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Khalatbari H, Shulkin BL, Parisi MT. PET/CT and PET/MR in Soft Tissue Sarcoma: An Update. Semin Nucl Med 2024; 54:313-331. [PMID: 38423851 DOI: 10.1053/j.semnuclmed.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024]
Abstract
Soft tissue sarcomas account for 6%-8% of pediatric cancers. The rhabdomyosarcoma family is the most frequent soft tissue sarcoma in this age group accounting for 3% of pediatric cancers. Rhabdomyosarcomas are high-grade tumors with a high propensity to metastasize. The risk-adapted, multimodal therapeutic approach for rhabdomyosarcomas incorporates a combination of surgery, radiotherapy, and multi-agent cytotoxic chemotherapy. Soft tissue sarcomas other than rhabdomyosarcoma account for 3%-4% of pediatric cancers. The nonrhabdomyosarcoma soft tissue sarcomas include both low-grade and high-grade tumors. While surgery is the mainstay of therapy in most non-rhabdomyosarcoma soft tissue sarcomas, many cases require a multimodal therapeutic approach including radiotherapy and chemotherapy. In North America, most pediatric patients with soft tissue sarcomas are treated in Children's Oncology Group clinical trials. In this article, we will primarily focus on the staging, risk stratification, imaging recommendations, and interpretations in accordance with the Children's Oncology Group trials. We will review the results and recommendations of International Soft Tissue Sarcoma Database Consortium and European trials in relevant sections where they provide complementary guidelines.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
| | | | - Marguerite T Parisi
- University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
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2
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Basavalingu D, Sadic M, Cheeney S, Parisi MT. A Rare Case of Abnormal Diffuse Brain Uptake on an 123I MIBG Scan in a Patient With High-Risk Neuroblastoma. Clin Nucl Med 2024; 49:438-441. [PMID: 38574255 DOI: 10.1097/rlu.0000000000005179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT 123I-meta-iodobenzylguanidine (123I-MIBG) is extensively used for initial staging and response evaluation in children with neuroblastoma. Physiological uptake of 123I-MIBG occurs in the salivary glands, liver, adrenal gland, myocardium, bowel, and thyroid gland. 123I-MIBG cannot cross an intact blood-brain barrier. We present the rare case of a 3-year-old boy with neuroblastoma and meningeal metastases who underwent an 123I-MIBG scan for disease restaging that showed abnormal brain uptake. Abnormal MIBG uptake in the brain can occur if there is disruption of the blood-brain barrier either secondary to metastases or after damage to blood-brain barrier.
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Affiliation(s)
- Deepashri Basavalingu
- From the Nuclear Medicine Resident, Department of Radiology, University of Washington School of Medicine. Corresponding author, involved in the preparation and editing of manuscript including images. Nothing to disclose
| | - Murat Sadic
- Acting Instructor and PET-CT Fellow, Department of Radiology, University of Washington School of Medicine. Preparation of the manuscript and selection of figures. Nothing to disclose
| | - Safia Cheeney
- From the Nuclear Medicine Resident, Department of Radiology, University of Washington School of Medicine. Corresponding author, involved in the preparation and editing of manuscript including images. Nothing to disclose
| | - Marguerite T Parisi
- Professor Emeritus, Department of Radiology, University of Washington School of Medicine, Attending Radiologist, Seattle Children's Hospital. Mentorship, image selection of figures and editing of the manuscript Nothing to disclose
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3
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Weiss AR, Chen YL, Scharschmidt TJ, Xue W, Gao Z, Black JO, Choy E, Davis JL, Fanburg-Smith JC, Kao SC, Kayton ML, Kessel S, Lim R, Million L, Okuno SH, Ostrenga A, Parisi MT, Pryma DA, Randall RL, Rosen MA, Shulkin BL, Terezakis S, Venkatramani R, Zambrano E, Wang D, Hawkins DS, Spunt SL. Outcomes After Preoperative Chemoradiation With or Without Pazopanib in Non-Rhabdomyosarcoma Soft Tissue Sarcoma: A Report From Children's Oncology Group and NRG Oncology. J Clin Oncol 2023; 41:4842-4848. [PMID: 37523624 PMCID: PMC10852395 DOI: 10.1200/jco.23.00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 08/02/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.ARST1321 was a phase II study designed to compare the near complete pathologic response rate after preoperative chemoradiation with/without pazopanib in children and adults with intermediate-/high-risk chemotherapy-sensitive body wall/extremity non-Rhabdomyosarcoma Soft Tissue Sarcoma (ClinicalTrials.gov identifier: NCT02180867). Enrollment was stopped early following a predetermined interim analysis that found the rate of near complete pathologic response to be significantly greater with the addition of pazopanib. As a planned secondary aim of the study, the outcome data for this cohort were analyzed. Eight-five eligible patients were randomly assigned to receive (regimen A) or not receive (regimen B) pazopanib in combination with ifosfamide and doxorubicin + preoperative radiotherapy followed by primary resection at week 13 and then further chemotherapy at week 25. As of December 31, 2021, at a median survivor follow-up of 3.3 years (range, 0.1-5.8 years), the 3-year event-free survival for all patients in the intent-to-treat analysis was 52.5% (95% CI, 34.8 to 70.2) for regimen A and 50.6% (95% CI, 32 to 69.2) for regimen B (P = .8677, log-rank test); the 3-year overall survival was 75.7% (95% CI, 59.7 to 91.7) for regimen A and 65.4% (95% CI, 48.1 to 82.7) for regimen B (P = .1919, log-rank test). Although the rate of near complete pathologic response was significantly greater with the addition of pazopanib, outcomes were not statistically significantly different between the two regimens.
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Affiliation(s)
| | | | | | - Wei Xue
- University of Florida, Gainesville, FL
| | | | | | - Edwin Choy
- Massachusetts General Hospital, Boston, MA
| | | | | | - Simon C. Kao
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | - Sandy Kessel
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, RI
| | - Ruth Lim
- Massachusetts General Hospital, Boston, MA
| | - Lynn Million
- Stanford University School of Medicine, Palo Alto, CA
| | | | | | | | | | | | | | | | | | | | | | - Dian Wang
- Rush University Medical Center, Chicago, IL
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Hodax JK, Brady C, DiVall S, Ahrens KR, Carlin K, Khalatbari H, Parisi MT, Salehi P. Low Pretreatment Bone Mineral Density in Gender Diverse Youth. Transgend Health 2023; 8:467-471. [PMID: 37810939 PMCID: PMC10551758 DOI: 10.1089/trgh.2021.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Gender diverse adolescents have low pretreatment bone mineral density (BMD), with variable changes in BMD after initiation of gender-affirming treatment. We aimed to assess factors associated with low BMD in gender diverse youth. Sixty-four patients were included in our analysis (73% assigned male at birth). Subtotal whole-body BMD Z-scores were low in 30% of patients, and total lumbar spine BMD Z-scores low in 14%. There was a positive association with body mass index, and no association with vitamin D level. Male sex assigned at birth was associated with lower pretreatment BMD, with lower average BMD Z-scores compared to previous studies.
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Affiliation(s)
- Juanita K. Hodax
- Division of Pediatric Endocrinology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Charles Brady
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Sara DiVall
- Division of Pediatric Endocrinology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Kym R. Ahrens
- University of Washington School of Medicine, Seattle, Washington, USA
- Division of Adolescent Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kristen Carlin
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Hedieh Khalatbari
- University of Washington School of Medicine, Seattle, Washington, USA
- Division of Radiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Marguerite T. Parisi
- University of Washington School of Medicine, Seattle, Washington, USA
- Division of Radiology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Parisa Salehi
- Division of Pediatric Endocrinology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
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5
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Streby KA, Parisi MT, Shulkin BL, LaBarre B, Bagatell R, Diller L, Grupp SA, Matthay KK, Voss SD, Yu AL, London WB, Park JR, Yanik GA, Naranjo A. Impact of diagnostic and end-of-induction Curie scores with tandem high-dose chemotherapy and autologous transplants for metastatic high-risk neuroblastoma: A report from the Children's Oncology Group. Pediatr Blood Cancer 2023; 70:e30418. [PMID: 37199022 PMCID: PMC10511015 DOI: 10.1002/pbc.30418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/12/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Diagnostic mIBG (meta-iodobenzylguanidine) scans are an integral component of response assessment in children with high-risk neuroblastoma. The role of end-of-induction (EOI) Curie scores (CS) was previously described in patients undergoing a single course of high-dose chemotherapy (HDC) and autologous hematopoietic cell transplant (AHCT) as consolidation therapy. OBJECTIVE We now examine the prognostic significance of CS in patients randomized to tandem HDC and AHCT on the Children's Oncology Group (COG) trial ANBL0532. STUDY DESIGN A retrospective analysis of mIBG scans obtained from patients enrolled in COG ANBL0532 was performed. Evaluable patients had mIBG-avid, International Neuroblastoma Staging System (INSS) stage 4 disease, did not progress during induction therapy, consented to consolidation randomization, and received either single or tandem HDC (n = 80). Optimal CS cut points maximized the outcome difference (≤CS vs. >CS cut-off) according to the Youden index. RESULTS For recipients of tandem HDC, the optimal cut point at diagnosis was CS = 12, with superior event-free survival (EFS) from study enrollment for patients with CS ≤ 12 (3-year EFS 74.2% ± 7.9%) versus CS > 12 (59.2% ± 7.1%) (p = .002). At EOI, the optimal cut point was CS = 0, with superior EOI EFS for patients with CS = 0 (72.9% ± 6.4%) versus CS > 0 (46.5% ± 9.1%) (p = .002). CONCLUSION In the setting of tandem transplantation for children with high-risk neuroblastoma, CS at diagnosis and EOI may identify a more favorable patient group. Patients treated with tandem HDC who exhibited a CS ≤ 12 at diagnosis or CS = 0 at EOI had superior EFS compared to those with CS above these cut points.
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Affiliation(s)
- Keri A. Streby
- Division of Hematology/Oncology/BMT, Department of Pediatrics, Nationwide Children’s Hospital/The Ohio State University, Columbus, Ohio
| | - Marguerite T. Parisi
- Department of Radiology, Seattle Children’s Hospital/University of Washington School of Medicine, Seattle, Washington
- Department of Pediatrics, Seattle Children’s Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Barry L. Shulkin
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Adjunct Professor of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brian LaBarre
- Children’s Oncology Group Statistics & Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Rochelle Bagatell
- Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lisa Diller
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Stephan A. Grupp
- Department of Pediatrics, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katherine K. Matthay
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
| | - Stephan D. Voss
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alice L. Yu
- University of California in San Diego, San Diego, California
- Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wendy B. London
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts
| | - Julie R. Park
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Gregory A. Yanik
- Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Arlene Naranjo
- Children’s Oncology Group Statistics & Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida
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6
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Chan SS, Coblentz A, Bhatia A, Kaste SC, Mhlanga J, Parisi MT, Thacker P, Voss SD, Weidman EK, Siegel MJ. Imaging of pediatric hematopoietic stem cell transplant recipients: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30013. [PMID: 36546505 PMCID: PMC10644273 DOI: 10.1002/pbc.30013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/28/2022] [Accepted: 09/05/2022] [Indexed: 12/24/2022]
Abstract
Imaging in hematopoietic stem cell transplantation patients is not targeted at evaluating the transplant per se. Rather, imaging is largely confined to evaluating peri-procedural and post-procedural complications. Alternatively, imaging may be performed to establish a baseline study for comparison should the patient develop certain post-procedural complications. This article looks to describe the various imaging modalities available with recommendations for which imaging study should be performed in specific complications. We also provide select imaging protocols for different indications and modalities for the purpose of establishing a set minimal standard for imaging in these complex patients.
