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Bischoff P, Reck M, Overbeck T, Christopoulos P, Rittmeyer A, Lüders H, Kollmeier J, Kulhavy J, Kemper M, Reinmuth N, Röper J, Janning M, Sommer L, Aguinarte L, Koch M, Wiesweg M, Wesseler C, Waller CF, Kauffmann-Guerrero D, Stenzinger A, Stephan-Falkenau S, Trautmann M, Lassmann S, Tiemann M, Klauschen F, Sebastian M, Griesinger F, Wolf J, Loges S, Frost N. Outcome of First-Line Treatment With Pembrolizumab According to KRAS/TP53 Mutational Status for Nonsquamous Programmed Death-Ligand 1-High (≥50%) NSCLC in the German National Network Genomic Medicine Lung Cancer. J Thorac Oncol 2024; 19:803-817. [PMID: 38096950 DOI: 10.1016/j.jtho.2023.12.015] [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: 08/24/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Programmed death-ligand 1 expression currently represents the only validated predictive biomarker for immune checkpoint inhibition in metastatic NSCLC in the clinical routine, but it has limited value in distinguishing responses. Assessment of KRAS and TP53 mutations (mut) as surrogate for an immunosupportive tumor microenvironment (TME) might help to close this gap. METHODS A total of 696 consecutive patients with programmed death-ligand 1-high (≥50%), nonsquamous NSCLC, having received molecular testing within the German National Network Genomic Medicine Lung Cancer between 2017 and 2020, with Eastern Cooperative Oncology Group performance status less than or equal to 1 and pembrolizumab as first-line palliative treatment, were included into this retrospective cohort analysis. Treatment efficacy and outcome according to KRAS/TP53 status were correlated with TME composition and gene expression analysis of The Cancer Genome Atlas lung adenocarcinoma cohort. RESULTS Proportion of KRASmut and TP53mut was 53% (G12C 25%, non-G12C 28%) and 51%, respectively. In KRASmut patients, TP53 comutations increased response rates (G12C: 69.7% versus 46.5% [TP53mut versus wild-type (wt)], p = 0.004; non-G12C: 55.4% versus 39.5%, p = 0.03), progression-free survival (G12C: hazard ratio [HR] = 0.59, p = 0.009, non-G12C: HR = 0.7, p = 0.047), and overall survival (G12C: HR = 0.72, p = 0.16, non-G12C: HR = 0.56, p = 0.002), whereas no differences were observed in KRASwt patients. After a median follow-up of 41 months, G12C/TP53mut patients experienced the longest progression-free survival and overall survival (33.7 and 65.3 mo), which correlated with high tumor-infiltrating lymphocyte densities in the TME and up-regulation of interferon gamma target genes. Proinflammatory pathways according to TP53 status (mut versus wt) were less enhanced and not different in non-G12C and KRASwt, respectively. CONCLUSIONS G12C/TP53 comutations identify a subset of patients with a very favorable long-term survival with immune checkpoint inhibitor monotherapy, mediated by highly active interferon gamma signaling in a proinflammatory TME.
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Affiliation(s)
- Philip Bischoff
- Institute of Pathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany; BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North, German Center of Lung Research, Grosshansdorf, Germany
| | - Tobias Overbeck
- Department of Haematology and Medical Oncology, University Medical Center Göttingen and Lungentumorzentrum Universität Göttingen, Göttingen, Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik and National Center for Tumor Diseases (NCT) at Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Achim Rittmeyer
- Department of Thoracic Oncology, LKI Lungenfachklinik Immenhausen, Immenhausen, Germany
| | - Heike Lüders
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany; Berlin Lung Institute, Berlin, Germany
| | - Jonas Kulhavy
- Translational Oncology/Early Clinical Trial Unit (ECTU), Comprehensive Cancer Center Mainfranken and Bavarian Cancer Research Center (BZKF), University Hospital Wuerzburg, Wuerzburg, Germany
| | - Marcel Kemper
- Department of Medicine A for Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Niels Reinmuth
- Asklepios Lung Clinic, member of the German Center for Lung Research (DZL), Munich-Gauting, Germany
| | - Julia Röper
- Department of Hematology and Oncology, Pius-Hospital, University Dept. of Internal Medicine-Oncology, Oldenburg, Germany
| | - Melanie Janning
- DKFZ-Hector Cancer Institute and Department of Personalized Oncology at the University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Division of Personalized Medical Oncology (A420), German Cancer Research Center (DKFZ), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Linna Sommer
- Department of Thoracic Oncology, Carl-Gustav-Carus Dresden University Hospital, Dresden, Germany
| | - Lukas Aguinarte
- Hematology/Oncology, Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Myriam Koch
- University Hospital Regensburg, Department of Internal Medicine 2, Regensburg, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Claas Wesseler
- Department of Thoracic Oncology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Cornelius F Waller
- Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre Freiburg and Faculty of Medicine, Freiburg, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL-CPCM), Munich, Germany
| | | | | | - Marcel Trautmann
- University of Münster, Division of Translational Pathology, Gerhard-Domagk-Institute of Pathology, Münster University Hospital, Münster, Germany
| | - Silke Lassmann
- Institute for Surgical Pathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Frederick Klauschen
- Institute of Pathology, Ludwig-Maximilians-University, Munich, Germany; Berlin Institute for the Foundation of Learning and Data (BIFOLD) and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Sebastian
- Hematology/Oncology, Department of Medicine II, University Hospital Frankfurt, Frankfurt, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, Pius-Hospital, University Dept. of Internal Medicine-Oncology, Oldenburg, Germany
| | - Jürgen Wolf
- Department I of Internal Medicine, Center for Integrated Oncology (CIO), University Hospital of Cologne, Cologne, Germany
| | - Sonja Loges
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Nikolaj Frost
- Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany.
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Blasi M, Kuon J, Lüders H, Misch D, Kauffmann-Guerrero D, Hilbrandt M, Kazdal D, Falkenstern-Ge RF, Hackanson B, Dintner S, Faehling M, Kirchner M, Volckmar AL, Kopp HG, Allgäuer M, Grohé C, Tufman A, Reck M, Frost N, Stenzinger A, Thomas M, Christopoulos P. First-line immunotherapy for lung cancer with MET exon 14 skipping and the relevance of TP53 mutations. Eur J Cancer 2024; 199:113556. [PMID: 38271745 DOI: 10.1016/j.ejca.2024.113556] [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: 12/06/2023] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND The efficacy of checkpoint inhibitors for non-small cell lung cancer (NSCLC) with MET exon 14 skipping (METΔ14ex) remains controversial. MATERIALS AND METHODS 110 consecutive METΔ14ex NSCLC patients receiving first-line chemotherapy (CHT) and/or immunotherapy (IO) in 10 German centers between 2016-2022 were analyzed. RESULTS Combined CHT-IO was given to 35/110 (32%) patients, IO alone to 43/110 (39%), and CHT to 32/110 (29%) upfront. Compared to CHT, CHT-IO showed longer progression-free survival (median PFS 6 vs. 2.5 months, p = 0.004), more objective responses (ORR 49% vs. 28%, p = 0.086) and numerically longer overall survival (OS 16 vs. 10 months, p = 0.240). For IO monotherapy, OS (14 vs. 16 months) and duration of response (26 vs. 22 months) were comparable to those of CHT-IO. Primary progressive disease (PD) was more frequent with IO compared to CHT-IO (13/43 vs. 3/35, p = 0.018), particularly for never-smokers (p = 0.041). Higher PD-L1 TPS were not associated with better IO outcomes, but TP53 mutated tumors showed numerically improved ORR (56% vs. 32%, p = 0.088) and PFS (6 vs. 3 months, p = 0.160), as well as longer OS in multivariable analysis (HR=0.54, p = 0.034) compared to their wild-type counterparts. Any second-line treatment was administered to 35/75 (47%) patients, with longer survival for capmatinib or tepotinib compared to crizotinib (PFS 10 vs. 3 months, p = 0.013; OS 16 vs. 13 months, p = 0.270). CONCLUSION CHT-IO is superior to CHT, and IO alone also effective for METΔ14ex NSCLC, especially in the presence of TP53 mutations and independent of PD-L1 expression, but never-smokers are at higher risk of primary PD.
