins. Despite the delay in diagnosis, we noted a good therapeutic response and stabilization of the disease. Conclusion Anti-MDA 5 antibodies must be identified as soon as JDM is diagnosed; their presence is a risk factor for severe lung damage, which must be systematically investigated and treated to improve the prognosis.
Collapse
Affiliation(s)
- N Ayad
- Department of Pediatrics, Djillali Belkhenchir Birtraria Hospital, Algiers—, Algeria
| | - M Gherbi
- Department of Pediatrics, Djillali Belkhenchir Birtraria Hospital, Algiers—, Algeria
| | - O Gacem
- Department of Pediatrics, Djillali Belkhenchir Birtraria Hospital, Algiers—, Algeria
| | | | | | - L Amirat
- Department of Pediatrics, Djillali Belkhenchir Birtraria Hospital, Algiers—, Algeria
| | - M Chouli
- Department of Pediatrics, Djillali Belkhenchir Birtraria Hospital, Algiers—, Algeria
| | - K Abba
- Department of Pediatrics, Djillali Belkhenchir Birtraria Hospital, Algiers—, Algeria
| | | | - M Achir
- Department of Pediatrics, Djillali Belkhenchir Birtraria Hospital, Algiers—, Algeria
| | - M. S Ladj
- Department of Pediatrics, Djillali Belkhenchir Birtraria Hospital, Algiers—, Algeria
| |
Collapse
|
2
|
Stenman M, Benmakhlouf H, Wersäll P, Johnstone P, Hatiboglu MA, Mayer-da-Silva J, Harmenberg U, Lindskog M, Sinclair G. Metastatic renal cell carcinoma to the brain: optimizing patient selection for gamma knife radiosurgery. Acta Neurochir (Wien) 2021; 163:333-342. [PMID: 32902689 DOI: 10.1007/s00701-020-04537-w] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/11/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The effects of single-fraction gamma knife radiosurgery (sf-GKRS) on patients with renal cell carcinoma (RCC) brain metastases (BM) in the era of targeted agents (TA) and immune checkpoint inhibitors (ICI) are insufficiently studied. METHODS AND MATERIALS Clear cell metastatic RCC patients treated with sf-GKRS due to BM in 2005-2014 at three European centres were retrospectively analysed (n = 43). Median follow-up was 56 months. Ninety-five percent had prior nephrectomy, 53% synchronous metastasis and 86% extracranial disease at first sf-GKRS. Karnofsky performance status (KPS) ranged from 60 to 100%. Outcome measures were overall survival (OS), local control (LC) and adverse radiation effects (ARE). RESULTS One hundred and ninety-four targets were irradiated. The median number of targets at first sf-GKRS was two. The median prescription dose was 22.0 Gy. Thirty-seven percent had repeated sf-GKRS. Eighty-eight percent received TA. LC rates at 12 and 18 months were 97% and 90%. Median OS from the first sf-GKRS was 15.7 months. Low serum albumin (HR for death 5.3), corticosteroid use pre-sf-GKRS (HR for death 5.8) and KPS < 80 (HR for death 9.1) were independently associated with worse OS. No further prognostic information was gleaned from MSKCC risk group, synchronous metastasis, age, number of BM or extracranial metastases. Other prognostic scores for BM radiosurgery, including DS-GPA, renal-GPA, LLV-SIR and CITV-SIR, again, did not add further prognostic value. ARE were seldom symptomatic and were associated with tumour volume, 10-Gy volume and pre-treatment perifocal oedema. ARE were less common among patients treated with TA within 1 month of sf-GKRS. CONCLUSIONS We identified albumin, corticosteroid use and KPS as independent prognostic factors for sf-GKRS of clear cell RCC BM. Studies focusing on the prognostic significance of albumin in sf-GKRS are rare. Further studies with a larger number of patients are warranted to confirm the above analytical outcome. Also, in keeping with previous studies, our data showed optimal rates of local tumour control and limited toxicity post radiosurgery, rendering GKRS the tool of choice in the management of RCC BM.