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Affiliation(s)
- Sherwin S Chan
- Department of Radiology, Children’s Mercy Kansas City, Kansas City, MO; Department of Radiology, University of Missouri at Kansas City School of Medicine, Kansas City, MO
| | - Ailish Coblentz
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Aashim Bhatia
- Department of Radiology, Division of Neuroradiology Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sue C. Kaste
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - Joyce Mhlanga
- Department of Radiology, Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA
| | | | - Stephan D. Voss
- Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA. 02115
| | - Elizabeth K. Weidman
- Department of Radiology, Weill Cornell Medicine – New York Presbyterian Hospital, New York, NY
| | - Marilyn J Siegel
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
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7
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Squires JH, Martinez-Rios C, Davis JC, Dietz KR, Epelman MS, Lai HA, Lim-Dunham JE, McDaniel JD, Mhlanga JC, Pandit-Taskar N, Parisi MT, Trout AT, Weidman EK, Alazraki AL. Imaging of pediatric thyroid tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29957. [PMID: 36165682 PMCID: PMC10658740 DOI: 10.1002/pbc.29957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022]
Abstract
Pediatric thyroid cancer is rare in children; however, incidence is increasing. Papillary thyroid cancer and follicular thyroid cancer are the most common subtypes, comprising about 90% and 10% of cases, respectively. This paper provides consensus imaging recommendations for evaluation of pediatric patients with thyroid cancer at diagnosis and during follow-up.
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Affiliation(s)
- Judy H Squires
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Claudia Martinez-Rios
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - James C Davis
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly R Dietz
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Monica S Epelman
- Department of Radiology, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Hollie A Lai
- CHOC-Children's Health Orange County, Orange, California, USA
| | - Jennifer E Lim-Dunham
- Department of Radiology, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Janice D McDaniel
- Department of Radiology, Akron Children's Hospital, Akron, Ohio, USA
- Department of Radiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Joyce C Mhlanga
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
- Department of Radiology, Weill Cornell Medical College, New York City, New York, USA
| | - Marguerite T Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Elizabeth K Weidman
- Department of Radiology, Weill Cornell Medicine - New York Presbyterian Hospital, New York City, New York, USA
| | - Adina L Alazraki
- Department of Radiology, Division of Pediatric Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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8
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Lai HA, Sharp SE, Bhatia A, Dietz KR, McCarville B, Rajderkar D, Servaes S, Shulkin BL, Singh S, Trout AT, Watal P, Parisi MT. Imaging of pediatric neuroblastoma: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29974. [PMID: 36184716 PMCID: PMC10680359 DOI: 10.1002/pbc.29974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/07/2022]
Abstract
Neuroblastoma is the most common extracranial solid neoplasm in children. This manuscript provides consensus-based imaging recommendations for pediatric neuroblastoma patients at diagnosis and during follow-up.
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Affiliation(s)
- Hollie A. Lai
- Department of Radiology, Children’s Health Orange County, Orange, CA
| | - Susan E. Sharp
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Aashim Bhatia
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kelly R. Dietz
- Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Sabah Servaes
- Department of Radiology, West Virginia University Children’s Hospital, Morgantown, WV
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, University of TN Health Science Center, St. Jude Children’s Research Hospital, Memphis, TN
| | - Sudha Singh
- Department of Radiology, Monroe Carrell Jr Children’s Hospital, Vanderbilt University, Nashville, TN
| | - Andrew T. Trout
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Pankaj Watal
- Department of Radiology, Nemours Children’s Hospital, Florida and University of Central Florida College of Medicine, Orlando, FL
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA
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9
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Rees MA, Morin CE, Behr GG, Davis JC, Lai H, Morani AC, Parisi MT, Saigal G, Singh S, Yedururi S, Towbin AJ, Shulkin BL. Imaging of pediatric adrenal tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29973. [PMID: 36193741 PMCID: PMC10658400 DOI: 10.1002/pbc.29973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022]
Abstract
Adrenal tumors other than neuroblastoma are uncommon in children. The most frequently encountered are adrenocortical carcinoma and pheochromocytoma. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary adrenal malignancy other than neuroblastoma at diagnosis and during follow-up.
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Affiliation(s)
- Mitchell A. Rees
- Department of Radiology, Nationwide Children’s Hospital, Columbus, OH
| | - Cara E. Morin
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Gerald G. Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Hollie Lai
- Department of Radiology, Children’s Health of Orange County, Orange, CA
| | - Ajaykumar C. Morani
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marguerite T. Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA
| | - Gaurav Saigal
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL
| | - Sudha Singh
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | - Sireesha Yedururi
- Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexander J. Towbin
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
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10
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Mercer MK, Parisi MT, Revels JW, Blacklock L, Elojeimy S. Altered Biodistribution on 99m Tc-Dimercaptosuccinic Acid Renal Scan. Clin Nucl Med 2023; 48:e170-e172. [PMID: 36630966 DOI: 10.1097/rlu.0000000000004528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
ABSTRACT 99m Tc-dimercaptosuccinic acid ( 99m Tc-DMSA) scans are used to evaluate renal cortical defects typically related to parenchymal scarring or pyelonephritis, and ectopic renal parenchyma. 99m Tc-DMSA binds to metalloproteins in proximal tubular cells and typically localizes to the renal cortex, with minimal excretion. Planar and SPECT images are obtained 2 to 4 hours after IV administration of 99m Tc-DMSA. Altered 99m Tc-DMSA biodistribution has been reported in various conditions, including renal injury, technical issues, infiltrative processes, and hematologic disorders. Here, we present a case of altered biodistribution, with hepatic and splenic radiotracer uptake in the setting of hepatosplenomegaly and hematologic abnormalities concerning for a systemic hematologic disorder/lymphohistiocytosis.
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Affiliation(s)
- Megan K Mercer
- From the Department of Radiology, Medical University of South Carolina, Charleston, SC
| | - Marguerite T Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | | | | | - Saeed Elojeimy
- From the Department of Radiology, Medical University of South Carolina, Charleston, SC
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11
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Aboughalia HA, Cheeney SHE, Elojeimy S, Blacklock LC, Parisi MT. Meckel diverticulum scintigraphy: technique, findings and diagnostic pitfalls. Pediatr Radiol 2023; 53:493-508. [PMID: 36323958 DOI: 10.1007/s00247-022-05527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/24/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Meckel diverticulum, the most common congenital anomaly of the gastrointestinal tract, results from the aberrant involution of the omphalomesenteric duct and accounts for more than 50% of unexplained lower gastrointestinal bleeding in the pediatric population. The most accurate imaging tool to identify a Meckel diverticulum containing ectopic gastric mucosa is the Technetium-99m pertechnetate Meckel scan, a scintigraphic study with a reported accuracy of 90% in the pediatric population. In addition to depicting a Meckel diverticulum with ectopic gastric mucosa, careful attention to the normal biodistribution of the radiotracer can lead to the identification of unexpected pathology with implications for patient management. This article serves to review the embryological origin and anatomical features of Meckel diverticulum, highlight the role of scintigraphy in evaluating Meckel diverticulum, and discuss the proper imaging technique when performing this test. We will focus on pitfalls that can lead to an erroneous diagnosis as well as incidental findings that can affect patient management.
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Affiliation(s)
- Hassan A Aboughalia
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Safia H E Cheeney
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Saeed Elojeimy
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Lisa C Blacklock
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
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12
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Erbe AK, Diccianni MB, Mody R, Naranjo A, Zhang FF, Birstler J, Kim K, Feils AS, Hung JT, London WB, Shulkin BL, Mathew V, Parisi MT, Servaes S, Asgharzadeh S, Maris JM, Park J, Yu AL, Sondel PM, Bagatell R. KIR/KIR-ligand genotypes and clinical outcomes following chemoimmunotherapy in patients with relapsed or refractory neuroblastoma: a report from the Children's Oncology Group. J Immunother Cancer 2023; 11:e006530. [PMID: 36822669 PMCID: PMC9950969 DOI: 10.1136/jitc-2022-006530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND In the Children's Oncology Group ANBL1221 phase 2 trial for patients with first relapse/first declaration of refractory high-risk neuroblastoma, irinotecan and temozolomide (I/T) combined with either temsirolimus (TEMS) or immunotherapy (the anti-GD2 antibody dinutuximab (DIN) and granulocyte macrophage colony stimulating factory (GM-CSF)) was administered. The response rate among patients treated with I/T/DIN/GM-CSF in the initial cohort (n=17) was 53%; additional patients were enrolled to permit further evaluation of this chemoimmunotherapy regimen. Potential associations between immune-related biomarkers and clinical outcomes including response and survival were evaluated. METHODS Patients were evaluated for specific immunogenotypes that influence natural killer (NK) cell activity, including killer immunoglobulin-like receptors (KIRs) and their ligands, Fc gamma receptors, and NCR3. Total white cells and leucocyte subsets were assessed via complete blood counts, and flow cytometry of peripheral blood mononuclear cells was performed to assess the potential association between immune cell subpopulations and surface marker expression and clinical outcomes. Appropriate statistical tests of association were performed. The Bonferroni correction for multiple comparisons was performed where indicated. RESULTS Of the immunogenotypes assessed, the presence or absence of certain KIR and their ligands was associated with clinical outcomes in patients treated with chemoimmunotherapy rather than I/T/TEMS. While median values of CD161, CD56, and KIR differed in responders and non-responders, statistical significance was not maintained in logistic regression models. White cell and neutrophil counts were associated with differences in survival outcomes, however, increases in risk of event in patients assigned to chemoimmunotherapy were not clinically significant. CONCLUSIONS These findings are consistent with those of prior studies showing that KIR/KIR-ligand genotypes are associated with clinical outcomes following anti-GD2 immunotherapy in children with neuroblastoma. The current study confirms the importance of KIR/KIR-ligand genotype in the context of I/T/DIN/GM-CSF chemoimmunotherapy administered to patients with relapsed or refractory disease in a clinical trial. These results are important because this regimen is now widely used for treatment of patients at time of first relapse/first declaration of refractory disease. Efforts to assess the role of NK cells and genes that influence their function in response to immunotherapy are ongoing. TRIAL REGISTRATION NUMBER NCT01767194.