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Affiliation(s)
- Miriam Blasi
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, A Partnership Between DKFZ and Heidelberg University Hospital, Germany; Translational Lung Research Center (TLRC) Heidelberg, member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Jonas Kuon
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, A Partnership Between DKFZ and Heidelberg University Hospital, Germany; Translational Lung Research Center (TLRC) Heidelberg, member of the German Center for Lung Research (DZL), Heidelberg, Germany; Lungenklinik Loewenstein, Department of Thoracic Oncology, Loewenstein, Germany
| | - Heike Lüders
- Department of Respiratory Medicine, Evangelische Lungenklinik Berlin, Berlin, Germany
| | - Daniel Misch
- Department of Pneumology, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), member of the German Center for Lung Research (DZL), Munich, Germany
| | - Moritz Hilbrandt
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Kazdal
- Translational Lung Research Center (TLRC) Heidelberg, member of the German Center for Lung Research (DZL), Heidelberg, Germany; Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Björn Hackanson
- Department of Hematology/Oncology, University Medical Center Augsburg, Augsburg, Germany as part of the BZKF (Bavarian Center for Cancer Research) and Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sebastian Dintner
- Pathology, Medical Faculty, University of Augsburg, Augsburg, Germany, part of the Bavarian Cancer Research Center (BZKF), Augsburg, Germany
| | - Martin Faehling
- Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Esslingen, Germany
| | - Martina Kirchner
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna-Lena Volckmar
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Georg Kopp
- Robert Bosch Centrum für Tumorerkrankungen (RBCT), Stuttgart, Germany
| | - Michael Allgäuer
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Grohé
- Department of Respiratory Medicine, Evangelische Lungenklinik Berlin, Berlin, Germany
| | - Amanda Tufman
- Department of Medicine V, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), member of the German Center for Lung Research (DZL), Munich, Germany
| | - Martin Reck
- Department of Pneumology, LungenClinic Großhansdorf, Großhansdorf, Germany; Airway Research Center North (ARCN), member of the German Center for Lung Research (DZL), Großhansdorf, Germany
| | - Nikolaj Frost
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Albrecht Stenzinger
- Translational Lung Research Center (TLRC) Heidelberg, member of the German Center for Lung Research (DZL), Heidelberg, Germany; Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Thomas
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, A Partnership Between DKFZ and Heidelberg University Hospital, Germany; Translational Lung Research Center (TLRC) Heidelberg, member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Petros Christopoulos
- Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, A Partnership Between DKFZ and Heidelberg University Hospital, Germany; Translational Lung Research Center (TLRC) Heidelberg, member of the German Center for Lung Research (DZL), Heidelberg, Germany.
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Frost N, Unger K, Gerriet Blum T, Misch D, Kurz S, Lüders H, Olive E, Raspe M, Hilbrandt M, Koch M, Böhmer D, Senger C, Witzenrath M, Grohé C, Bauer T, Modest DP, Kollmeier J. Management, risk factors and prognostic impact of checkpoint-inhibitor pneumonitis (CIP) in lung cancer – A multicenter observational analysis. Lung Cancer 2023; 179:107184. [PMID: 37040677 DOI: 10.1016/j.lungcan.2023.107184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Checkpoint-inhibitor pneumonitis (CIP) represents a major immune-related adverse event (irAE) in patients with lung cancer. We aimed for the clinical characterization, diagnostics, risk factors, treatment and outcome in a large cohort of patients from everyday clinical practice. PATIENTS AND METHODS For this retrospective analysis, 1,376 patients having received checkpoint inhibitors (CPI) in any line of therapy from June 2015 until February 2020 from three large-volume lung cancer centers in Berlin, Germany were included and analyzed. RESULTS With a median follow-up of 35 months, all-grade, high-grade (CTCAE ≥ 3) and fatal CIP were observed in 83 (6.0%), 37 (2.7%) and 12 (0.9%) patients, respectively, with a median onset 4 months after initiation of CPI therapy. The most common radiologic patterns were organizing pneumonia (OP) and non-specific interstitial pneumonia (NSIP) (37% and 31%). All except 7 patients with G1-2 CIP interrupted treatment. Corticosteroids were administered to 74 patients with a median starting dose of 0.75 mg/kg. After complete restitution (n = 67), re-exposure to CPI (n = 14) led to additional irAE in 43% of the cases. Thoracic radiotherapy targeting the lung was the only independent risk factor for CIP (odds ratio 2.8, p < 0.001) and pretherapeutic diffusing capacity for carbon monoxide inversely correlated with CIP severity. Compared with patients without CIP and non-CIP irAE, CIP was associated with impaired overall survival (hazard ratios 1.23, p = 0.24 and 2.01, p = 0.005). CONCLUSIONS High-grade CIP accounts for almost half of all CIP cases in an allcomer lung cancer population. A continuous vigilance, rapid diagnostics and adequate treatment are key to prevent disease progression associated with impaired survival.
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Christopoulos P, Kluck K, Kirchner M, Lüders H, Roeper J, Falkenstern-Ge RF, Szewczyk M, Sticht F, Saalfeld FC, Wesseler C, Hackanson B, Dintner S, Faehling M, Kuon J, Janning M, Kauffmann-Guerrero D, Kazdal D, Kurz S, Eichhorn F, Bozorgmehr F, Shah R, Tufman A, Wermke M, Loges S, Brueckl WM, Schulz C, Misch D, Frost N, Kollmeier J, Reck M, Griesinger F, Grohé C, Hong JL, Lin HM, Budczies J, Stenzinger A, Thomas M. The impact of TP53 co-mutations and immunologic microenvironment on outcome of lung cancer with EGFR exon 20 insertions. Eur J Cancer 2022; 170:106-118. [DOI: 10.1016/j.ejca.2022.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/22/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
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Frost N, Kollmeier J, Vollbrecht C, Grah C, Matthes B, Pultermann D, von Laffert M, Lüders H, Olive E, Raspe M, Mairinger T, Ochsenreither S, Blum T, Hummel M, Suttorp N, Witzenrath M, Grohé C. KRAS G12C/TP53 co-mutations identify long-term responders to first line palliative treatment with pembrolizumab monotherapy in PD-L1 high (≥50%) lung adenocarcinoma. Transl Lung Cancer Res 2021; 10:737-752. [PMID: 33718018 PMCID: PMC7947421 DOI: 10.21037/tlcr-20-958] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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] [Indexed: 01/10/2023]
Abstract
Background Pembrolizumab is a standard of care as first line palliative therapy in PD-L1 overexpressing (≥50%) non-small cell lung cancer (NSCLC). This study aimed at the identification of KRAS and TP53-defined mutational subgroups in the PD-L1 high population to distinguish long-term responders from those with limited benefit. Methods In this retrospective, observational study, patients from 4 certified lung cancer centers in Berlin, Germany, having received pembrolizumab monotherapy as first line palliative treatment for lung adenocarcinoma (LuAD) from 2017 to 2018, with PD-L1 expression status and targeted NGS data available, were evaluated. Results A total of 119 patients were included. Rates for KRAS, TP53 and combined mutations were 52.1%, 47.1% and 21.9%, respectively, with no association given between KRAS and TP53 mutations (P=0.24). By trend, PD-L1 expression was higher in KRAS-positive patients (75% vs. 65%, P=0.13). Objective response rate (ORR), median progression-free survival (PFS) and overall survival (OS) in the KRASG12C group (n=32, 51.6%) were 63.3%, 19.8 months (mo.) and not estimable (NE), respectively. Results in KRASother and wild type patients were similar and by far lower (42.7%, P=0.06; 6.2 mo., P<0.001; 23.4 mo., P=0.08). TP53 mutations alone had no impact on response and survival. However, KRASG12C/TP53 co-mutations (n=12) defined a subset of long-term responders (ORR 100.0%, PFS 33.3 mo., OS NE). In contrast, patients with KRASother/TP53 mutations showed a dismal prognosis (ORR 27.3%, P=0.002; PFS 3.9 mo., P=0.001, OS 9.7 mo., P=0.02). Conclusions A comprehensive assessment of KRAS subtypes and TP53 mutations allows a highly relevant prognostic differentiation of patients with metastatic, PD-L1 high LuAD treated upfront with pembrolizumab.