Collapse
Affiliation(s)
- M Stenman
- Department of Immunology, Genetics, and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - H Benmakhlouf
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - P Wersäll
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - P Johnstone
- Department of Oncology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - M A Hatiboglu
- Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - J Mayer-da-Silva
- Centro Gamma Knife, CUF Infante Santo Hospital, Lisbon, Portugal
| | - U Harmenberg
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M Lindskog
- Department of Immunology, Genetics, and Pathology, Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - G Sinclair
- Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey.
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
- Department of Oncology, North Middlesex University Hospital NHS Trust, London, UK.
| |
Collapse
|
3
|
Sinclair G, Stenman M, Benmakhlouf H, Johnstone P, Wersäll P, Lindskog M, Hatiboglu MA, Harmenberg U. Adaptive radiosurgery based on two simultaneous dose prescriptions in the management of large renal cell carcinoma brain metastases in critical areas: Towards customization. Surg Neurol Int 2020; 11:21. [PMID: 32123609 PMCID: PMC7049890 DOI: 10.25259/sni_275_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/06/2019] [Accepted: 12/13/2019] [Indexed: 12/23/2022] Open
Abstract
Background: The long-term benefits of local therapy in metastatic renal cell carcinoma (mRCC) have been widely documented. In this context, single fraction gamma knife radiosurgery (SF-GKRS) is routinely used in the management of brain metastases. However, SF-GKRS is not always feasible due to volumetric and regional constraints. We intend to illustrate how a dose-volume adaptive hypofractionated GKRS technique based on two concurrent dose prescriptions termed rapid rescue radiosurgery (RRR) can be utilized in this particular scenario. Case Description: A 56-year-old man presented with left-sided hemiparesis; the imaging showed a 13.1 cc brain metastasis in the right central sulcus (Met 1). Further investigation confirmed the histology to be a metastatic clear cell RCC. Met 1 was treated with upfront RRR. Follow-up magnetic resonance imaging (MRI) at 10 months showed further volume regression of Met 1; however, concurrently, a new 17.3 cc lesion was reported in the boundaries of the left frontotemporal region (Met 2) as well as a small metastasis (<1 cc) in the left temporal lobe (Met 3). Met 2 and Met 3 underwent RRR and SF-GKRS, respectively. Results: Gradual and sustained tumor ablation of Met 1 and Met 2 was demonstrated on a 20 months long follow- up. The patient succumbed to extracranial disease 21 months after the treatment of Met 1 without evidence of neurological impairment post-RRR. Conclusion: Despite poor prognosis and precluding clinical factors (failing systemic treatment, eloquent location, and radioresistant histology), RRR provided optimal tumor ablation and salvage of neurofunction with limited toxicity throughout follow-up.
Collapse
Affiliation(s)
- Georges Sinclair
- Departments of Neurosurgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey.,Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - M Stenman
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - H Benmakhlouf
- Departments of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - P Johnstone
- Department of Oncology, Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | - P Wersäll
- Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - M Lindskog
- Department of Immunology Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M A Hatiboglu
- Department of Neurosurgery, Bezmialem Vakif University Medical School, Istanbul, Turkey
| | - U Harmenberg
- Department of Oncology-Pathology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
4
|
Sinclair G, Benmakhlouf H, Martin H, Brigui M, Maeurer M, Dodoo E. The role of radiosurgery in the acute management of fourth ventricle compression due to brain metastases. Surg Neurol Int 2018; 9:112. [PMID: 29930878 PMCID: PMC5991270 DOI: 10.4103/sni.sni_387_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/15/2017] [Accepted: 12/26/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Approximately 20–30% of all intracranial metastases are located in the posterior fossa. The clinical evolution hinges on factors such as tumor growth dynamics, local topographic conditions, performance status, and prompt intervention. Fourth ventricle (V4) compression with secondary life-threatening obstructive hydrocephalus remains a major concern, often requiring acute surgical intervention. We have previously reported on the application of adaptive hypofractionated Gamma Knife Radiosurgery in the acute management of critically located metastases, a technique known to us as rapid rescue radiosurgery (3R). We report the results of 3R in the management of posterior fossa lesions and ensuing V4 decompression. Case Descriptions: Four patients with V4 compression due to posterior fossa metastases were treated with 3R by three separate gamma knife radiosurgical sessions (GKRS) over a period of seven days. Mean V4 volume was 1.02 cm3 at GKRS 1, 1.13 cm3 at GKRS 2, and 1.12 cm3 at GKRS 3. Mean tumor volume during the week of treatment was 10 cm3 at both GKRS 1 and 2 and 9 cm3 at GKRS 3. On average, we achieved a tumor volume reduction of 52% and a V4 size increase of 64% at the first follow-up (4 weeks after GKRS 3). Long-term follow-up showed continued local tumor control, stable V4 volume, and absence of hydrocephalus. Conclusion: For this series, 3R was effective in terms of rapid tumor ablation, V4 decompression, and limited radiation-induced toxicity. This surgical procedure may become an additional tool in the management of intractable posterior fossa metastasis with V4 compression.