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Affiliation(s)
- Amy K Erbe
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Mitch B Diccianni
- Department of Pediatrics, University of California, San Diego, California, USA
| | - Rajen Mody
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, Florida, USA
| | - Fan F Zhang
- Children's Oncology Group Statistics and Data Center, Monrovia, California, USA
| | - Jen Birstler
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin, USA
| | - KyungMann Kim
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin, USA
| | - Arika S Feils
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Jung-Tung Hung
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wendy B London
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Barry L Shulkin
- Departments of Diagnostic Imaging and Comprehensive Cancer Center, St. Jude Children's Research Hospital and the University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Varsha Mathew
- Department of Pediatrics, University of California, San Diego, California, USA
| | - Marguerite T Parisi
- Department of Pediatrics, Seattle Children's Hospital and the University, Seattle, Washington, USA
| | - Sabah Servaes
- Department of Pediatrics, The Children's Hospital, Philadelphia, Pennsylvania, USA
| | - Shahab Asgharzadeh
- Department Cancer and Blood Disease Institute, Childrens Hospital of Los Angeles, Los Angeles, California, USA
| | - John M Maris
- Department of Pediatrics, The Children's Hospital, Philadelphia, Pennsylvania, USA
| | - Julie Park
- Department of Pediatrics, Seattle Children's Hospital and the University, Seattle, Washington, USA
| | - Alice L Yu
- Department of Pediatrics, University of California, San Diego, California, USA
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Paul M Sondel
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin, USA
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, USA
| | - Rochelle Bagatell
- Department of Pediatrics, The Children's Hospital, Philadelphia, Pennsylvania, USA
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13
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Khalatbari H, Shulkin BL, Parisi MT. Emerging Trends in Radionuclide Imaging of Infection and Inflammation in Pediatrics: Focus on FDG PET/CT and Immune Reactivity. Semin Nucl Med 2023; 53:18-36. [PMID: 36307254 DOI: 10.1053/j.semnuclmed.2022.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
The most common indication for 18F-FDG PET/CT is tumor imaging, which may be performed for initial diagnosis, staging, therapeutic response monitoring, surveillance, or suspected recurrence. In the routine practice of pediatric nuclear medicine, most infectious, inflammatory, and autoimmune processes that are detected on 18F-FDG PET/CT imaging - except for imaging in fever or inflammation of unknown origin - are coincidental and not the main indication for image acquisition. However, interpreting these "coincidental" findings is of utmost importance to avoid erroneously attributing these findings to a neoplastic process. We review the recent literature on fever of unknown origin as well as inflammation of unknown origin in pediatrics and then focus on the 18F FDG PET/CT imaging findings seen in two specific entities with increased immune reactivity: hemophagocytic lymphohistiocytosis syndrome and the immune-related adverse events associated with checkpoint inhibitors. We will subsequently close with two sections highlighting related topics and relevant references for further reading.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Barry L Shulkin
- Department of Diagnostic Radiology, St. Jude Children's Research Hospital, Memphis, TN.
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, Seattle, WA; Department of Radiology, University of Washington School of Medicine, Seattle, WA
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14
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Desai AV, Gilman AL, Ozkaynak MF, Naranjo A, London WB, Tenney SC, Diccianni M, Hank JA, Parisi MT, Shulkin BL, Smith M, Moscow JA, Shimada H, Matthay KK, Cohn SL, Maris JM, Bagatell R, Sondel PM, Park JR, Yu AL. Outcomes Following GD2-Directed Postconsolidation Therapy for Neuroblastoma After Cessation of Random Assignment on ANBL0032: A Report From the Children's Oncology Group. J Clin Oncol 2022; 40:4107-4118. [PMID: 35839426 PMCID: PMC9746736 DOI: 10.1200/jco.21.02478] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/31/2022] [Accepted: 05/11/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Postconsolidation immunotherapy including dinutuximab, granulocyte-macrophage colony-stimulating factor, and interleukin-2 improved outcomes for patients with high-risk neuroblastoma enrolled on the randomized portion of Children's Oncology Group study ANBL0032. After random assignment ended, all patients were assigned to immunotherapy. Survival and toxicities were assessed. PATIENTS AND METHODS Patients with a pre-autologous stem cell transplant (ASCT) response (excluding bone marrow) of partial response or better were eligible. Demographics, stage, tumor biology, pre-ASCT response, and adverse events were summarized using descriptive statistics. Event-free survival (EFS) and overall survival (OS) from time of enrollment (up to day +200 from last ASCT) were evaluated. RESULTS From 2009 to 2015, 1,183 patients were treated. Five-year EFS and OS for the entire cohort were 61.1 ± 1.9% and 71.9 ± 1.7%, respectively. For patients ≥ 18 months old at diagnosis with International Neuroblastoma Staging System stage 4 disease (n = 662) 5-year EFS and OS were 57.0 ± 2.4% and 70.9 ± 2.2%, respectively. EFS was superior for patients with complete response/very good partial response pre-ASCT compared with those with PR (5-year EFS: 64.2 ± 2.2% v 55.4 ± 3.2%, P = .0133); however, OS was not significantly different. Allergic reactions, capillary leak, fever, and hypotension were more frequent during interleukin-2-containing cycles than granulocyte-macrophage colony-stimulating factor-containing cycles (P < .0001). EFS was superior in patients with higher peak dinutuximab levels during cycle 1 (P = .034) and those with a high affinity FCGR3A genotype (P = .0418). Human antichimeric antibody status did not correlate with survival. CONCLUSION Analysis of a cohort assigned to immunotherapy after cessation of random assignment on ANBL0032 confirmed previously described survival and toxicity outcomes. EFS was highest among patients with end-induction complete response/very good partial response. Among patients with available data, higher dinutuximab levels and FCGR3A genotype were associated with superior EFS. These may be predictive biomarkers for dinutuximab therapy.
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Affiliation(s)
| | | | - Mehmet Fevzi Ozkaynak
- Maria Fareri Children's Hospital Westchester Medical Center, New York Medical College, Valhalla, NY
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
| | - Wendy B. London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA
| | - Sheena C. Tenney
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
| | | | | | - Marguerite T. Parisi
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | | | - Malcolm Smith
- Clinical Investigations Branch, National Cancer Institute, Bethesda, MD
| | - Jeffrey A. Moscow
- Investigational Drug Branch, National Cancer Institute, Bethesda, MD
| | | | | | | | - John M. Maris
- Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA
| | - Rochelle Bagatell
- Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, PA
| | - Paul M. Sondel
- University of Wisconsin Carbone Cancer Center, Madison, WI
| | - Julie R. Park
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Alice L. Yu
- University of California in San Diego, San Diego, CA
- Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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15
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Federico SM, Naranjo A, Zhang F, Marachelian A, Desai AV, Shimada H, Braunstein SE, Tinkle CL, Yanik GA, Asgharzadeh S, Sondel PM, Yu AL, Acord M, Parisi MT, Shulkin BL, DuBois SG, Bagatell R, Park JR, Furman WL, Shusterman S. A pilot induction regimen incorporating dinutuximab and sargramostim for the treatment of newly diagnosed high-risk neuroblastoma: A report from the Children's Oncology Group. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10003 Background: The addition of dinutuximab (DIN) in the post-consolidation setting led to improved event-free survival rates for patients with high-risk neuroblastoma. Chemoimmunotherapy including irinotecan, temozolomide, DIN and sargramostim (GM-CSF) in patients with recurrent or refractory neuroblastoma results in robust objective clinical responses. Evaluation of chemoimmunotherapy in the induction setting for patients with newly-diagnosed high-risk neuroblastoma (HR-NBL) warrants investigation. Methods: Children’s Oncology Group (COG) ANBL17P1 is a prospective, single arm, limited institution pilot study to assess the tolerability and feasibility of administering DIN (17.5mg/m2/dose, IV Days 2-5) and GM-CSF (250mcg/m2/dose, subcutaneous Days 6-count recovery) with COG Induction chemotherapy Cycles 3-5 for patients with newly-diagnosed high-risk neuroblastoma. The primary endpoint of tolerability included the number of toxic deaths and number of patients experiencing predefined unacceptable toxicities during Induction Cycles 3-5. Unacceptable toxicities included: hypotension requiring pressors > 24 hours, respiratory toxicity requiring ventilatory support > 24 hours, Grade 4 neuropathy that did not resolve prior to the next cycle, and failure to recover the ANC to > 750 mm3 by day 35. Feasibility was assessed as being able to receive > 75% of planned DIN doses administered during Induction Cycles 3-5. Revised International Neuroblastoma Response Criteria (INRC) were used to assess end of Induction (EOI) response. Results: Forty-two eligible and evaluable patients with newly-diagnosed high-risk neuroblastoma enrolled at 8 sites (22 [52.4%] males; median age 3.3 years at diagnosis) from January 14, 2019 to June 4, 2020. The most common DIN related Grade >3 toxicities observed during Induction Cycles 3-5 included fever (31.0%) and pain (9.5%). None of the patients experienced a toxic death or unacceptable toxicity during Induction Cycles 3-5. Thus, the regimen was deemed tolerable. Patients received 97.4% - 101.8% of the total DIN dose expected to be administered during Induction Cycles 3-5. Therefore, the regimen was deemed feasible. Thirty-eight of 42 patients completed the EOI evaluations, including 11 with complete response, 22 with partial response, 0 with minor response, 3 with stable disease and 2 with progressive disease. The overall EOI objective response rate (CR+PR+MR) was 86.8%. Conclusions: The administration of DIN and GM-CSF to COG Induction Cycles 3-5 for patients with newly-diagnosed high-risk neuroblastoma was tolerable and feasible. The objective response rate at EOI appears encouraging. This therapeutic regimen will be studied in a randomized phase 3 trial to further evaluate the efficacy of Induction phase chemoimmunotherapy for high-risk neuroblastoma. Clinical trial information: NCT03786783.
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Affiliation(s)
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
| | - Fan Zhang
- Children's Oncology Group, Monrovia, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Steven G. DuBois
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
| | | | - Julie R. Park
- Seattle Children's Hospital, Cancer and Blood Disorders Center, Seattle, WA
| | - Wayne Lee Furman
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN
| | - Suzanne Shusterman
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA
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16
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Streby KA, Parisi MT, Shulkin BL, LaBarre B, Bagatell R, Diller L, Grupp SA, Matthay KK, Voss SD, Yu AL, London WB, Park JR, Yanik GA, Naranjo A. Impact of diagnostic and end-of-induction Curie scores in tandem autologous hematopoietic cell transplant for patients with high-risk neuroblastoma: A report from the Children’s Oncology Group. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10027 Background: Diagnostic mIBG (meta-iodobenzylguanidine) scans are an integral component of response assessment in children with high-risk neuroblastoma. The role of end of induction (EOI) Curie Scores (CS) has been previously described in patients undergoing a single autologous hematopoietic cell transplant (AHCT) as consolidation therapy. We now examine the prognostic significance of CS in patients randomized to tandem or single AHCT on the Children’s Oncology Group (COG) trial ANBL0532. Methods: A retrospective analysis of mIBG scans obtained from patients enrolled in COG ANBL0532 (n = 652) was performed. Evaluable patients (n = 179) had mIBG-avid, International Neuroblastoma Staging System (INSS) stage 4 disease, did not progress during induction therapy, consented to consolidation randomization, and received either a single (n = 99) or tandem AHCT (n = 80). In addition, evaluable patients had paired mIBG scans at time of initial diagnosis and EOI. Optimal CS cut points maximized the outcome difference (≤ vs > CS cut-off) according to the Youden index. Log-rank tests compared EFS subgroups, with p < 0.05 considered statistically significant. 3-year EFS is presented ± standard error. EFS was estimated for relative reductions in CS of 50% and 75% from diagnosis to EOI. Results: For recipients of tandem AHCT, the optimal cut point at diagnosis was CS = 12, with superior EFS from study enrollment for patients with CS<12 (74.2±7.9%; n = 31) vs CS > 12 (59.2±7.1%; n = 49) (p = 0.002). At EOI, the optimal cut point was CS = 0, with superior EFS from EOI for patients with CS = 0 (72.9±6.4%; n = 48) vs CS > 0 (46.5±9.1%; n = 32) (p = 0.002). The cut point at diagnosis for recipients of single AHCT was CS = 21 (p = 0.04), while the EOI CS had an optimal cut point of 2, but without a significant difference in EFS (p = 0.29). Absolute CS at diagnosis and at EOI had a greater impact on outcome than the relative reduction in CS between diagnosis and EOI, for both single and tandem AHCT. Conclusions: In the setting of tandem transplantation for children with high-risk neuroblastoma, Curie scores at diagnosis and end-induction may identify a more favorable patient group. Patients treated with tandem AHCT who exhibited a CS<12 at diagnosis or CS = 0 at EOI had superior EFS compared to those with CS above these cut points. Similar to prior reports, a CS<2 was the optimal cut point for single transplant recipients. Clinical trial information: NCT00567567.