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Affiliation(s)
- Nikolaj Frost
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany
| | - Claudia Vollbrecht
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pathology, Berlin, Germany
| | - Christian Grah
- Gemeinschaftskrankenhaus Havelhöhe, Department of Pneumonology, Berlin, Germany
| | - Burkhard Matthes
- Gemeinschaftskrankenhaus Havelhöhe, Department of Pneumonology, Berlin, Germany
| | - Dennis Pultermann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | - Maximilian von Laffert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pathology, Berlin, Germany
| | - Heike Lüders
- Klinik für Pneumologie - Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Elisabeth Olive
- Klinik für Pneumologie - Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Matthias Raspe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | - Thomas Mairinger
- Helios Klinikum Emil von Behring, Department of Pathology, Berlin, Germany
| | - Sebastian Ochsenreither
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Hematology, Oncology and Tumorimmunology, Berlin, Germany
| | - Torsten Blum
- Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin, Germany
| | - Michael Hummel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pathology, Berlin, Germany
| | - Norbert Suttorp
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | - Martin Witzenrath
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Infectious Diseases and Pulmonary Medicine, Berlin, Germany
| | - Christian Grohé
- Klinik für Pneumologie - Evangelische Lungenklinik Berlin Buch, Berlin, Germany
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6
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Grasse S, Lienhard M, Frese S, Kerick M, Steinbach A, Grimm C, Hussong M, Rolff J, Becker M, Dreher F, Schirmer U, Boerno S, Ramisch A, Leschber G, Timmermann B, Grohé C, Lüders H, Vingron M, Fichtner I, Klein S, Odenthal M, Büttner R, Lehrach H, Sültmann H, Herwig R, Schweiger MR. Epigenomic profiling of non-small cell lung cancer xenografts uncover LRP12 DNA methylation as predictive biomarker for carboplatin resistance. Genome Med 2018; 10:55. [PMID: 30029672 PMCID: PMC6054719 DOI: 10.1186/s13073-018-0562-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 03/25/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022] Open
Abstract
Background Non-small cell lung cancer (NSCLC) is the most common cause of cancer-related deaths worldwide and is primarily treated with radiation, surgery, and platinum-based drugs like cisplatin and carboplatin. The major challenge in the treatment of NSCLC patients is intrinsic or acquired resistance to chemotherapy. Molecular markers predicting the outcome of the patients are urgently needed. Methods Here, we employed patient-derived xenografts (PDXs) to detect predictive methylation biomarkers for platin-based therapies. We used MeDIP-Seq to generate genome-wide DNA methylation profiles of 22 PDXs, their parental primary NSCLC, and their corresponding normal tissues and complemented the data with gene expression analyses of the same tissues. Candidate biomarkers were validated with quantitative methylation-specific PCRs (qMSP) in an independent cohort. Results Comprehensive analyses revealed that differential methylation patterns are highly similar, enriched in PDXs and lung tumor-specific when comparing differences in methylation between PDXs versus primary NSCLC. We identified a set of 40 candidate regions with methylation correlated to carboplatin response and corresponding inverse gene expression pattern even before therapy. This analysis led to the identification of a promoter CpG island methylation of LDL receptor-related protein 12 (LRP12) associated with increased resistance to carboplatin. Validation in an independent patient cohort (n = 35) confirmed that LRP12 methylation status is predictive for therapeutic response of NSCLC patients to platin therapy with a sensitivity of 80% and a specificity of 84% (p < 0.01). Similarly, we find a shorter survival time for patients with LRP12 hypermethylation in the TCGA data set for NSCLC (lung adenocarcinoma). Conclusions Using an epigenome-wide sequencing approach, we find differential methylation patterns from primary lung cancer and PDX-derived cancers to be very similar, albeit with a lower degree of differential methylation in primary tumors. We identify LRP12 DNA methylation as a powerful predictive marker for carboplatin resistance. These findings outline a platform for the identification of epigenetic therapy resistance biomarkers based on PDX NSCLC models. Electronic supplementary material The online version of this article (10.1186/s13073-018-0562-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabrina Grasse
- Translational Epigenetics and Tumor Genetics, University Hospital Cologne, Cologne, Germany.,Department of Vertebrate Genomics, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Matthias Lienhard
- Department of Computational Molecular Biology, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | | | - Martin Kerick
- Department of Vertebrate Genomics, Max Planck Institute for Molecular Genetics, Berlin, Germany.,Present Address: Department of Cell Biology and Immunology, Institute for Parasitology and Biomedicine, Granada, Spain
| | - Anne Steinbach
- Translational Epigenetics and Tumor Genetics, University Hospital Cologne, Cologne, Germany.,Department of Biology, Chemistry and Pharmacy, Free University Berlin, Berlin, Germany
| | - Christina Grimm
- Translational Epigenetics and Tumor Genetics, University Hospital Cologne, Cologne, Germany
| | - Michelle Hussong
- Translational Epigenetics and Tumor Genetics, University Hospital Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne, CMMC, Cologne, Germany
| | - Jana Rolff
- Experimental Pharmacology and Oncology Berlin-Buch GmbH, Berlin, Germany
| | - Michael Becker
- Experimental Pharmacology and Oncology Berlin-Buch GmbH, Berlin, Germany
| | - Felix Dreher
- Alacris Theranostics GmbH Berlin, Berlin, Germany
| | - Uwe Schirmer
- Cancer Genome Research Group, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Translational Lung Research, Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Stefan Boerno
- Sequencing Core Facility, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Anna Ramisch
- Department of Computational Molecular Biology, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | | | - Bernd Timmermann
- Sequencing Core Facility, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | | | | | - Martin Vingron
- Department of Computational Molecular Biology, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Iduna Fichtner
- Experimental Pharmacology and Oncology Berlin-Buch GmbH, Berlin, Germany
| | - Sebastian Klein
- Institute of Pathology, University of Cologne, Cologne, Germany.,Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany
| | | | | | - Hans Lehrach
- Department of Vertebrate Genomics, Max Planck Institute for Molecular Genetics, Berlin, Germany.,Alacris Theranostics GmbH Berlin, Berlin, Germany
| | - Holger Sültmann
- Cancer Genome Research Group, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Translational Lung Research, Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Ralf Herwig
- Department of Computational Molecular Biology, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Michal R Schweiger
- Translational Epigenetics and Tumor Genetics, University Hospital Cologne, Cologne, Germany. .,Department of Vertebrate Genomics, Max Planck Institute for Molecular Genetics, Berlin, Germany. .,Center for Molecular Medicine Cologne, CMMC, Cologne, Germany.
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Grohé C, Kurz S, Lüders H, Tessmer A, Kollmeier J, Serke M, Heigener D. Klinischer Verlauf typischer und atypischer Karzinoide (bpNET) – Indikatoren zur Prognosebestimmung und Therapieplanung. Pneumologie 2018. [DOI: 10.1055/s-0037-1619270] [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: 10/28/2022]
Affiliation(s)
- C Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin – Krankenhausbetriebs gGmbH
| | - S Kurz
- Evangelische Lungenklinik Berlin
| | - H Lüders
- Evangelische Lungenklinik Berlin
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Tessmer A, Lüders H, Olive E, Kurz S, Grohé C. Zunehmende Bedeutung älterer Patienten mit Lungenkarzinomen – eine Zentrumsanalyse. Pneumologie 2018. [DOI: 10.1055/s-0037-1619216] [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: 10/28/2022]
Affiliation(s)
- A Tessmer
- Klinik für Pneumologie, Evangelische Lungenklink Berlin
| | - H Lüders
- Studienzentrum Thoraxchirurgie, Evangelische Lungenklinik Berlin
| | - E Olive
- Evangelische Lungenklinik Berlin
| | - S Kurz
- Klinik für Pneumologie, Evangelische Lungenklink Berlin
| | - C Grohé
- Klinik für Pneumologie, Evangelische Lungenklink Berlin
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Grohé C, Olive E, Lüders H, Tessmer A, Kurz S, Sänger K. Rascher Tumorprogress ist ein wichtiger Indikator der Therapiesteuerung des fortgeschrittenen Lungenkarzinom. Pneumologie 2018. [DOI: 10.1055/s-0037-1619217] [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: 10/28/2022]
Affiliation(s)
- C Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin – Krankenhausbetriebs gGmbH
| | - E Olive
- Evangelische Lungenklinik Berlin
| | - H Lüders
- Evangelische Lungenklinik Berlin
| | | | - S Kurz
- Evangelische Lungenklinik Berlin
| | - K Sänger
- Evangelische Lungenklinik Berlin
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Kurz S, Lüders H, Grohé C. PneuNET-Register – ein bundesweites Register zur Erfassung von neuroendokrinen Tumoren der Lunge. Pneumologie 2017. [DOI: 10.1055/s-0037-1598332] [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: 10/20/2022]
Affiliation(s)
- S Kurz
- Pneumologie, Evangelische Lungenklinik Berlin
| | - H Lüders
- Studienzentrum Thoraxchirurgie, Evangelische Lungenklinik Berlin
| | - C Grohé
- Pneumologie, Evangelische Lungenklinik Berlin
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Dörffel W, Riepenhausen M, Lüders H, Brämswig J. Late Effects Following Treatment of Hodgkin Lymphoma During Childhood and Adolescence. Results of the Hodgkin Lymphoma Late Effects Research Project. Klin Padiatr 2016; 228:286-293. [DOI: 10.1055/s-0042-110406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- W. Dörffel
- Clinic for Pediatric and Youth Medicine, Helios Hospital Berlin-Buch, Berlin, Germany
| | - M. Riepenhausen
- Hodgkin Lymphoma Late Effect Research Project, University Children's Hospital Gießen, Gießen, Germany
| | - H. Lüders
- Protestant Lung Hospital, Berlin, Germany
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Dörffel W, Riepenhausenl M, Lüders H, Brämswig J, Schellong G. Secondary Malignancies Following Treatment for Hodgkin's Lymphoma in Childhood and Adolescence. Dtsch Arztebl Int 2016; 112:320-7, i. [PMID: 26037468 DOI: 10.3238/arztebl.2015.0320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND About 155 persons under age 18 develop Hodgkin's lymphoma (HL) in Germany every year. More than 90% survive at least 20 years. They may, however, suffer from late sequelae of treatment, including secondary malignant neoplasia (SMN). METHODS 2548 patients from the German, Austrian, and Swiss pediatric Hodgkin's lymphoma studies that were conducted over the period 1978-2002 were asked every 2-3 years about possible late sequelae of treatment, either directly or through their physicians. The documented cases of SMN were analyzed for cumulative incidence, standardized incidence rates (SIR), and absolute excess risk (AER). RESULTS 147 cases of SMN were diagnosed in 138 of the 2548 patients, including 47 cases of thyroid cancer, 37 of breast cancer, and 15 of hematopoietic neoplasia. The cumulative incidence of SMN at 20, 25, and 30 years was 7% , 11.2% , and 18.7% , respectively. These percentages are rather low compared to other international studies. For all types of SMN, the SIR was 9.1 and the AER was 16.8. Among the 123 patients with secondary solid tumors, 105 (85% ) had a tumor in the irradiated region. CONCLUSION Survivors of pediatric HL must be informed about the risk of late sequelae of treatment for HL, including SMN in the irradiated region, and that they will need regular follow-up examinations. In the future, radiotherapy for children and adolescents should be further reduced or entirely avoided.