Collapse
Affiliation(s)
- G Sinclair
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - H Benmakhlouf
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - H Martin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - M Brigui
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - M Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - E Dodoo
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
5
|
Ghazal M, Carlsson-Tedgren A, Benmakhlouf H. EP-1728: Small field dosimetry formalism implemented using various detectors on several linear accelerators. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32037-1] [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: 10/14/2022]
|
6
|
Benmakhlouf H, Brualla L, Andreo P, Sempau J. SU-F-T-367: Using PRIMO, a PENELOPE-Based Software, to Improve the Small Field Dosimetry of Linear Accelerators. Med Phys 2016. [DOI: 10.1118/1.4956552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
7
|
Mirzakhanian L, Benmakhlouf H, Seuntjens J. TH-AB-201-09. Med Phys 2016. [DOI: 10.1118/1.4958038] [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: 11/07/2022] Open
|
8
|
Benmakhlouf H, Andreo P. SU-E-T-432: Field Size Influence On the Electron and Photon Spectra Within Small MV Field Detectors. Med Phys 2015. [DOI: 10.1118/1.4924793] [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: 11/07/2022] Open
|
9
|
Benmakhlouf H, Johansson J, Paddick I, Andreo P. Monte Carlo calculated and experimentally determined output correction factors for small field detectors in Leksell Gamma Knife Perfexion beams. Phys Med Biol 2015; 60:3959-73. [DOI: 10.1088/0031-9155/60/10/3959] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
10
|
Benmakhlouf H, Wangerid T, Kraepelien T, Forander P. SU-E-J-240: The Impact On Clinical Dose-Distributions When Using MR-Images Registered with Stereotactic CT-Images in Gamma Knife Radiosurgery. Med Phys 2014. [DOI: 10.1118/1.4888293] [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: 11/07/2022] Open
|
11
|
Benmakhlouf H, Sempau J, Andreo P. SU-E-T-29: Monte Carlo Calculated Output Corrections Factors K(Q,f-Clin) for Varian_Clinac-IX 6MV Small Fields. Med Phys 2013. [DOI: 10.1118/1.4814463] [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: 11/07/2022] Open
|
12
|
Rhissassi K, Hali F, Benmakhlouf H, Aksim M, Zamiati S, Chbani K, L.Ouzidane, Benchekkroun S, Benchikhi H. Rhabdomyosarcome alvéolaire périanale métastatique aux seins. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.01.194] [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: 10/27/2022]
|
13
|
Boudiaf H, Fernane L, Hamadouche H, Aouabed Y, Fernini F, Ayad N, Gherbi M, Guers S, Khelfat, Benmakhlouf H, Achir M. Manifestations dermatologiques de la maladie de Kawasaki : étude prospective portant sur 93 cas. Ann Dermatol Venereol 2012. [DOI: 10.1016/j.annder.2012.10.205] [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: 11/15/2022]
|
14
|
Benmakhlouf H, Johansson J, Andreo P. SU-E-T-30: Monte Carlo Calculated Detector Corrections K(Q, F-Clin) for Determination of Output Factors for the Leksell Gamma Knife. Med Phys 2012. [DOI: 10.1118/1.4735085] [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: 11/07/2022] Open
|
15
|
Chikhi S, Djamouh K, Benmakhlouf H, Fernini F, Boudiaf H, Hamadouche N, Aouabed Y, Guers S, Ayad N, Achir M. P121 - Les atteintes neuropsychiatriques dans le lupus érythémateux systémique. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70522-4] [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: 10/19/2022]
|