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Affiliation(s)
- Keri A. Streby
- Nationwide Children's Hospital/The Ohio State University, Columbus, OH
| | | | | | - Brian LaBarre
- Children’s Oncology Group Statistics & Data Center, Department of Biostatistics, University of Florida, Gainesville, FL
| | | | - Lisa Diller
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Stephan A. Grupp
- Pediatric Oncology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | - Wendy B. London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - Julie R. Park
- Seattle Children's Hospital, Cancer and Blood Disorders Center, Seattle, WA
| | - Gregory A. Yanik
- C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
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17
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Khalatbari H, Shulkin BL, Aldape L, Parisi MT. Pediatric Nuclear Medicine: Technical Aspects. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00074-0] [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: 11/16/2022] Open
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18
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Quintanilla-Dieck L, Khalatbari HK, Dinauer CA, Rastatter JC, Chelius DC, Katowitz WR, Shindo ML, Parisi MT, Kazahaya K. Management of Pediatric Graves Disease: A Review. JAMA Otolaryngol Head Neck Surg 2021; 147:1110-1118. [PMID: 34647991 DOI: 10.1001/jamaoto.2021.2715] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The incidence of Graves disease (GD) is rising in children, and adequate care of these patients requires a multidisciplinary approach. Whether patients are seen in the context of endocrinology, nuclear medicine, or surgery, it is important to know the nuances of the therapeutic options in children. Observations Given the rarity of GD in children, it is important to recognize its various clinical presenting signs and symptoms, as well as the tests that may be important for diagnosis. The diagnosis is typically suspected clinically and then confirmed biochemically. Imaging tests, including thyroid ultrasonography and/or nuclear scintigraphy, may also be used as indicated during care. It is important to understand the indications for and interpretation of laboratory and imaging tools so that a diagnosis is made efficiently and unnecessary tests are not ordered. Clinicians should be well-versed in treatment options to appropriately counsel families. There are specific scenarios in which medical therapy, radioactive iodine therapy, or surgery should be offered. Conclusions and Relevance The diagnosis and treatment of pediatric patients with GD requires a multidisciplinary approach, involving pediatric specialists in the fields of endocrinology, ophthalmology, radiology, nuclear medicine, and surgery/otolaryngology. Antithyroid drugs are typically the first-line treatment, but sustained remission rates with medical management are low in the pediatric population. Consequently, definitive treatment is often necessary, either with radioactive iodine or with surgery, ideally performed by experienced, high-volume pediatric experts. Specific clinical characteristics, such as patients younger than 5 years or the presence of a thyroid nodule, may make surgery the optimal treatment for certain patients.
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Affiliation(s)
| | - Hedieh K Khalatbari
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle.,Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle
| | - Catherine A Dinauer
- Department of Pediatrics, Section of Pediatric Endocrinology, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey C Rastatter
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.,Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel C Chelius
- Department of Otolaryngology-Head and Neck Surgery, Pediatric Thyroid Tumor Program, Baylor College of Medicine, Texas Children's Hospital, Houston.,Pediatric Head and Neck Tumor Program, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - William R Katowitz
- Department of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maisie L Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle.,Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle
| | - Ken Kazahaya
- Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia
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19
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Weiss BD, Yanik G, Naranjo A, Zhang FF, Fitzgerald W, Shulkin BL, Parisi MT, Russell H, Grupp S, Pater L, Mattei P, Mosse Y, Lai HA, Jarzembowski JA, Shimada H, Villablanca JG, Giller R, Bagatell R, Park JR, Matthay KK. A safety and feasibility trial of 131 I-MIBG in newly diagnosed high-risk neuroblastoma: A Children's Oncology Group study. Pediatr Blood Cancer 2021; 68:e29117. [PMID: 34028986 PMCID: PMC9150928 DOI: 10.1002/pbc.29117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/02/2021] [Accepted: 04/27/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION 131 I-meta-iodobenzylguanidine (131 I-MIBG) is effective in relapsed neuroblastoma. The Children's Oncology Group (COG) conducted a pilot study (NCT01175356) to assess tolerability and feasibility of induction chemotherapy followed by 131 I- MIBG therapy and myeloablative busulfan/melphalan (Bu/Mel) in patients with newly diagnosed high-risk neuroblastoma. METHODS Patients with MIBG-avid high-risk neuroblastoma were eligible. After the first two patients to receive protocol therapy developed severe sinusoidal obstruction syndrome (SOS), the trial was re-designed to include an 131 I-MIBG dose escalation (12, 15, and 18 mCi/kg), with a required 10-week gap before Bu/Mel administration. Patients who completed induction chemotherapy were evaluable for assessment of 131 I-MIBG feasibility; those who completed 131 I-MIBG therapy were evaluable for assessment of 131 I-MIBG + Bu/Mel feasibility. RESULTS Fifty-nine of 68 patients (86.8%) who completed induction chemotherapy received 131 I-MIBG. Thirty-seven of 45 patients (82.2%) evaluable for 131 I-MIBG + Bu/Mel received this combination. Among those who received 131 I-MIBG after revision of the study design, one patient per dose level developed severe SOS. Rates of moderate to severe SOS at 12, 15, and 18 mCi/kg were 33.3%, 23.5%, and 25.0%, respectively. There was one toxic death. The 131 I-MIBG and 131 I-MIBG+Bu/Mel feasibility rates at the 15 mCi/kg dose level designated for further study were 96.7% (95% CI: 83.3%-99.4%) and 81.0% (95% CI: 60.0%-92.3%). CONCLUSION This pilot trial demonstrated feasibility and tolerability of administering 131 I-MIBG followed by myeloablative therapy with Bu/Mel to newly diagnosed children with high-risk neuroblastoma in a cooperative group setting, laying the groundwork for a cooperative randomized trial (NCT03126916) testing the addition of 131 I-MIBG during induction therapy.
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Affiliation(s)
- Brian D. Weiss
- Cincinnati Children’s Hospital, University of Cincinnati School of Medicine
| | - Gregory Yanik
- CS Mott Children’s Hospital, University of Michgian School of Medicine
| | - Arlene Naranjo
- Children’s Oncology Group Statistics & Data Center, University of Florida, Gainesville, FL
| | - Fan F Zhang
- Children’s Oncology Group Statistics & Data Center, Monrovia, CA
| | | | - Barry L. Shulkin
- St. Jude Children’s Research Hospital; University of Tennessee Health Science Center
| | | | - Heidi Russell
- Texas Children’s Cancer and Hematology Centers,,Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Stephan Grupp
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Luke Pater
- Cincinnati Children’s Hospital, University of Cincinnati School of Medicine
| | - Peter Mattei
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Yael Mosse
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | | | | | | | - Judith G. Villablanca
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California
| | - Roger Giller
- Children’s Hospital Colorado, University of Colorado School of Medicine
| | - Rochelle Bagatell
- Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Julie R. Park
- Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Katherine K Matthay
- UCSF Benioff Children’s Hospital, University of California San Francisco School of Medicine, San Francisco, CA
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20
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Abstract
The role for PET with fludeoxyglucose F 18 (18F-FDG PET)/computed tomography (CT) in the management of pediatric sarcomas continues to be controversial. The literature supports a role for PET/CT in the staging and surveillance of certain specific pediatric sarcoma subtypes; however, the data are less clear regarding whether PET/CT can be used as a biomarker for prognostication. Despite the interest in using this imaging modality in the management of pediatric sarcomas, most studies are limited by retrospective design and small sample size. Additional data are necessary to fully understand how best to use 18F-FDG PET/CT in pediatric sarcoma management.
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Affiliation(s)
- Douglas J Harrison
- Division of Pediatrics, MD Anderson Cancer Center, Unit 87, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA; Department of Pediatrics, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4850 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Barry L Shulkin
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
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21
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Granger MM, Naranjo A, Bagatell R, DuBois SG, McCune JS, Tenney SC, Weiss BD, Mosse YP, Asgharzadeh S, Grupp SA, Hogarty MD, Gastier-Foster JM, Mills D, Shulkin BL, Parisi MT, London WB, Han-Chang J, Panoff J, von Allmen D, Jarzembowski JA, Park JR, Yanik GA. Myeloablative Busulfan/Melphalan Consolidation following Induction Chemotherapy for Patients with Newly Diagnosed High-Risk Neuroblastoma: Children's Oncology Group Trial ANBL12P1. Transplant Cell Ther 2021; 27:490.e1-490.e8. [PMID: 33823167 DOI: 10.1016/j.jtct.2021.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/12/2021] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
Consolidation using high-dose chemotherapy with autologous stem cell transplantation (ASCT) is an important component of frontline therapy for children with high-risk neuroblastoma. The optimal preparative regimen is uncertain, although recent data support a role for busulfan/melphalan (BuMel). The Children's Oncology Group (COG) conducted a trial (ANBL12P1) to assess the tolerability and feasibility of BuMel ASCT following a COG induction. Patients with newly diagnosed high-risk neuroblastoma who did not progress during induction therapy and met organ function requirements received i.v. busulfan (every 24 hours for 4 doses based on age and weight) and melphalan (140 mg/m2 for 1 dose), followed by ASCT. Busulfan doses were adjusted to achieve to an average daily area under the curve (AUC) <5500 µM × minute. The primary endpoint was the occurrence of severe sinusoidal obstruction syndrome (SOS) or grade ≥4 pulmonary complications within the first 28 days after completion of consolidation therapy. A total of 146 eligible patients were enrolled, of whom 101 underwent BuMel ASCT. The overall incidence of protocol-defined unacceptable toxicity during consolidation was 6.9% (7 of 101). Six patients (5.9%) developed SOS, with 4 (4%) meeting the criteria for severe SOS. An additional 3 patients (3%) experienced grade ≥4 pulmonary complications during consolidation. The median busulfan AUC was 4558 µM × min (range, 3462 to 5189 µM × minute) for patients with SOS and 3512 µM × min (2360 to 5455 µM × minute) (P = .0142). No patients died during consolidation. From the time of study enrollment, the mean 3-year event-free survival for all 146 eligible patients was 55.6 ± 4.2%, and the mean 3-year overall survival was 74.5 ± 3.7%. The BuMel myeloablative regimen following COG induction was well tolerated, with acceptable pulmonary and hepatic toxicity.