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Affiliation(s)
- Wolfgang Dörffel
- Department of Pediatrics, HELIOS Klinikum Berlin-Buch, Department of Pediatric Rheumatology and Immunology, University Children's Hospital Münster, Protestant Lung Hospital, Berlin
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Michels S, Scheel AH, Scheffler M, Schultheis AM, Gautschi O, Aebersold F, Diebold J, Pall G, Rothschild S, Bubendorf L, Hartmann W, Heukamp L, Schildhaus HU, Fassunke J, Ihle MA, Künstlinger H, Heydt C, Fischer R, Nogovà L, Mattonet C, Hein R, Adams A, Gerigk U, Schulte W, Lüders H, Grohé C, Graeven U, Müller-Naendrup C, Draube A, Kambartel KO, Krüger S, Schulze-Olden S, Serke M, Engel-Riedel W, Kaminsky B, Randerath W, Merkelbach-Bruse S, Büttner R, Wolf J. Clinicopathological Characteristics of RET Rearranged Lung Cancer in European Patients. J Thorac Oncol 2016; 11:122-7. [PMID: 26762747 DOI: 10.1016/j.jtho.2015.09.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/11/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rearrangements of RET are rare oncogenic events in patients with non-small cell lung cancer (NSCLC). While the characterization of Asian patients suggests a predominance of nonsmokers of young age in this genetically defined lung cancer subgroup, little is known about the characteristics of non-Asian patients. We present the results of an analysis of a European cohort of patients with RET rearranged NSCLC. METHODS Nine hundred ninety-seven patients with KRAS/EGFR/ALK wildtype lung adenocarcinomas were analyzed using fluorescence in situ hybridization for RET fusions. Tumor specimens were molecularly profiled and clinicopathological characteristics of the patients were collected. RESULTS Rearrangements of RET were identified in 22 patients, with a prevalence of 2.2% in the KRAS/EGFR/ALK wildtype subgroup. Co-occurring genetic aberrations were detected in 10 patients, and the majority had mutations in TP53. The median age at diagnosis was 62 years (range, 39-80 years; mean ± SD, 61 ± 11.7 years) with a higher proportion of men (59% versus 41%). There was only a slight predominance of nonsmokers (54.5%) compared to current or former smokers (45.5%). CONCLUSIONS Patients with RET rearranged adenocarcinomas represent a rare and heterogeneous NSCLC subgroup. In some contrast to published data, we see a high prevalence of current and former smokers in our white RET cohort. The significance of co-occurring aberrations, so far, is unclear.
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Affiliation(s)
- Sebastian Michels
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Andreas Hans Scheel
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Anne Maria Schultheis
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Oliver Gautschi
- Department for Medical Oncology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Joachim Diebold
- Institute of Pathology, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Georg Pall
- Department for Internal Medicine, Haematology and Oncology, University Hospital Innsbruck, Innsbruck, Austria
| | - Sacha Rothschild
- Department for Oncology, University Hospital Basel, Basel, Switzerland
| | - Lukas Bubendorf
- Department for Cytopathology, University Hospital Basel, Basel, Switzerland
| | - Wolfgang Hartmann
- Gerhard-Domagk-Institute of Pathology, University Hospital of Münster, Münster, Germany
| | - Lukas Heukamp
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | | | - Jana Fassunke
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Michaela Angelika Ihle
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Helen Künstlinger
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Carina Heydt
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Rieke Fischer
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Lucia Nogovà
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Christian Mattonet
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany
| | - Rebecca Hein
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Anne Adams
- Institute of Medical Statistics, Informatics and Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Ulrich Gerigk
- Thoracic Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
| | - Wolfgang Schulte
- Departent for Pulmonology Cardiology and Allergology, Johanniter Hospital, Bonn, Germany
| | - Heike Lüders
- Evangelic Lung Clinic Berlin, Department of Pneumology, Berlin, Germany
| | - Christian Grohé
- Evangelic Lung Clinic Berlin, Department of Pneumology, Berlin, Germany
| | - Ullrich Graeven
- Department for Hematology, Oncology and Gastroenterology, Maria Hilf Hospital Mönchengladbach, Mönchengladbach, Germany
| | | | - Andreas Draube
- Department for Internal Medicine, St. Vinzenz Hospital Cologne, Cologne, Germany
| | - Karl-Otto Kambartel
- Department for Pulmonology and Allergology, Bethanien Hospital Moers, Moers, Germany
| | - Stefan Krüger
- Department for Pulmonology/Allergology/Sleep Medicine and Respiratory Care, Florence-Nightingale-Hospital, Düsseldorf, Germany
| | - Susanne Schulze-Olden
- Department for Pulmonology/Allergology/Sleep Medicine and Respiratory Care, Florence-Nightingale-Hospital, Düsseldorf, Germany
| | - Monika Serke
- Department for Pulmonology and Thoracic Oncology, Lung Clinic Hemer, Hemer, Germany
| | | | - Britta Kaminsky
- Clinic for Pulmonology and Allergology, Bethanien Hospital, Solingen, Germany
| | - Winfried Randerath
- Clinic for Pulmonology and Allergology, Bethanien Hospital, Solingen, Germany
| | - Sabine Merkelbach-Bruse
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Reinhard Büttner
- Network Genomic Medicine, Cologne, Germany; Institute of Pathology, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Center for Integrated Oncology Köln Bonn, Cologne, Germany; Lung Cancer Group Cologne, Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; Network Genomic Medicine, Cologne, Germany.
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Graff M, Lüders H, Leschber G. Rückgang der 30-Tage-Mortalität nach VATS-Talkumpoudrage. Zentralbl Chir 2015. [DOI: 10.1055/s-0035-1559937] [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: 10/23/2022]
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Frick A, Lüders H, Leschber G. Thirty and 90-Day Mortality After Lung Cancer Resection in 2242 Patients. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv048.03] [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: 11/12/2022] Open
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Kurz S, Tessmer A, Krempien R, Lüders H, Bauer TT, Grohé C, Kollmeier J. Sequentielle Chemo – IM Radiotherapie zur Behandlung des malignen Pleuramesotheliom. Pneumologie 2015. [DOI: 10.1055/s-0035-1544663] [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: 10/24/2022]
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Dörffel W, Riepenhausen M, Lüders H, Brämswig J, Schellong G. Subsequent Malignant Neoplasms in Survivors of Pediatric DAL/GPOH-Hodgkin-Lymphoma Trials. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Lüders H, Rühl U, Marciniak H, Haerting J, Claviez A, Mann G, Schellong G, Wickmann L, Dörffel W. The impact of central review and central therapy planning on the treatment of children and adolescents with Hodgkin lymphoma. Eur J Cancer 2014; 50:425-33. [DOI: 10.1016/j.ejca.2013.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 08/16/2013] [Accepted: 09/25/2013] [Indexed: 11/17/2022]
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Dörffel W, Lüders H, Claviez A, Hasenclever D, Rühl U. Reply to A.S. Reese. J Clin Oncol 2013; 31:3610-1. [DOI: 10.1200/jco.2013.51.7656] [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: 11/20/2022] Open
Affiliation(s)
| | - Heike Lüders
- Evangelische Lungenklinik Berlin, Berlin, Germany
| | | | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig, Germany
| | - Ursula Rühl
- VIVANTES Hospital Berlin-Moabit, Berlin, Germany
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Dörffel W, Claviez A, Lüders H, Rühl U. Treatment of Hodgkin's lymphoma in childhood and adolescence without radiotherapy. Transl Pediatr 2013; 2:131-2. [PMID: 26835305 PMCID: PMC4728929 DOI: 10.3978/j.issn.2224-4336.2013.07.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Wolfgang Dörffel
- 1 Department of Pediatrics, HELIOS Klinikum Berlin-Buch, Berlin, Germany ; 2 Department of Pediatrics, University of Schleswig-Holstein, Kiel, Germany ; 3 Evangelische Lungenklinik Berlin, Germany ; 4 Department of Radiation Oncology, VIVANTES Hospital Berlin-Moabit, Berlin, Germany
| | - Alexander Claviez
- 1 Department of Pediatrics, HELIOS Klinikum Berlin-Buch, Berlin, Germany ; 2 Department of Pediatrics, University of Schleswig-Holstein, Kiel, Germany ; 3 Evangelische Lungenklinik Berlin, Germany ; 4 Department of Radiation Oncology, VIVANTES Hospital Berlin-Moabit, Berlin, Germany
| | - Heike Lüders
- 1 Department of Pediatrics, HELIOS Klinikum Berlin-Buch, Berlin, Germany ; 2 Department of Pediatrics, University of Schleswig-Holstein, Kiel, Germany ; 3 Evangelische Lungenklinik Berlin, Germany ; 4 Department of Radiation Oncology, VIVANTES Hospital Berlin-Moabit, Berlin, Germany
| | - Ursula Rühl
- 1 Department of Pediatrics, HELIOS Klinikum Berlin-Buch, Berlin, Germany ; 2 Department of Pediatrics, University of Schleswig-Holstein, Kiel, Germany ; 3 Evangelische Lungenklinik Berlin, Germany ; 4 Department of Radiation Oncology, VIVANTES Hospital Berlin-Moabit, Berlin, Germany
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Dörffel W, Rühl U, Lüders H, Claviez A, Albrecht M, Bökkerink J, Holte H, Karlen J, Mann G, Marciniak H, Niggli F, Schmiegelow K, Schwarze EW, Pötter R, Wickmann L, Schellong G. Treatment of Children and Adolescents With Hodgkin Lymphoma Without Radiotherapy for Patients in Complete Remission After Chemotherapy: Final Results of the Multinational Trial GPOH-HD95. J Clin Oncol 2013; 31:1562-8. [DOI: 10.1200/jco.2012.45.3266] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [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
Purpose To minimize the risk of late effects in pediatric Hodgkin lymphoma (HL) by omitting radiotherapy (RT) in patients in complete remission (CR) after chemotherapy and reducing the standard radiation dose to 20 Gy in patients in incomplete remission. Patients and Methods Between 1995 and 2001, 925 patients with classical HL (cHL) were registered from seven European countries in German Society of Pediatric Oncology and Hematology Hodgkin Lymphoma Trial 95. Patients in treatment group 1 (TG1; early stages) received two cycles of vincristine, prednisone, procarbazine, and doxorubicin or vincristine, prednisone, etoposide, and doxorubicin chemotherapy; additional two or four cycles of cyclophosphamide, vincristine, prednisone, and procarbazine were added in TG2 (intermediate stages) or TG3 (advanced stages), respectively. Patients in CR (assessed by computed tomography or magnetic resonance imaging) did not undergo RT. Those with tumor volume reduction more than 75% received reduced involved-field RT with 20 Gy and an additional 10- or 15-Gy boost only for larger residuals. Results Rates of overall survival, progression-free survival (PFS), and event-free survival at 10 years were (± SE) 96.3% ± 0.6%, 88.2% ± 1.1%, and 85.4% ± 1.3%, respectively. PFS for TG1 patients without or with RT was 97.0% ± 2.1% versus 92.2% ± 1.7% (P = .214) but was unsatisfactory for nonirradiated patients in TG2 (68.5% ± 7.4% v 91.4% ± 1.9%; P < .0001), with similar but not significant results in TG3 (82.6% ± 5.4% v 88.7% ± 2.0%, P = .259). Reduction of the standard radiation dose from 25 to 20 Gy did not increase failure rate. Conclusion RT can be omitted in early stage HL in so defined CR following this chemotherapy. RT with 20(−35) Gy proved to be sufficient in patients with incomplete remission following chemotherapy.