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Affiliation(s)
- M Meaghan Granger
- Department of Pediatrics, Cook Children's Medical Center, Fort Worth, Texas.
| | - Arlene Naranjo
- Children's Oncology Group Statistics & Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Rochelle Bagatell
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven G DuBois
- Dana-Farber / Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts
| | | | - Sheena C Tenney
- Children's Oncology Group Statistics & Data Center, Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Brian D Weiss
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Yael P Mosse
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shahab Asgharzadeh
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California
| | - Stephen A Grupp
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael D Hogarty
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie M Gastier-Foster
- Institute for Genomic Medicine, Nationwide Children's Hospital and Departments of Pathology and Pediatrics, Ohio State University College of Medicine, Columbus, Ohio
| | - Denise Mills
- Department of Nursing, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Barry L Shulkin
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Marguerite T Parisi
- Departments of Radiology, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Wendy B London
- Dana-Farber / Boston Children's Cancer and Blood Disorder Center and Harvard Medical School, Boston, Massachusetts
| | - John Han-Chang
- Department of Radiation Oncology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Joseph Panoff
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida
| | - Daniel von Allmen
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Julie R Park
- Departments of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Gregory A Yanik
- Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, Michigan
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22
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Shulkin BL, Nadel HR, Parisi MT. Questions and comments about 'Pediatric applications of Dotatate: early diagnostic and therapeutic experience'. Pediatr Radiol 2021; 51:495-496. [PMID: 33175200 DOI: 10.1007/s00247-020-04872-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/03/2020] [Accepted: 10/06/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN, 38105, USA.
| | - Helen R Nadel
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
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23
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Keshav N, Verma N, Parisi MT, Matesan M, Elojeimy S. Pictorial Summary of Congenital Gallbladder and Biliary Duct Anomalies Presentation on HIDA Imaging. Curr Probl Diagn Radiol 2021; 51:282-287. [PMID: 33483187 DOI: 10.1067/j.cpradiol.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 12/17/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022]
Abstract
Hepatobiliary iminodiacetic acid (HIDA) scan is one of the principal imaging modalities for the evaluation of the gallbladder and biliary tree. Congenital biliary anomalies are rare and can be difficult to recognize on HIDA scan. They may also mimic other biliary pathology. The purpose of this article is to review the spectrum of congenital gallbladder and biliary anomalies and describe their imaging appearance on HIDA scan. In addition, the diagnostic utility of functional imaging with HIDA when evaluating biliary tract anomalies is described.
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Affiliation(s)
- Nandan Keshav
- Department of Radiology, University of New Mexico, Albuquerque, New Mexico
| | - Nupur Verma
- Department of Radiology, University of Florida, Gainesville, FL
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Manuela Matesan
- Department of Radiology, Division of Nuclear Medicine, University of Washington, Seattle, WA
| | - Saeed Elojeimy
- Division of Nuclear Medicine, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC.
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24
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Khalatbari H, Binkovitz LA, Parisi MT. Dual-energy X-ray absorptiometry bone densitometry in pediatrics: a practical review and update. Pediatr Radiol 2021; 51:25-39. [PMID: 32857206 DOI: 10.1007/s00247-020-04756-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/13/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022]
Abstract
The assessment of pediatric bone mineral content and density is an evolving field. In this manuscript we provide a practical review and update on the interpretation of dual-energy X-ray absorptiometry (DXA) in pediatrics including historical perspectives as well as a discussion of the recently published 2019 Official Position Statements of the International Society of Clinical Densitometry (ISCD) that apply to children.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Larry A Binkovitz
- Department of Radiology, Divisions of Pediatric Radiology and Nuclear Medicine, Mayo Clinic Graduate School of Medicine, Rochester, MN, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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25
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Harrison DJ, Chi YY, Tian J, Hingorani P, Mascarenhas L, McCowage GB, Weigel BJ, Venkatramani R, Wolden SL, Yock TI, Rodeberg DA, Hayes-Jordan AA, Teot LA, Spunt SL, Meyer WH, Hawkins DS, Shulkin BL, Parisi MT. Metabolic response as assessed by 18 F-fluorodeoxyglucose positron emission tomography-computed tomography does not predict outcome in patients with intermediate- or high-risk rhabdomyosarcoma: A report from the Children's Oncology Group Soft Tissue Sarcoma Committee. Cancer Med 2020; 10:857-866. [PMID: 33340280 PMCID: PMC7897958 DOI: 10.1002/cam4.3667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Strategies to optimize management in rhabdomyosarcoma (RMS) include risk stratification to assign therapy aiming to minimize treatment morbidity yet improve outcomes. This analysis evaluated the relationship between complete metabolic response (CMR) as assessed by 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET) imaging and event-free survival (EFS) in intermediate-risk (IR) and high-risk (HR) RMS patients. METHODS FDG-PET imaging characteristics, including assessment of CMR and maximum standard uptake values (SUVmax) of the primary tumor, were evaluated by central review. Institutional reports of SUVmax were used when SUVmax values could not be determined by central review. One hundred and thirty IR and 105 HR patients had FDG-PET scans submitted for central review or had SUVmax data available from institutional report at any time point. A Cox proportional hazards regression model was used to evaluate the relationship between these parameters and EFS. RESULTS SUVmax at study entry did not correlate with EFS for IR (p = 0.32) or HR (p = 0.86) patients. Compared to patients who did not achieve a CMR, EFS was not superior for IR patients who achieved a CMR at weeks 4 (p = 0.66) or 15 (p = 0.46), nor for HR patients who achieved CMR at week 6 (p = 0.75) or 19 (p = 0.28). Change in SUVmax at week 4 (p = 0.21) or 15 (p = 0.91) for IR patients or at week 6 (p = 0.75) or 19 (p = 0.61) for HR patients did not correlate with EFS. CONCLUSION Based on these data, FDG-PET does not appear to predict EFS in IR or HR-RMS. It remains to be determined whether FDG-PET has a role in predicting survival outcomes in other RMS subpopulations.
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Affiliation(s)
| | | | - Jing Tian
- University of Florida, Gainesville, FL, USA
| | - Pooja Hingorani
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leo Mascarenhas
- Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | - Brenda J Weigel
- University of Minnesota/Masonic Cancer Center, Minneapolis, MN, USA
| | - Rajkumar Venkatramani
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center, Houston, TX, USA
| | | | - Torunn I Yock
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | | | | | - Sheri L Spunt
- Lucile Packard Children's Hospital Stanford University, Palo Alto, CA, USA
| | - William H Meyer
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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26
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Weiss AR, Chen YL, Scharschmidt TJ, Chi YY, Tian J, Black JO, Davis JL, Fanburg-Smith JC, Zambrano E, Anderson J, Arens R, Binitie O, Choy E, Davis JW, Hayes-Jordan A, Kao SC, Kayton ML, Kessel S, Lim R, Meyer WH, Million L, Okuno SH, Ostrenga A, Parisi MT, Pryma DA, Randall RL, Rosen MA, Schlapkohl M, Shulkin BL, Smith EA, Sorger JI, Terezakis S, Hawkins DS, Spunt SL, Wang D. Pathological response in children and adults with large unresected intermediate-grade or high-grade soft tissue sarcoma receiving preoperative chemoradiotherapy with or without pazopanib (ARST1321): a multicentre, randomised, open-label, phase 2 trial. Lancet Oncol 2020; 21:1110-1122. [PMID: 32702309 DOI: 10.1016/s1470-2045(20)30325-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Outcomes for children and adults with advanced soft tissue sarcoma are poor with traditional therapy. We investigated whether the addition of pazopanib to preoperative chemoradiotherapy would improve pathological near complete response rate compared with chemoradiotherapy alone. METHODS In this joint Children's Oncology Group and NRG Oncology multicentre, randomised, open-label, phase 2 trial, we enrolled eligible adults (aged ≥18 years) and children (aged between 2 and <18 years) from 57 hospitals in the USA and Canada with unresected, newly diagnosed trunk or extremity chemotherapy-sensitive soft tissue sarcoma, which were larger than 5 cm in diameter and of intermediate or high grade. Eligible patients had Lansky (if aged ≤16 years) or Karnofsky (if aged >16 years) performance status score of at least 70. Patients received ifosfamide (2·5 g/m2 per dose intravenously on days 1-3 with mesna) and doxorubicin (37·5 mg/m2 per dose intravenously on days 1-2) with 45 Gy preoperative radiotherapy, followed by surgical resection at week 13. Patients were randomly assigned (1:1) using a web-based system, in an unmasked manner, to receive oral pazopanib (if patients <18 years 350 mg/m2 once daily; if patients ≥18 years 600 mg once daily) or not (control group), with pazopanib not given immediately before or after surgery at week 13. The study projected 100 randomly assigned patients were needed to show an improvement in the number of participants with a 90% or higher pathological response at week 13 from 40% to 60%. Analysis was done per protocol. This study has completed accrual and is registered with ClinicalTrials.gov, NCT02180867. FINDINGS Between July 7, 2014, and Oct 1, 2018, 81 eligible patients were enrolled and randomly assigned to the pazopanib group (n=42) or the control group (n=39). At the planned second interim analysis with 42 evaluable patients and a median follow-up of 0·8 years (IQR 0·3-1·6) in the pazopanib group and 1 year (0·3-1·6) in the control group, the number of patients with a 90% pathological response or higher was 14 (58%) of 24 patients in the pazopanib group and four (22%) of 18 patients in the control group, with a between-group difference in the number of 90% or higher pathological response of 36·1% (83·8% CI 16·5-55·8). On the basis of an interim analysis significance level of 0·081 (overall one-sided significance level of 0·20, power of 0·80, and O'Brien-Fleming-type cumulative error spending function), the 83·8% CI for response difference was between 16·5% and 55·8% and thus excluded 0. The improvement in pathological response rate with the addition of pazopanib crossed the predetermined boundary and enrolment was stopped. The most common grade 3-4 adverse events were leukopenia (16 [43%] of 37 patients), neutropenia (15 [41%]), and febrile neutropenia (15 [41%]) in the pazopanib group, and neutropenia (three [9%] of 35 patients) and febrile neutropenia (three [9%]) in the control group. 22 (59%) of 37 patients in the pazopanib group had a pazopanib-related serious adverse event. Paediatric and adult patients had a similar number of grade 3 and 4 toxicity. There were seven deaths (three in the pazopanib group and four in the control group), none of which were treatment related. INTERPRETATION In this presumed first prospective trial of soft tissue sarcoma spanning nearly the entire age spectrum, adding pazopanib to neoadjuvant chemoradiotherapy improved the rate of pathological near complete response, suggesting that this is a highly active and feasible combination in children and adults with advanced soft tissue sarcoma. The comparison of survival outcomes requires longer follow-up. FUNDING National Institutes of Health, St Baldrick's Foundation, Seattle Children's Foundation.
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Affiliation(s)
- Aaron R Weiss
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA.
| | - Yen-Lin Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas J Scharschmidt
- Department of Orthopaedics, James Cancer Hospital and Nationwide Children's Hospital, Columbus, OH, USA
| | - Yueh-Yun Chi
- Department of Pediatrics and Preventative Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jing Tian
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Jennifer O Black
- Department of Pathology, Children's Hospital Colorado, Aurora, CO, USA
| | - Jessica L Davis
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | | | - Eduardo Zambrano
- Department of Pathology, Rocky Mountain Hospital for Children, Presbyterian St Luke Medical Centre, Denver, CO, USA
| | - James Anderson
- Department of Biostatistics and Research Decision Sciences, Merck and Co, North Wales, PA, USA
| | - Robin Arens
- Department of Clinical Trials, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Odion Binitie
- Department of Sarcoma, Moffitt Cancer Center, Tampa, FL, USA
| | - Edwin Choy
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Andrea Hayes-Jordan
- Department of Surgery, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Simon C Kao
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mark L Kayton
- Department of Surgery, Palm Beach Children's Hospital, St Mary's Medical Center, Florida Atlantic University, West Palm Beach, FL, USA
| | - Sandy Kessel
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, RI, USA
| | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - William H Meyer
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lynn Million
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Scott H Okuno
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | - Andrew Ostrenga
- Department of Pharmacy, University of Mississippi Medical Center, Jackson, MS, USA
| | - Marguerite T Parisi
- Department of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA
| | - Daniel A Pryma
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA, USA
| | - Mark A Rosen
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Schlapkohl
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ethan A Smith
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joel I Sorger
- Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephanie Terezakis
- Department of Radiation Oncology, University of Minnesota, Masonic Cancer Center, Minneapolis, MN, USA
| | - Douglas S Hawkins
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA
| | - Sheri L Spunt
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA
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Hodax JK, Brady C, DiVall SA, Carlin K, Khalatbari H, Parisi MT, Salehi P. OR27-04 Risk Factors For Low Baseline Bone Mineral Density In Gender Diverse Youth. J Endocr Soc 2020. [PMCID: PMC7207584 DOI: 10.1210/jendso/bvaa046.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Sex steroids such as testosterone and estrogen are necessary for accumulation of bone mass. Transgender youth treated with gonadotropin releasing hormone analogues (GnRHa) to block natal puberty for gender-affirming care are at risk of low bone mineral density (BMD). Previous studies indicate that transfemale patients assigned male at birth (AMAB) have low BMD at baseline, during and after GnRHa treatment despite cross hormone treatment. Transmales assigned female at birth (AFAB), however, have normal BMD at baseline that decreases upon GnRHa treatment, with normalization upon cross hormone therapy. The reason(s) for the low baseline BMD in transfemales is unclear. We aimed to assess the baseline characteristics of transgender youth at a single multidisciplinary gender clinic prior to medical intervention and determine factors associated with BMD. Methods This is a retrospective chart review of patients <19 years old evaluated in the gender clinic. Dual-energy x-ray absorptiometry (DXA) scans were obtained prior to initiation of GnRHa or cross-hormone therapy per Endocrine Society guidelines for the treatment of gender dysphoria. We included patients with DXA scans completed prior to initiation of treatment with GnRHa or cross gender hormones and excluded those with concurrent medical diagnoses that may affect bone density. Data collected were bone mineral density (BMD) Z-scores, anthropometric data, vitamin D and calcium levels, and calcium intake. Multivariable linear regression models were used to assess the impact of vitamin D levels, height Z-score, weight Z-score, and BMI Z-score on subtotal body BMD Z-score, adjusted for sex assigned at birth and age. Results Sixty-four patients were included in our analysis. Of these, 73% were AMAB and 27% AFAB. Gender identity was male in 14%, female in 44%, and non-binary in 42%. Average height Z-score was 0.12, weight Z-score 0.27, and BMI Z-score 0.22 (using sex assigned at birth). Subtotal body BMD Z-scores were greater than zero in 11%, between zero and greater than -2 in 59%, and less than or equal to -2 in 30% of tested patients. AMAB patients had lower BMD Z-scores compared to those AFAB (p<0.05 for all Z-scores). There was a positive association with BMI, height, and weight Z-scores and increasing BMD Z-scores after adjusting for sex assigned at birth and age (p<0.05 for all Z-scores). Patients who consumed <2 servings of calcium per day had lower BMD Z-scores (p<0.05 for all Z-scores). Average vitamin D level was 24 ng/ml (+/- 9.5 SD) with no significant association with BMD Z-scores (adjusted for sex assigned at birth). Conclusions Patients AMAB and patients with calcium intake of < 2 servings/day are associated with lower baseline BMD in a cohort of adolescents seen in a multidisciplinary gender clinic. Height, weight, and BMI are associated linearly with BMD Z-score, following patterns previously described in other populations.
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Affiliation(s)
- Juanita K Hodax
- Seattle Children’s Hospital/University of Washington, Seattle, WA, USA
| | | | - Sara A DiVall
- Seattle Children’s Hospital/University of Washington, Seattle, WA, USA
| | | | - Hedieh Khalatbari
- Seattle Children’s Hospital/University of Washington, Seattle, WA, USA
| | | | - Parisa Salehi
- Seattle Children’s Hospital/University of Washington, Seattle, WA, USA
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28
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Otjen JP, Stanescu AL, Alessio AM, Parisi MT. Correction to: Ovarian torsion: developing a machine-learned algorithm for diagnosis. Pediatr Radiol 2020; 50:757-758. [PMID: 32221630 DOI: 10.1007/s00247-020-04665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The original version of this paper included errors in Fig. 3. The corrected Fig. 3 is presented here.
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Affiliation(s)
- Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital and the University of Washington, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital and the University of Washington, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Adam M Alessio
- Computational Mathematics, Science, and Engineering (CMSE), Biomedical Engineering (BME) and Radiology, Institute for Quantitative Health Science & Engineering (IQ), Michigan State University, East Lansing, MI, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital and the University of Washington, Seattle Children's Hospital, MA.7.220, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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29
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Mody R, Yu AL, Naranjo A, Zhang FF, London WB, Shulkin BL, Parisi MT, Servaes SEN, Diccianni MB, Hank JA, Felder M, Birstler J, Sondel PM, Asgharzadeh S, Glade-Bender J, Katzenstein H, Maris JM, Park JR, Bagatell R. Irinotecan, Temozolomide, and Dinutuximab With GM-CSF in Children With Refractory or Relapsed Neuroblastoma: A Report From the Children's Oncology Group. J Clin Oncol 2020; 38:2160-2169. [PMID: 32343642 DOI: 10.1200/jco.20.00203] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The combination of irinotecan, temozolomide, dintuximab, and granulocyte-macrophage colony-stimulating factor (I/T/DIN/GM-CSF) demonstrated activity in patients with relapsed/refractory neuroblastoma in the randomized Children's Oncology Group ANBL1221 trial. To more accurately assess response rate and toxicity, an expanded cohort was nonrandomly assigned to I/T/DIN/GM-CSF. PATIENTS AND METHODS Patients were eligible at first relapse or first designation of refractory disease. Oral T and intravenous (IV) irinotecan were administered on days 1 to 5 of 21-day cycles. DIN was administered IV (days 2-5), and GM-CSF was administered subcutaneously (days 6-12). The primary end point was objective response, analyzed on an intent-to-treat basis per the International Neuroblastoma Response Criteria. RESULTS Seventeen eligible patients were randomly assigned to I/T/DIN/GM-CSF (February 2013 to March 2015); 36 additional patients were nonrandomly assigned to I/T/DIN/GM-CSF (August 2016 to May 2017). Objective (complete or partial) responses were observed in nine (52.9%) of 17 randomly assigned patients (95% CI, 29.2% to 76.7%) and 13 (36.1%) of 36 expansion patients (95% CI, 20.4% to 51.8%). Objective responses were seen in 22 (41.5%) of 53 patients overall (95% CI, 28.2% to 54.8%); stable disease was also observed in 22 of 53. One-year progression-free and overall survival for all patients receiving I/T/DIN/GM-CSF were 67.9% ± 6.4% (95% CI, 55.4% to 80.5%) and 84.9% ± 4.9% (95% CI, 75.3% to 94.6%), respectively. Two patients did not receive protocol therapy and were evaluable for response but not toxicity. Common grade ≥ 3 toxicities were fever/infection (18 [35.3%] of 51), neutropenia (17 [33.3%] of 51), pain (15 [29.4%] of 51), and diarrhea (10 [19.6%] of 51). One patient met protocol-defined criteria for unacceptable toxicity (grade 4 hypoxia). Higher DIN trough levels were associated with response. CONCLUSION I/T/DIN/GM-CSF has significant antitumor activity in patients with relapsed/refractory neuroblastoma. Study of chemoimmunotherapy in the frontline setting is indicated, as is further evaluation of predictive biomarkers.
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Affiliation(s)
- Rajen Mody
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Alice L Yu
- University of California San Diego, San Diego, CA.,Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taiwan
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
| | - Fan F Zhang
- Children's Oncology Group Statistics and Data Center, Monrovia, CA
| | - Wendy B London
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Barry L Shulkin
- St Jude Children's Research Hospital and University of Tennessee Health Science Center, Memphis, TN
| | | | - Sabah-E-Noor Servaes
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - Shahab Asgharzadeh
- Children's Hospital of Los Angeles and University of Southern California, Los Angeles, CA
| | | | | | - John M Maris
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | - Julie R Park
- Seattle Children's Hospital and University of Washington, Seattle, WA
| | - Rochelle Bagatell
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
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Shusterman S, Naranjo A, Van Ryn C, Hank JA, Parisi MT, Shulkin BL, Servaes S, London WB, Shimada H, Gan J, Gillies SD, Maris JM, Park JR, Sondel PM. Antitumor Activity and Tolerability of hu14.18-IL2 with GMCSF and Isotretinoin in Recurrent or Refractory Neuroblastoma: A Children's Oncology Group Phase II Study. Clin Cancer Res 2019; 25:6044-6051. [PMID: 31358541 DOI: 10.1158/1078-0432.ccr-19-0798] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/03/2019] [Accepted: 07/12/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE Combining anti-GD2 (disialoganglioside) mAb with GM-CSF, IL2, and isotretinoin is now FDA-approved for high-risk neuroblastoma minimal residual disease (MRD) therapy. The humanized anti-GD2 antibody conjugated to IL2 (hu14.18-IL2) has clinical activity in neuroblastoma and is more effective in neuroblastoma-bearing mice than antibody and cytokine given separately. We therefore evaluated the safety, tolerability, and antitumor activity of hu14.18-IL2 given with GM-CSF and isotretinoin in a schedule similar to standard MRD therapy. PATIENTS AND METHODS Hu14.18-IL2 was given at the recommended phase II dose of 12 mg/m2/day on days 4-6 of a 28-day cycle with GM-CSF (250 mg/m2/dose, days 1-2 and 8-14) and isotretinoin (160 mg/m2/day, days 11-25). Tolerability was determined on the basis of the number of unacceptable toxicities observed. Response was evaluated separately for patients with disease measurable by standard radiologic criteria (stratum 1), and for patients with disease evaluable only by I123-metaiodobenzylguanidine (I123-MIBG) scan and/or bone marrow histology (stratum 2). RESULTS Fifty-two patients with recurrent or refractory neuroblastoma were enrolled; 51 were evaluable for toxicity and 45 were evaluable for response. Four patients had unacceptable toxicities, well below the protocol-defined rule for tolerability. Other grade 3 and 4 nonhematologic toxicities were expected and reversible. No responses were seen in stratum 1 (n = 14). In stratum 2 (n = 31), 5 objective responses were confirmed by central review (3 complete, 2 partial). CONCLUSIONS Hu14.18-IL2 given in combination with GM-CSF and isotretinoin is safe and tolerable. Patients with MIBG and/or bone marrow-only disease had a 16.1% response rate, confirming activity of the combination.
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Affiliation(s)
- Suzanne Shusterman
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts.