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Affiliation(s)
- Wolfgang Dörffel
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Ursula Rühl
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Heike Lüders
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Alexander Claviez
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Marion Albrecht
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Jos Bökkerink
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Harald Holte
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Jonas Karlen
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Georg Mann
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Heinz Marciniak
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Felix Niggli
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Kjeld Schmiegelow
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Ernst-Wilhelm Schwarze
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Richard Pötter
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Lutz Wickmann
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
| | - Günther Schellong
- Wolfgang Dörffel, Heike Lüders, Heinz Marciniak, and Lutz Wickmann, HELIOS Hospital Berlin-Buch, Berlin-Buch; Ursula Rühl and Marion Albrecht, VIVANTES Hospital Berlin-Moabit, Berlin-Moabit; Alexander Claviez, University of Schleswig-Holstein, Kiel; Ernst-Wilhelm Schwarze, Municipal Clinic Dortmund, Dortmund; Günther Schellong, University Hospital of Münster, Münster, Germany; Jos Bökkerink, Academisch Ziekenhuis Nijmegen, the Netherlands; Harald Holte, Oslo University Hospital, Oslo, Norway; Jonas
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Böker B, Lüders H, Grohé C. [Prognostic relevance of body mass index and rash for patients with metastatic non-small-cell lung cancer under therapy with erlotinib]. Pneumologie 2012; 66:89-95. [PMID: 22337328 DOI: 10.1055/s-0031-1291617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Tyrosine kinase inhibition (TKI) such as erlotinib is a well established treatment option in the palliative care of patients with non small cell lung cancer (NSCLC). Histology and sex have been associated with different prognostic outcome measures in patients treated with erlotinib. Furthermore, the degree of rash, developed during treatment might be a relevant marker in respect to tumor response. To dissect these clinical relevant features we analysed a cohort of 275 patients treated with erlotinib in different lines of chemotherapy in our hospital. Nutrition status plays an important role in the prognosis of patients in a palliative chemotherapeutic setting, we therefore included body mass index measurements (BMI) in our analysis. We found that BMI and smoking status influence different survival patterns. Male patients have a poorer survival based on low BMI, rash development and smoking status. We therefore conclude that both nutritional and smoking status should be taken into account in the surveillance of patients with NSCLC in a palliative therapeutic setting under TKI treatment.
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Affiliation(s)
- B Böker
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin-Buch
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Hitomi T, Koubeissi M, Kaffashi F, Turnbull J, Lüders H. P16-11 Visual processing in the inferior temporal cortex. Clin Neurophysiol 2010. [DOI: 10.1016/s1388-2457(10)60818-8] [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: 10/18/2022]
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Glünder G, Hinz KH, Lüders H, Stiburek B. Zur therapeutischen Wirksamkeit von Tetracyclin HCl und Sulfaquinoxalin/Trimethoprim bei der Puten-Bordetellose. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1439-0450.1979.tb00852.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hinz KH, Lai KW, Lüders H. Lichttaglänge und Oxytetracyclin-Blutplasmaspiegel bei Legehennen nach Verabreichung von Oxytetracyclin in therapeutischer Dosierung über das Futter. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1439-0450.1972.tb00383.x] [Citation(s) in RCA: 2] [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: 12/01/2022]
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Lüders H, Lai KW, Hinz KH. Blut- und Gewebespiegel von Sulfamethazin und Sulfaquinoxalin bei Broilern nach Verabreichung der Medikamente über das Trinkwasser* Ein Beitrag zur Massentherapie des Geflügels. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1439-0450.1974.tb00472.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zaba O, Teber I, Lüders H, Leschber G, Grohé C. Langzeitdaten zum Bronchuskarzinoid. Pneumologie 2010. [DOI: 10.1055/s-0030-1251239] [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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Wieser HG, Blume WT, Fish D, Goldensohn E, Hufnagel A, King D, Sperling MR, Lüders H, Pedley TA. Proposal for a New Classification of Outcome with Respect to Epileptic Seizures Following Epilepsy Surgery. Epilepsia 2008. [DOI: 10.1046/j.1528-1157.2001.35100.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Noachtar S, Baykan B, Aykutlu E, Feddersen B, Desudchit T, Ozel S, Lüders H. Analysis of seizures consisting mainly of alteration of consciousness: A video-EEG study of 388 seizures in 117 patients with generalized and focal epilepsies. Clin Neurophysiol 2007. [DOI: 10.1016/j.clinph.2006.11.187] [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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Untch M, Keil E, Kettritz U, Mairinger T, Fleige B, Dresel S, Krempien R, Kretzschmar A, Preussker P, Loll H, Lüders H, Wildberger J, Schuler E. Das Interdisziplinäre Brustzentrum im HELIOS Klinikum Berlin-Buch. Breast Care (Basel) 2007. [DOI: 10.1159/000109748] [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: 11/19/2022] Open
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Noachtar S, Baykan B, Aykutlu E, Feddersen B, Desudchit T, Ozel S, Lüders H. Analysis of seizures consisting mainly of alteration of consciousness: a video-EEG study of 388 seizures in 117 patients with generalized and focal epilepsies. KLIN NEUROPHYSIOL 2006. [DOI: 10.1055/s-2006-939249] [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: 10/20/2022]
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Tiemann M, Claviez A, Lüders H, Zimmermann M, Schellong G, Dörffel W, Parwaresch R. Proliferation characteristics in pediatric Hodgkin's lymphoma point to a cell cycle arrest in the G(1) phase. Mod Pathol 2005; 18:1440-7. [PMID: 16056247 DOI: 10.1038/modpathol.3800466] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 11/09/2022]
Abstract
This study was undertaken to determine the prognostic relevance of the proliferation rate in neoplastic cells in children and adolescents with Hodgkin's lymphoma. Paraffin-embedded biopsy specimens were immunostained with the proliferation-associated monoclonal antibodies Ki-S5 (Ki-67 antigen) and Ki-S2 (which detects the repp86 protein). Repp86 is a protein of about 100 kDa encoded by a gene located on human chromosome band 20q11.2. In contrast to the Ki-67 antigen, repp86 expression is restricted to the cell cycle phases G(2), S and M. Immunohistochemical results on diagnostic lymph node biopsy specimens from 224 patients included in two pediatric multicenter Hodgkin's trials, GPOH HD-90 and HD-95, were compared with clinical data. High Ki-67 antigen expression was a striking feature of Hodgkin's and Reed-Sternberg cells as well as lymphocytic and histiocytic cells (median: 80%, range: 20-100%), in contrast to low repp86 expression (median: 20%, range: 10-80%; P<0.001). The proliferation rate was independent of histological subtype, stage and presence of B symptoms. The probability of event-free and overall survival (+/-standard error) of all patients at 5 years was 91.6+/-2.0 and 98.1+/-1.0%, respectively. The proliferation rate of tumor cells did not influence the outcome. The difference between Ki-67 and repp86 expression in Hodgkin's and Reed-Sternberg or lymphocytic and histiocytic cells points to a possible cell cycle arrest in the G(1) phase, which may explain the obvious paradox of a highly proliferating but slowly growing paucicellular tumor. High Ki-67 expression does not seem to be an adverse prognostic factor in pediatric and adolescent patients with Hodgkin's lymphoma treated by effective risk-adapted chemo-radiotherapy regimens.