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, Florida
| | - Collin Van Ryn
- Coordinating Center for Biometric Research, University of Minnesota, Twin Cities, Minneapolis, Minnesota
| | - Jaquelyn A Hank
- Departments of Pediatrics, Human Oncology and Genetics and the University of Wisconsin, Madison, Wisconsin
| | - Marguerite T Parisi
- Seattle Children's Hospital and the University of Washington, Seattle, Washington
| | - Barry L Shulkin
- St. Jude Children's Research Hospital and the University of Tennessee Health Science Center, University of Tennessee, Memphis, Tennessee
| | - Sabah Servaes
- Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wendy B London
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - Hiroyuki Shimada
- Children's Hospital of Los Angeles and University of Southern California, Los Angeles, California
| | - Jacek Gan
- Departments of Pediatrics, Human Oncology and Genetics and the University of Wisconsin, Madison, Wisconsin
| | | | - John M Maris
- Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie R Park
- Seattle Children's Hospital and the University of Washington, Seattle, Washington
| | - Paul M Sondel
- Departments of Pediatrics, Human Oncology and Genetics and the University of Wisconsin, Madison, Wisconsin
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Braunstein SE, London WB, Kreissman SG, Villablanca JG, Davidoff AM, DeSantes K, Castleberry RP, Murray K, Diller L, Matthay K, Cohn SL, Shulkin B, von Allmen D, Parisi MT, Van Ryn CC, Park JR, Quaglia MPL, Haas-Kogan DA. Role of the extent of prophylactic regional lymph node radiotherapy on survival in high-risk neuroblastoma: A report from the COG A3973 study. Pediatr Blood Cancer 2019; 66:e27736. [PMID: 30968542 PMCID: PMC7281832 DOI: 10.1002/pbc.27736] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 02/18/2019] [Accepted: 03/09/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE Neuroblastoma is the most common extracranial solid pediatric malignancy, with poor outcomes in high-risk disease. Standard treatment approaches employ an increasing array of aggressive multimodal therapies, of which local control with surgery and radiotherapy remains a backbone; however, the benefit of broad regional nodal irradiation remains controversial. We analyzed centrally reviewed radiation therapy data from patients enrolled on COG A3973 to evaluate the impact of primary site irradiation and the extent of regional nodal coverage stratified by extent of surgical resection. METHODS Three hundred thirty high-risk neuroblastoma patients with centrally reviewed radiotherapy plans were analyzed. Outcome was evaluated by the extent of nodal irradiation. For the 171 patients who also underwent surgery (centrally reviewed), outcome was likewise analyzed according to the extent of resection. Overall survival (OS), event-free survival (EFS), and cumulative incidence of local progression (CILP) were examined by Kaplan-Meier, log-rank test (EFS, OS), and Grey test (CILP). RESULTS The five-year CILP, EFS, and OS for all 330 patients receiving radiotherapy on A3973 were 8.5% ± 1.5%, 47.2% ± 3.0%, and 59.7% ± 3.0%, respectively. There were no significant differences in outcomes based on the extent of lymph node irradiation regardless of the degree of surgical resection (< 90% or ≥90%). CONCLUSION Although local control remains a significant component of treatment of high-risk neuroblastoma, our results suggest there is no benefit of extensive lymph node irradiation, irrespective of the extent of surgical resection preceding stem cell transplant.
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Affiliation(s)
| | - Wendy B. London
- Department of Pediatric Oncology/Hematology, Biostatistics Division, Dana Farber/Children’s Hospital Cancer Center
| | | | - Judith G. Villablanca
- Department of Pediatrics, Keck School of Medicine, University of Southern California
| | - Andrew M. Davidoff
- Department of Surgery, Pediatrics Division, St. Jude’s Children’s Research Hospital
| | | | | | - Kevin Murray
- Department of Pediatrics, University of Louisville
| | - Lisa Diller
- Department of Pediatric Oncology/Hematology, Dana Farber/Children’s Hospital Cancer Center
| | - Katherine Matthay
- Department of Pediatric Hematology-Oncology, University of California, San Francisco
| | - Susan L. Cohn
- Department of Pediatrics, Section of Hematology/Oncology, University of Chicago
| | - Barry Shulkin
- Department of Diagnostic Imaging, Pediatrics Division, St. Jude’s Children’s Research Hospital
| | | | | | - C. Collin Van Ryn
- Department of Biostatistics, University of Florida, College of Public Health
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Khalatbari H, Parisi MT, Kwatra N, Harrison DJ, Shulkin BL. Pediatric Musculoskeletal Imaging: The Indications for and Applications of PET/Computed Tomography. PET Clin 2018; 14:145-174. [PMID: 30420216 DOI: 10.1016/j.cpet.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of PET/computed tomography (CT) for the evaluation and management of children, adolescents, and young adults continues to expand. The principal tracer used is 18F-fluorodeoxyglucose and the principal indication is oncology, particularly musculoskeletal neoplasms. The purpose of this article is to review the common applications of PET/CT for imaging of musculoskeletal issues in pediatrics and to introduce the use of PET/CT for nononcologic issues, such as infectious/inflammatory disorders, and review the use of 18F-sodium fluoride in trauma and sports-related injuries.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas J Harrison
- Department of Pediatrics, MD Anderson Cancer Center, 7600 Beechnut Street, Houston, TX 77074, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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Bermo MS, Khalatbari H, Parisi MT. Two signs indicative of successful access in nuclear medicine cerebrospinal fluid diversionary shunt studies. Pediatr Radiol 2018; 48:1130-1138. [PMID: 29737381 DOI: 10.1007/s00247-018-4150-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Successful shunt access is the first step in a properly performed nuclear medicine cerebrospinal fluid (CSF) shunt study. OBJECTIVE To determine the significance of the radiotracer configuration at the injection site during initial nuclear medicine CSF shunt imaging and the lack of early systemic radiotracer activity as predictors of successful shunt access. MATERIALS AND METHODS With Institutional Review Board approval, three nuclear medicine physicians performed a retrospective review of all consecutive CSF shunt studies performed in children at our institution in 2015. Antecedent nuclear medicine CSF shunt studies in these patients were also assessed and included in the review. The appearance of the reservoir site immediately after radiotracer injection was classified as either figure-of-eight or round/ovoid configuration. The presence or absence of early systemic distribution of the tracer on the 5-min static images was noted and separately evaluated. RESULTS A total of 98 nuclear medicine ventriculoperitoneal CSF shunt studies were evaluated. Figure-of-eight configuration was identified in 87% of studies and, when present, had 93% sensitivity, 78% specificity, 92% accuracy, 98% positive predictive value (PPV) and 54% negative predictive value (NPV) as a predictor of successful shunt access. Early systemic activity was absent in 89 of 98 studies. Lack of early systemic distribution of the radiotracer had 98% sensitivity, 78% specificity, 96% accuracy, 98% PPV and 78% NPV as a predictor of successful shunt access. Figure-of-eight configuration in conjunction with the absence of early systemic tracer activity had 99% PPV for successful shunt access. CONCLUSION Figure-of-eight configuration at the injection site or lack of early systemic radiotracer activity had moderate specificity for successful shunt access. Specificity and PPV significantly improved when both signs were combined in assessment.
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Affiliation(s)
- Mohammed S Bermo
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Hedieh Khalatbari
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Marguerite T Parisi
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Mody R, Naranjo A, Yu AL, Hibbitts E, London WB, Shulkin BL, Parisi MT, Servaes SEN, Dicciani MB, Sondel PM, Glade-Bender J, Katzenstein H, Maris J, Park JR, Bagatell R. Phase II trial of irinotecan/temozolomide/dinutuximab/granulocyte macrophage colony stimulating factor (I/T/DIN/GMCSF) in children with relapsed/refractory neuroblastoma (NBL): A report from the Children's Oncology Group (COG). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
| | | | | | - Wendy B. London
- Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA
| | | | | | | | | | | | | | | | - John Maris
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie R. Park
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA
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35
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Stanescu AL, Kamps SE, Dick AAS, Parisi MT, Phillips GS. Intraoperative Doppler sonogram in pediatric liver transplants: a pictorial review of intraoperative and early postoperative complications. Pediatr Radiol 2018; 48:401-410. [PMID: 29273893 DOI: 10.1007/s00247-017-4053-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/12/2017] [Accepted: 12/05/2017] [Indexed: 01/10/2023]
Abstract
A spectrum of vascular complications can be seen in pediatric liver transplant patients, including occlusion and hemodynamically significant narrowing of the vessels that provide inflow to or outflow from the graft. Intraoperative Doppler ultrasound (US) has the potential benefit of identifying vascular complications in pediatric liver transplant patients prior to abdominal closure. Importantly, intraoperative Doppler US can be used as a problem-solving tool in situations such as position-dependent kinking of the portal or hepatic veins, or in suspected vasospasm of the hepatic artery. Furthermore, this technique can be used for real-time reassessment after surgical correction of vascular complications. This pictorial review of intraoperative Doppler US in pediatric liver transplant patients illustrates normal findings and common vascular complications, including examples after surgical correction, in the perioperative period.
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Affiliation(s)
- A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Shawn E Kamps
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - André A S Dick
- Department of Surgery, Section of Pediatric Transplant, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, 98105, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, 98105, USA
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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36
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Maloney E, Stanescu AL, Ngo AV, Parisi MT, Iyer RS. The Pediatric Patella: Normal Development, Anatomical Variants and Malformations, Stability, Imaging, and Injury Patterns. Semin Musculoskelet Radiol 2018; 22:81-94. [PMID: 29409075 DOI: 10.1055/s-0037-1608004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We discuss the pediatric patella, with an emphasis on diagnostic imaging. Topics include normal patellar development, anatomical variants and their physiologic significance, genetic syndromes that alter the appearance of the patella, physiology of patellar tracking and stability, patellofemoral instability, and injury patterns and classification. Recognition of appropriate development on imaging prevents diagnostic error and unnecessary evaluation. Knowledge of the pertinent features of syndromes associated with morphological patellar abnormalities can aid in generating a succinct and relevant differential diagnosis. In patellofemoral instability, the patient's baseline anatomy, factors that predispose to instability, and the specific injuries that occur as a result are critical considerations for determining the course of treatment. Patellar sleeve fractures are unique to pediatric patients, and timely identification is critical to achieving an optimal treatment outcome.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology, University of Washington, Seattle, Washington
| | - A Luana Stanescu
- Department of Radiology, University of Washington, Seattle, Washington.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Anh-Vu Ngo
- Department of Radiology, University of Washington, Seattle, Washington.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Marguerite T Parisi
- Department of Radiology, University of Washington, Seattle, Washington.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | - Ramesh S Iyer
- Department of Radiology, University of Washington, Seattle, Washington.,Department of Radiology, Seattle Children's Hospital, Seattle, Washington
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Abstract
With the exception of radiolabeled monoclonal antibodies, antibody fragments and radiolabeled peptides which have seen little application in the pediatric population, the nuclear medicine imaging procedures used in the evaluation of infection and inflammation are the same for both adults and children. These procedures include (1) either a two- or a three-phase bone scan using technetium-99m methylene diphosphonate; (2) Gallium 67-citrate; (3) in vitro radiolabeled white blood cell imaging (using 111Indium-oxine or 99mTechnetium hexamethyl-propylene-amine-oxime-labeled white blood cells); and (4) hybrid imaging with 18F-FDG. But children are not just small adults. Not only are the disease processes encountered in children different from those in adults, but there are developmental variants that can mimic, but should not be confused with, pathology. This article discusses some of the differences between adults and children with osteomyelitis, illustrates several of the common developmental variants that can mimic disease, and, finally, focuses on the increasing use of 18F-FDG PET/CT in the diagnosis and response monitoring of children with infectious and inflammatory processes. The value of and need for pediatric specific imaging protocols are reviewed.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA.; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA..