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Affiliation(s)
- Markus Tiemann
- Department of Hematopathology, University of Kiel, Kiel, Germany
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Schellong G, Dörffel W, Claviez A, Körholz D, Mann G, Scheel-Walter HG, Bökkerink JPM, Riepenhausen M, Lüders H, Pötter R, Rühl U. Salvage therapy of progressive and recurrent Hodgkin's disease: results from a multicenter study of the pediatric DAL/GPOH-HD study group. J Clin Oncol 2005; 23:6181-9. [PMID: 16135485 DOI: 10.1200/jco.2005.07.930] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [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: 11/20/2022] Open
Abstract
PURPOSE To evaluate a salvage therapy (ST-HD-86) for patients with progressive and relapsed Hodgkin's disease after primary treatment in the pediatric DAL/GPOH studies. The essential chemotherapeutic regimens were ifosfamide, etoposide, and prednisone (IEP) and doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). METHODS One hundred seventy-six patients with progression (n = 51) or first relapse (n = 125) were enrolled by 67 centers. The median time from initial diagnosis to progression/relapse was 1.1 year (range, 0.1 to 15.3 years), and the patients' median age was 14.7 years (range, 4.3 to 24.5 years). Salvage chemotherapy consisted of two to three cycles of IEP alternating with one to two cycles of ABVD supplemented in part by one to two cycles of cyclophosphamide, vincristine, procarbazine, and prednisone or lomustine (CCNU), etoposide, and prednimustine. Radiotherapy was given to involved areas using individualized doses. In the 1990s, additional high-dose chemotherapy with autologous stem-cell transplantation (SCT) was introduced for patients with unfavorable prognosis. RESULTS Disease-free survival (DFS) and overall survival (OS) after 10 years are 62% and 75%, respectively (SE, 4% each). Of 176 patients, 73 suffered second events. The risk-factor analysis revealed the time to progression/relapse as the strongest prognostic factor (P = .0001). Patients with progression have an inferior outcome (DFS, 41%; OS, 51%), whereas patients with late relapse (> 12 months after end of therapy) do well (DFS, 86%; OS, 90%), although none of them received SCT in second remission. CONCLUSION The result can be considered favorable. Whereas the salvage strategy for progressive disease has to be optimized further, it is possible to reduce intensity and avoid SCT in late relapses after Hodgkin's disease in childhood/adolescence.
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Affiliation(s)
- Günther Schellong
- Universitätsklinikum Münster, Kinderklinik, Pädiatrische Hämatologie und Onkologie, Albert-Schweitzer-Strasse 33, D-48129 Münster, Germany.
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Claviez A, Tiemann M, Lüders H, Krams M, Parwaresch R, Schellong G, Dörffel W. Impact of latent Epstein-Barr virus infection on outcome in children and adolescents with Hodgkin's lymphoma. J Clin Oncol 2005; 23:4048-56. [PMID: 15961758 DOI: 10.1200/jco.2005.01.701] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [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: 11/20/2022] Open
Abstract
PURPOSE The prognostic significance of latent Epstein-Barr virus (EBV) infection in Hodgkin's lymphoma (HL) is debated controversially. Especially in the pediatric age group, no conclusive data are available. PATIENTS AND METHODS Eight hundred forty-two children and adolescents (median age, 13.7 years) from pediatric multicenter treatment studies HD-90 and HD-95 were studied for latent EBV infection in Hodgkin's and Reed-Sternberg cells by immunostaining against latent membrane protein 1 (LMP-1). Results were compared with established risk factors. RESULTS Two hundred sixty-three patients (31%) were LMP positive. EBV infection correlated with sex (39% male v 23% female; P < .001), histologic subtype (69% mixed cellularity v 22% nodular sclerosis v 6% lymphocyte predominance; P < .001) and young age. With a median follow-up of 4.9 years, 820 patients (97%) are alive. Probability of overall survival at 10 years (+/- standard deviation) for EBV-negative and -positive patients was 98.1% +/- 0.6% and 95.1% +/- 1.4%, respectively (P = .017 by log-rank test). A negative effect of EBV infection became evident for patients with nodular sclerosis subtype Bennett II (P = .02), and those treated for advanced stages (P = .003). In multivariate analysis, LMP positivity was an independent factor for adverse outcome (RR = 3.08). Probability of failure-free survival (FFS) in LMP positive and negative patients was 89.1% +/- 2.3% and 84.1% +/- 3.9%, respectively (P = .86). CONCLUSION With effective combined treatment modalities in pediatric HL, latent EBV infection has no influence on FFS but is associated with an inferior overall survival in crucial subgroups.
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Affiliation(s)
- Alexander Claviez
- Department of Pediatrics, Germany Lymph Registry, University of Kiel, Schwanenweg 20, 24105 Kiel, Germany.
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Körholz D, Kluge R, Wickmann L, Hirsch W, Lüders H, Lotz I, Dannenberg C, Hasenclever D, Dörffel W, Sabri O. Importance of F18-fluorodeoxy-D-2-glucose positron emission tomography (FDG-PET) for staging and therapy control of Hodgkin's lymphoma in childhood and adolescence - consequences for the GPOH-HD 2003 protocol. Oncol Res Treat 2004; 26:489-93. [PMID: 14605468 DOI: 10.1159/000072984] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The prognosis for children and adolescents with Hodgkin's lymphoma is excellent. However, many patients will show secondary malignancies 15-30 years after the initial diagnosis, which appears to be connected with the intensity of treatment during primary disease. In the GPOH-HD 95 trial, the indication for radiotherapy was limited to patients who did not show a complete remission after chemotherapy, as determined radiographically. In the future protocol, the indication for radiotherapy in patients with early-stage Hodgkin's lymphoma should be further refined by using FDG-PET for evaluating the response to chemotherapy. Furthermore, in patients at an advanced stage of the disease, it should be determined if sequential FDG-PET research during chemotherapy can separate patients into subgroups with an excellent or a poor prognosis. This article gives a review of the current literature on FDG-PET in patients with Hodgkin's lymphoma and outlines the consequences for future protocols.
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Affiliation(s)
- D Körholz
- Department of Pediatrics, University of Leipzig Medical Center; Germany.
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38
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Wieser HG, Blume WT, Fish D, Goldensohn E, Hufnagel A, King D, Sperling MR, Lüders H. Proposal for a New Classification of Outcome with Respect to Epileptic Seizures Following Epilepsy Surgery. Epilepsia 2003. [DOI: 10.1046/j.1528-1157.2001.4220282.x] [Citation(s) in RCA: 505] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dörffel W, Lüders H, Rühl U, Albrecht M, Marciniak H, Parwaresch R, Pötter R, Schellong G, Schwarze EW, Wickmann L. Preliminary results of the multicenter trial GPOH-HD 95 for the treatment of Hodgkin's disease in children and adolescents: analysis and outlook. Klin Padiatr 2003; 215:139-45. [PMID: 12838937 DOI: 10.1055/s-2003-39372] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND In 5 consecutive pediatric and adolescent Hodgkin's disease trials DAL-HD since 1978 the invasive diagnostic procedures and the radiotherapy have gradually been reduced and chemotherapy modified to minimize toxicity and the risk of late effects. Since 1982 the overall survival increased up to 95%. In this trial the possibility of reducing local radiation doses to 20 Gy in patients with good response to chemotherapy and omitting radiotherapy totally for patients with complete remission after chemotherapy was tested. PATIENTS AND METHODS Over a period of 6 years, from August 1995 to July 2001, 1018 children and adolescents with Hodgkin's disease from Germany, Austria,Switzerland, the Netherlands, Sweden, Norway and Denmark were enrolled in this trial. The chemotherapy was equivalent to previous trial DAL-HD 90. The treatment group (TG) 1 (stages I and IIA) received 2 cycles OPPA for girls and 2 cycles OEPA for boys, TG2 (stages IIEA, IIB, IIIA) and TG3 (stages IIEB, IIIEA, IIIB, IV) received additional 2 or 4 cycles COPP respectively. In contrast to trial DAL-HD 90 boys in stage IIIB and IIIEB received OPPA instead of OEPA. The initial staging as well as the restaging for evaluating tumor volume reduction after chemotherapy was reviewed by the study center. Radiotherapy was planned accordingly: patients with complete remission after chemotherapy were not irradiated (21.9%); all other patients received local radiotherapy to the initially involved sites, depending on the tu-mor response. Patients with a partial remission of> 75 tumor regression were irradiated with 20 Gy (50AX), partial remission of< 75% with 30 Gy (4.1 %), and residual masses of > 50 ml were boosted up to 35 Gy (20.2 %). RESULTS 36 tumor progressions and 49 relapses occurred over a period of 7 1/2 years (median followup 3 years, data deadline 12/19/02). Kaplan-Meier-analysis after 5 years showed a probability for event-free survival (pEFS) for all patients of 0.88 and for overall survival (pOS) of 0.97. For the total group the pDFS (disease free survival) was lower in 222 non irradiated patients than in the 758 irradiated patients (0.88 vs. 0.92,p - 0.049). But there was a difference between the individual treatment groups. In TG 1 there was no difference between nonirradiated and irradiated patients (0.97 vs. 0.94) and the non-ir-radiated patients showed a better trend. In TG 2, and in TG 2 and TG 3 combined, the pDFS was significantly worse for non irradiated patients in comparison with the irradiated patients (TG2:0.78 vs. 0.92; TG 2 +3:0.79 vs. 0.91). Compared to former DAL-HD trials the pOS stayed stable despite therapy reduction. CONCLUSIONS A reduction of radiotherapy to 20 Gy for patients in all stages with good response to chemotherapy is possible without deterioration of the results. The omission of radiotherapy for patients in complete remission after chemotherapy is recommended only for patients in early stages (TG1). In future trials the possibility of a wider selection for chemotherapy alone for this group needs to be evaluated. In intermediate (TG2) and advanced (TG3) stages omission of radiotherapy for patients incomplete remission results in a lower pEFS, but the pOS is not significantly reduced. Only with knowledge of the long term effects of today's therapy we can give a satisfactory answer to the question whether in future trials the primary aim should be pEFS as high as possible due to front-line-therapy or reduction of late effects.
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Affiliation(s)
- W Dörffel
- Klinik für Kinderheilkunde und Jugenmedizin, Bereich Onkologie/Hämatologie, Helios-Klinikum Berlin, Germany.
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Wickmann L, Lüders H, Dörffel W. [18-FDG-PET-findings in children and adolescents with Hodgkin's disease: retrospective evaluation of the correlation to other imaging procedures in initial staging and to the predictive value of follow up examinations]. Klin Padiatr 2003; 215:146-50. [PMID: 12778354 DOI: 10.1055/s-2003-39373] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Today no evidence based medicine analyses exist about the value of positron emission tomography (PET) in children and adolescents with Morbus Hodgkin. The increasing number of registered PET-examinations within the scope of the GPOH-HD 95 trial motivated to analyse the validity of 18-FDG-PET-examination findings in comparison to the conventional diagnostic methods (CT/MRI/ultrasound) and to the patients follow up. 67 PET-primary staging findings and 48 PET-follow up findings of altogether 106 patients from 27 PET-centres were analysed. Concerning the primary staging findings a concordance of 92% of the PET-findings and the findings of the CT/MRI/ultrasound-examinations per localisation was found, but in more than 50% of the patients a discrepancy occurred in at least one of the 9 investigated localisations. The analysis of the PET follow up findings showed a negative predictive value of 94% in regularly examinations (without previous suspicion of relapse), but only a positive predictive value of 25%. In case of relapse suspicion there was a negative predictive value of 83% and a positive predictive value of 76% in PET. A good prognosis is possible to predict from negative PET follow up findings (relapse risk in regularly controls 7%, at relapse suspicion 17%), whereas the probability for a true relapse in positive PET follow up findings is only markedly increased in case of former relapse suspicion (relapse risk in regularly controls 25%, at relapse suspicion 82%). A prospective multicenter PET study should be realized to analyse systematically the value of PET diagnostics in staging and restaging examinations of children and adolescents with Hodgkin's disease, especially to validate the PET diagnostics in exclusion of vital tumor residuals.
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Affiliation(s)
- L Wickmann
- HELIOS Klinikum Berlin, Klinikum Buch, II. Klinik für Kinderheilkunde und Jugendmedizin.
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Abstract
OBJECTIVE To investigate the lateralization and localization of ictal EEG in focal epilepsy. METHODS A total of 486 ictal EEG of 72 patients with focal epilepsy arising from the mesial temporal, neocortical temporal, mesial frontal, dorsolateral frontal, parietal, and occipital regions were analyzed. RESULTS Surface ictal EEG was adequately localized in 72% of cases, more often in temporal than extratemporal epilepsy. Localized ictal onsets were seen in 57% of seizures and were most common in mesial temporal lobe epilepsy (MTLE), lateral frontal lobe epilepsy (LFLE), and parietal lobe epilepsy, whereas lateralized onsets predominated in neocortical temporal lobe epilepsy and generalized onsets in mesial frontal lobe epilepsy (MFLE) and occipital lobe epilepsy. Approximately two-thirds of seizures were localized, 22% generalized, 4% lateralized, and 6% mislocalized/lateralized. False localization/lateralization occurred in 28% of occipital and 16% of parietal seizures. Rhythmic temporal theta at ictal onset was seen exclusively in temporal lobe seizures, whereas localized repetitive epileptiform activity was highly predictive of LFLE. Seizures arising from the lateral convexity and mesial regions were differentiated by a high incidence of repetitive epileptiform activity at ictal onset in the former and rhythmic theta activity in the latter. CONCLUSIONS With the exception of mesial frontal lobe epilepsy, ictal recordings are very useful in the localization/lateralization of focal seizures. Some patterns are highly accurate in localizing the epileptogenic lobe. One limitation of ictal EEG is the potential for false localization/lateralization in occipital and parietal lobe epilepsies.
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Affiliation(s)
- N Foldvary
- Department of Neurology, The Cleveland Clinic Foundation, OH 44195, USA.
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Abstract
OBJECTIVE To investigate the lateralization and localization of ictal EEG in focal epilepsy. METHODS A total of 486 ictal EEG of 72 patients with focal epilepsy arising from the mesial temporal, neocortical temporal, mesial frontal, dorsolateral frontal, parietal, and occipital regions were analyzed. RESULTS Surface ictal EEG was adequately localized in 72% of cases, more often in temporal than extratemporal epilepsy. Localized ictal onsets were seen in 57% of seizures and were most common in mesial temporal lobe epilepsy (MTLE), lateral frontal lobe epilepsy (LFLE), and parietal lobe epilepsy, whereas lateralized onsets predominated in neocortical temporal lobe epilepsy and generalized onsets in mesial frontal lobe epilepsy (MFLE) and occipital lobe epilepsy. Approximately two-thirds of seizures were localized, 22% generalized, 4% lateralized, and 6% mislocalized/lateralized. False localization/lateralization occurred in 28% of occipital and 16% of parietal seizures. Rhythmic temporal theta at ictal onset was seen exclusively in temporal lobe seizures, whereas localized repetitive epileptiform activity was highly predictive of LFLE. Seizures arising from the lateral convexity and mesial regions were differentiated by a high incidence of repetitive epileptiform activity at ictal onset in the former and rhythmic theta activity in the latter. CONCLUSIONS With the exception of mesial frontal lobe epilepsy, ictal recordings are very useful in the localization/lateralization of focal seizures. Some patterns are highly accurate in localizing the epileptogenic lobe. One limitation of ictal EEG is the potential for false localization/lateralization in occipital and parietal lobe epilepsies.
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Affiliation(s)
- N Foldvary
- Department of Neurology, The Cleveland Clinic Foundation, OH 44195, USA.
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Rühl U, Albrecht M, Dieckmann K, Lüders H, Marciniak H, Schellenberg D, Wickmann L, Dörffel W. Response-adapted radiotherapy in the treatment of pediatric Hodgkin's disease: an interim report at 5 years of the German GPOH-HD 95 trial. Int J Radiat Oncol Biol Phys 2001; 51:1209-18. [PMID: 11728679 DOI: 10.1016/s0360-3016(01)01798-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [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: 11/26/2022]
Abstract
PURPOSE A multinational trial on pediatric Hodgkin's disease (HD) with the aim to reduce the risk of long-term toxicity of combined modality treatment by restricting dose and volume of radiation therapy (RT) while maintaining the excellent treatment results of previous German multicenter trials (DAL-HD82-90). METHODS AND MATERIALS Patients were treated according to stage of disease (CS) and defined risk factors in three treatment groups (TG) with 2, 4, or 6 cycles of combination chemotherapy. When a complete remission (CR) had been achieved, treatment was terminated without RT independent of initial stage or tumor bulk. Patients with a partial remission (PR) of >75% tumor regression were irradiated with 20 Gy using modified involved fields; in the case of PR <75% RT dose was 30 Gy, residual masses >50 mL received 35 Gy. RESULTS From August 1995 to July 2000 a total of 956 patients have been registered, 830 as trial patients, 39% in TG1, 27% in TG2, 34% in TG3. 827 patients were evaluable by June 2001 with a median follow-up of 38 months. Chemotherapy (CTx) resulted in CR in 22%, PR >75% in 62%, PR <75% in 12%. Event-free survival (EFS) for the entire group is 90% (SD 0.01), for TG1 94%, TG2 91%, and TG3 84%; the overall survival is 97% in Kaplan-Meier-analysis. Relapse-free survival (RFS) is superior for patients with RT after PR (93%) than for those without RT after CR (89%); the difference is significant (p = 0.01) for advanced stages, however not in TG1. Seventy-two events were observed by June 2001: 28 progressions during the initial therapy or within the first 3 months, 38 relapses, 3 second malignancies, three fatal accidents or infections; 18 patients have died. CONCLUSION Treatment results of the GPOH-HD 95 trial are excellent thus far. The reduction of RT dose and volume in PR has not caused a significant impairment of overall and event-free survival in comparison to the previous German trials; however, failure rates are higher in advanced stages when RT is omitted after achieving a CR. It is too early to tell whether the HD 95 protocol will be successful in reducing late toxicity.
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Affiliation(s)
- U Rühl
- Department of Radiation Oncology and Nuclear Medicine, Moabit Hospital Berlin, Berlin, Germany.
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Abstract
An overview of the following six cortical zones that have been defined in the presurgical evaluation of candidates for epilepsy surgery is given: the symptomatogenic zone; the irritative zone; the seizure onset zone; the epileptogenic lesion; the epileptogenic zone; and the eloquent cortex. The stepwise historical evolution of these different zones is described. The current diagnostic techniques used in the definition of these cortical zones, such as video-EEG monitoring, MRI and ictal single photon emission computed tomography, are discussed. Established diagnostic tests are set apart from procedures that should still be regarded as experimental, such as magnetoencephalography, dipole source localization and spike-triggered functional MRI. Possible future developments that might lead to a more direct definition of the epileptogenic zone are presented.
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Affiliation(s)
- F Rosenow
- Department of Neurology, Philipps University, Marburg, Germany
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45
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Abstract
The authors studied the localizing or lateralizing value of painful epileptic auras in 25 patients with focal epilepsy. Painful auras were seen in 4.1% patients with focal epilepsy arising from temporal, frontal, perirolandic, or parieto-occipital regions. Abdominal pain was present in 5% of all abdominal auras in temporal lobe epilepsy and 50% of all abdominal auras in frontal lobe epilepsy. In perirolandic epilepsy, painful somatosensory auras were lateralized contralateral to the epileptic hemisphere but not consistently in temporal lobe epilepsy.
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Affiliation(s)
- D R Nair
- Department of Neurology, Cleveland Clinic Foundation, OH 44195-5245, USA.
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Mohamed A, Wyllie E, Ruggieri P, Kotagal P, Babb T, Hilbig A, Wylie C, Ying Z, Staugaitis S, Najm I, Bulacio J, Foldvary N, Lüders H, Bingaman W. Temporal lobe epilepsy due to hippocampal sclerosis in pediatric candidates for epilepsy surgery. Neurology 2001; 56:1643-9. [PMID: 11425928 DOI: 10.1212/wnl.56.12.1643] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the clinical, EEG, MRI, and histopathologic features and explore seizure outcome in pediatric candidates for epilepsy surgery who have temporal lobe epilepsy (TLE) caused by hippocampal sclerosis (HS). METHODS The authors studied 17 children (4 to 12 years of age) and 17 adolescents (13 to 20 years of age) who had anteromesial temporal resection between 1990 and 1998. RESULTS All patients had seizures characterized by decreased awareness and responsiveness. Automatisms were typically mild to moderate in children and moderate to marked in adolescents. Among adolescents, interictal spikes were almost exclusively unilateral anterior temporal, as opposed to children in whom anterior temporal spikes were associated with mid/posterior temporal, bilateral temporal, extratemporal, or generalized spikes in 60% of cases. MRI showed hippocampal sclerosis on the side of EEG seizure onset in all patients. Fifty-four percent of children and 56% of adolescents had significant asymmetry of total hippocampal volumes, whereas the remaining patients had only focal atrophy of the hippocampal head or body. Subtle MRI abnormalities of ipsilateral temporal neocortex were seen in all children and 60% of adolescents studied with FLAIR images. On histopathology, there was an unexpectedly high frequency of dual pathology with mild to moderate cortical dysplasia as well as HS, seen in 79% of children and adolescents. Seventy-eight percent of patients were free of seizures at follow-up (mean, 2.6 years). A tendency for lower seizure-free outcome was observed in patients with bilateral temporal interictal sharp waves or bilateral HS on MRI. The presence of dual pathology did not portend poor postsurgical outcome. CONCLUSIONS TLE caused by HS similar to those in adults were seen in children as young as 4 years of age. Focal hippocampal atrophy seen on MRI often was not reflected in total hippocampal volumetry. Children may have an especially high frequency of dual pathology, with mild to moderate cortical dysplasia as well as HS, and MRI usually, but not always, predicts this finding. Postsurgical seizure outcome is similar to that in adult series.
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Affiliation(s)
- A Mohamed
- Department of Neurology, The Cleveland Clinic Foundation, OH 44195, USA
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Wieser HG, Blume WT, Fish D, Goldensohn E, Hufnagel A, King D, Sperling MR, Lüders H, Pedley TA. ILAE Commission Report. Proposal for a new classification of outcome with respect to epileptic seizures following epilepsy surgery. Epilepsia 2001; 42:282-6. [PMID: 11240604] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- H G Wieser
- Neurology Clinic, Epileptology & EEG, University Hospital, CH-8091 Zurich, Switzerland.
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Edwards JC, Wyllie E, Ruggeri PM, Bingaman W, Lüders H, Kotagal P, Dinner DS, Morris HH, Prayson RA, Comair YG. Seizure outcome after surgery for epilepsy due to malformation of cortical development. Neurology 2000; 55:1110-4. [PMID: 11071487 DOI: 10.1212/wnl.55.8.1110] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.8] [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: 11/15/2022] Open
Abstract
PURPOSE To explore seizure outcome after surgery for focal epilepsy due to malformation of cortical development (MCD), with focus on the role of MRI. METHODS Thirty-five patients who had surgery for intractable focal epilepsy due to MCD identified by preoperative MRI and confirmed by histopathologic analysis of resected tissue were studied. Patients were aged 3 months to 47 years (median, 14 years) at the time of surgery. Duration of follow-up was 1 to 7.9 (mean, 3.4) years. RESULTS At latest follow-up, 17 patients (49%) had Engel Class I outcome with no seizures or auras only; eight patients (23%) had Class II outcome, with rare disabling seizures; seven patients (20%) had worthwhile improvement; and three patients (9%) had no improvement. Seizure-free outcome tended to be more frequent among patients who had complete resection of unilateral MCD (excluding hemimegalencephaly) based on postoperative MRI (7/12; 58%), compared with patients with unilateral MCD who had incomplete resection (3/11; 27%), but the difference was not significant. The frequency of seizure-free outcome did not differ significantly between children (8/14; 57%), adolescents (7/15; 47%) or adults (2/6; 33%); between patients who had daily (12/24; 50%), weekly (4/9; 44%), or monthly (1/2; 50%) seizures preoperatively; between patients who had temporal (2/6; 33%) or extratemporal or multilobar resections (14/28; 50%); or between patients who were (9/16; 56%) or were not (8/19; 42%) studied with subdural electrodes. Results for all analyses were similar when analyzed at latest available follow-up or at 1 year after surgery. CONCLUSIONS Surgery can offer seizure-free outcome for approximately one half of carefully selected patients with intractable focal epilepsy due to MCD. Complete resection of the MRI-apparent lesion may improve the likelihood for favorable outcome. MRI evidence of hemimegalencephaly or bilateral MCD suggests a low likelihood for postoperative freedom from seizures.
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Affiliation(s)
- J C Edwards
- Department of Neurology, Cleveland Clinic Foundation, OH 44195, USA
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Lüders H, Acharya J, Baumgartner C, Benbadis S, Bleasel A, Burgess R, Dinner DS, Ebner A, Foldvary N, Geller E, Hamer H, Holthausen H, Kotagal P, Morris H, Meencke HJ, Noachtar S, Rosenow F, Sakamoto A, Steinhoff BJ, Tuxhorn I, Wyllie E. A new epileptic seizure classification based exclusively on ictal semiology. Acta Neurol Scand 1999; 99:137-41. [PMID: 10100955 DOI: 10.1111/j.1600-0404.1999.tb07334.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [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: 11/28/2022]
Abstract
Historically, seizure semiology was the main feature in the differential diagnosis of epileptic syndromes. With the development of clinical EEG, the definition of electroclinical complexes became an essential tool to define epileptic syndromes, particularly focal epileptic syndromes. Modern advances in diagnostic technology, particularly in neuroimaging and molecular biology, now permit better definitions of epileptic syndromes. At the same time detailed studies showed that there does not necessarily exist a one-to-one relationship between epileptic seizures or electroclinical complexes and epileptic syndromes. These developments call for the reintroduction of an epileptic seizure classification based exclusively on clinical semiology, similar to the seizure classifications which were used by neurologists before the introduction of the modern diagnostic methods. This classification of epileptic seizures should always be complemented by an epileptic syndrome classification based on all the available clinical information (clinical history, neurological exam, ictal semiology, EEG, anatomical and functional neuroimaging, etc.). Such an approach is more consistent with mainstream clinical neurology and would avoid the current confusion between the classification of epileptic seizures (which in the International Seizure Classification is actually a classification of electroclinical complexes) and the classification of epileptic syndromes.
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Affiliation(s)
- H Lüders
- The Cleveland Clinic Foundation, Department of Neurology, Ohio 44195, USA
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Szabó CA, Wyllie E, Siavalas EL, Najm I, Ruggieri P, Kotagal P, Lüders H. Hippocampal volumetry in children 6 years or younger: assessment of children with and without complex febrile seizures. Epilepsy Res 1999; 33:1-9. [PMID: 10022361 DOI: 10.1016/s0920-1211(98)00068-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [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: 11/17/2022]
Abstract
PURPOSE To study the relationship of complex febrile seizures (CFS) in the evolution of mesial temporal sclerosis. METHODS We studied five children 22-68 (mean 44) months old with MRI volumetry 2 days-46 months after their first CFS, and compared total hippocampal volumes and right to left hippocampal volume ratios to those of 11 controls, 15-83 (mean 55) months old, who had MRI for complaints which turned out to be neurologically insignificant. RESULTS In control children, total hippocampal volumes increased linearly with age, while right to left hippocampal volume ratios tended to decrease with age. In children with CFS total hippocampal volumes tended to be smaller than in controls. Right to left ratios were greater than 1 in all five children with CFS compared to seven of 11 controls. Hippocampal asymmetry was noted in only one child, with the right to left volume ratio exceeding two standard deviations from the control mean. The MRI of this child also demonstrated a subarachnoid cyst in the left frontocentral region, ipsilateral to the smaller hippocampus. Visual inspection of the remaining patients revealed no definite structural cortical abnormalities. None of the children developed subsequent afebrile seizures during the brief follow-up period. CONCLUSIONS Hippocampal volumetry in controls revealed a linear increase in total hippocampal volumes and a statistically nonsignificant trend toward reduced right larger than left hippocampal ratios between 17 and 83 months old. The tendency for smaller total hippocampal volumes and larger right to left hippocampal volume ratios in children with CFS compared to controls could suggest a developmental abnormality, injury during CFS, or be age-related. The significant hippocampal asymmetry in a single child with CFS suggests that age may not be a factor in every case. Further studies are needed to collect control data in young children as well as prospectively follow children with CFS with serial imaging to better understand the relationship between CFS and the evolution of hippocampal atrophy.
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Affiliation(s)
- C A Szabó
- Division of Neurology, University of Texas Health Science Center at San Antonio, USA
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