| | - Jeffrey P Otjen
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - A Luana Stanescu
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
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38
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Ladenstein R, Lambert B, Pötschger U, Castellani MR, Lewington V, Bar-Sever Z, Oudoux A, Śliwińska A, Taborska K, Biassoni L, Yanik GA, Naranjo A, Parisi MT, Shulkin BL, Nadel H, Gelfand MJ, Matthay KK, Park JR, Kreissman SG, Valteau-Couanet D, Boubaker A. Validation of the mIBG skeletal SIOPEN scoring method in two independent high-risk neuroblastoma populations: the SIOPEN/HR-NBL1 and COG-A3973 trials. Eur J Nucl Med Mol Imaging 2017; 45:292-305. [PMID: 28940046 DOI: 10.1007/s00259-017-3829-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/03/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Validation of the prognostic value of the SIOPEN mIBG skeletal scoring system in two independent stage 4, mIBG avid, high-risk neuroblastoma populations. RESULTS The semi-quantitative SIOPEN score evaluates skeletal meta-iodobenzylguanidine (mIBG) uptake on a 0-6 scale in 12 anatomical regions. Evaluable mIBG scans from 216 COG-A3973 and 341 SIOPEN/HR-NBL1 trial patients were reviewed pre- and post-induction chemotherapy. The prognostic value of skeletal scores for 5-year event free survival (5 yr.-EFS) was tested in the source and validation cohorts. At diagnosis, both cohorts showed a gradual non-linear increase in risk with cumulative scores. Several approaches were explored to test the relationship between score and EFS. Ultimately, a cutoff score of ≤3 was the most useful predictor across trials. A SIOPEN score ≤ 3 pre-induction was found in 15% SIOPEN patients and in 22% of COG patients and increased post-induction to 60% in SIOPEN patients and to 73% in COG patients. Baseline 5 yr.-EFS rates in the SIOPEN/HR-NBL1 cohort for scores ≤3 were 47% ± 7% versus 26% ± 3% for higher scores at diagnosis (p < 0.007) and 36% ± 4% versus 14% ± 4% (p < 0.001) for scores obtained post-induction. The COG-A3973 showed 5 yr.-EFS rates for scores ≤3 of 51% ± 7% versus 34% ± 4% for higher scores (p < 0.001) at diagnosis and 43% ± 5% versus 16% ± 6% (p = 0.004) for post-induction scores. Hazard ratios (HR) significantly favoured patients with scores ≤3 after adjustment for age and MYCN-amplification. Optimal outcomes were recorded in patients who achieved complete skeletal response. CONCLUSIONS Validation in two independent cohorts confirms the prognostic value of the SIOPEN skeletal score. In particular, patients with an absolute SIOPEN score > 3 after induction have very poor outcomes and should be considered for alternative therapeutic strategies.
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Affiliation(s)
- Ruth Ladenstein
- Children's Cancer Research Institute, Zimmermannplatz 10, 1090, Vienna, Austria. .,Medical University, Department of Paediatrics, Vienna, Austria.
| | - Bieke Lambert
- Radiology and Nuclear Medicine, Ghent University, Ghent, Belgium
| | - Ulrike Pötschger
- Children's Cancer Research Institute, Zimmermannplatz 10, 1090, Vienna, Austria
| | - Maria-Rita Castellani
- Nuclear Medicine Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Zvi Bar-Sever
- Schneider Children's Medical Center of Israel, Petah-Tikva, Israel
| | - Aurore Oudoux
- Department of Nuclear Medicine Lille, Oscar Lambret Center, Lille, France
| | | | | | - Lorenzo Biassoni
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL, USA
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine/ Seattle Children's Hospital, Seattle, WA, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Helen Nadel
- Department of Radiology, BC Children's Hospital, Vancouver, BC, Canada
| | - Michael J Gelfand
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine K Matthay
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Julie R Park
- Department of Pediatrics, University of Washington School of Medicine/ Seattle Children's Hospital, Seattle, WA, USA
| | - Susan G Kreissman
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Dominique Valteau-Couanet
- Pediatric and Adolescent Oncology, Gustave Roussy Institute, Université Paris-Sud, Villejuif, France
| | - Ariane Boubaker
- Institute of Radiology, Clinique de La Source, Lausanne, Switzerland
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Yanik GA, Parisi MT, Naranjo A, Nadel H, Gelfand MJ, Park JR, Ladenstein RL, Poetschger U, Boubaker A, Valteau-Couanet D, Lambert B, Castellani MR, Bar-Sever Z, Oudoux A, Kaminska A, Kreissman SG, Shulkin BL, Matthay KK. Validation of Postinduction Curie Scores in High-Risk Neuroblastoma: A Children's Oncology Group and SIOPEN Group Report on SIOPEN/HR-NBL1. J Nucl Med 2017; 59:502-508. [PMID: 28887399 DOI: 10.2967/jnumed.117.195883] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/12/2017] [Indexed: 11/16/2022] Open
Abstract
A semiquantitative 123I-metaiodobenzylguanidine (123I-MIBG) scoring method (the Curie score, or CS) was previously examined in the Children's Oncology Group (COG) high-risk neuroblastoma trial, COG A3973, with a postinduction CS of more than 2 being associated with poor event-free survival (EFS). The validation of the CS in an independent dataset, International Society of Paediatric Oncology European Neuroblastoma/High-Risk Neuroblastoma 1 (SIOPEN/HR-NBL1), is now reported. Methods: A retrospective analysis of 123I-MIBG scans obtained from patients who had been prospectively enrolled in SIOPEN/HR-NBL1 was performed. All patients exhibited 123I-MIBG-avid, International Neuroblastoma Staging System stage 4 neuroblastoma. 123I-MIBG scans were evaluated at 2 time points, diagnosis (n = 345) and postinduction (n = 330), before consolidation myeloablative therapy. Scans of 10 anatomic regions were evaluated, with each region being scored 0-3 on the basis of disease extent and a cumulative CS generated. Cut points for outcome analysis were identified by Youden methodology. CSs from patients enrolled in COG A3973 were used for comparison. Results: The optimal cut point for CS at diagnosis was 12 in SIOPEN/HR-NBL1, with a significant outcome difference by CS noted (5-y EFS, 43.0% ± 5.7% [CS ≤ 12] vs. 21.4% ± 3.6% [CS > 12], P < 0.0001). The optimal CS cut point after induction was 2 in SIOPEN/HR-NBL1, with a postinduction CS of more than 2 being associated with an inferior outcome (5-y EFS, 39.2% ± 4.7% [CS ≤ 2] vs. 16.4% ± 4.2% [CS > 2], P < 0.0001). The postinduction CS maintained independent statistical significance in Cox models when adjusted for the covariates of age and MYCN gene copy number. Conclusion: The prognostic significance of postinduction CSs has now been validated in an independent cohort of patients (SIOPEN/HR-NBL1), with a postinduction CS of more than 2 being associated with an inferior outcome in 2 independent large, cooperative group trials.
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Affiliation(s)
- Gregory A Yanik
- Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor, Michigan
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine/Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine/Seattle Children's Hospital, Seattle, Washington
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, Florida
| | - Helen Nadel
- Department of Radiology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Michael J Gelfand
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Julie R Park
- Department of Pediatrics, University of Washington School of Medicine/Seattle Children's Hospital, Seattle, Washington
| | - Ruth L Ladenstein
- Department of Pediatrics, St. Anna Children's Hospital, Vienna, Austria
| | - Ulrike Poetschger
- Department of Statistics, St. Anna Children's Cancer Research Institute, Vienna, Austria
| | - Ariane Boubaker
- Institute of Radiology, Clinique de La Source, Lausanne, Switzerland
| | - Dominique Valteau-Couanet
- Department of Pediatric and Adolescent Oncology, Gustave Roussy Institute, Universite Paris-Sud, Villejuif, France
| | - Bieke Lambert
- Radiology and Nuclear Medicine, Ghent University, Ghent, Belgium
| | | | - Zvi Bar-Sever
- Schneider Children's Medical Center of Israel, Petah-Tivka, Israel
| | | | - Anna Kaminska
- Children's Memorial Health Institute, Warsaw, Poland
| | - Susan G Kreissman
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee; and
| | - Katherine K Matthay
- Department of Pediatrics, University of California San Francisco School of Medicine, San Francisco, California
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Mody R, Naranjo A, Van Ryn C, Yu AL, London WB, Shulkin BL, Parisi MT, Servaes SEN, Diccianni MB, Sondel PM, Bender JG, Maris JM, Park JR, Bagatell R. Irinotecan-temozolomide with temsirolimus or dinutuximab in children with refractory or relapsed neuroblastoma (COG ANBL1221): an open-label, randomised, phase 2 trial. Lancet Oncol 2017; 18:946-957. [PMID: 28549783 DOI: 10.1016/s1470-2045(17)30355-8] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Outcomes for children with relapsed and refractory neuroblastoma are dismal. The combination of irinotecan and temozolomide has activity in these patients, and its acceptable toxicity profile makes it an excellent backbone for study of new agents. We aimed to test the addition of temsirolimus or dinutuximab to irinotecan-temozolomide in patients with relapsed or refractory neuroblastoma. METHODS For this open-label, randomised, phase 2 selection design trial of the Children's Oncology Group (COG; ANBL1221), patients had to have histological verification of neuroblastoma or ganglioneuroblastoma at diagnosis or have tumour cells in bone marrow with increased urinary catecholamine concentrations at diagnosis. Patients of any age were eligible at first designation of relapse or progression, or first designation of refractory disease, provided organ function requirements were met. Patients previously treated for refractory or relapsed disease were ineligible. Computer-based randomisation with sequence generation defined by permuted block randomisation (block size two) was used to randomly assign patients (1:1) to irinotecan and temozolomide plus either temsirolimus or dinutuximab, stratified by disease category, previous exposure to anti-GD2 antibody therapy, and tumour MYCN amplification status. Patients in both groups received oral temozolomide (100 mg/m2 per dose) and intravenous irinotecan (50 mg/m2 per dose) on days 1-5 of 21-day cycles. Patients in the temsirolimus group also received intravenous temsirolimus (35 mg/m2 per dose) on days 1 and 8, whereas those in the dinutuximab group received intravenous dinutuximab (17·5 mg/m2 per day or 25 mg/m2 per day) on days 2-5 plus granulocyte macrophage colony-stimulating factor (250 μg/m2 per dose) subcutaneously on days 6-12. Patients were given up to a maximum of 17 cycles of treatment. The primary endpoint was the proportion of patients achieving an objective (complete or partial) response by central review after six cycles of treatment, analysed by intention to treat. Patients, families, and those administering treatment were aware of group assignment. This study is registered with ClinicalTrials.gov, number NCT01767194, and follow-up of the initial cohort is ongoing. FINDINGS Between Feb 22, 2013, and March 23, 2015, 36 patients from 27 COG member institutions were enrolled on this groupwide study. One patient was ineligible (alanine aminotransferase concentration was above the required range). Of the remaining 35 patients, 18 were randomly assigned to irinotecan-temozolomide-temsirolimus and 17 to irinotecan-temozolomide-dinutuximab. Median follow-up was 1·26 years (IQR 0·68-1·61) among all eligible participants. Of the 18 patients assigned to irinotecan-temozolomide-temsirolimus, one patient (6%; 95% CI 0·0-16·1) achieved a partial response. Of the 17 patients assigned to irinotecan-temozolomide-dinutuximab, nine (53%; 95% CI 29·2-76·7) had objective responses, including four partial responses and five complete responses. The most common grade 3 or worse adverse events in the temsirolimus group were neutropenia (eight [44%] of 18 patients), anaemia (six [33%]), thrombocytopenia (five [28%]), increased alanine aminotransferase (five [28%]), and hypokalaemia (four [22%]). One of the 17 patients assigned to the dinutuximab group refused treatment after randomisation; the most common grade 3 or worse adverse events in the remaining 16 patients evaluable for safety were pain (seven [44%] of 16), hypokalaemia (six [38%]), neutropenia (four [25%]), thrombocytopenia (four [25%]), anaemia (four [25%]), fever and infection (four [25%]), and hypoxia (four [25%]); one patient had grade 4 hypoxia related to therapy that met protocol-defined criteria for unacceptable toxicity. No deaths attributed to protocol therapy occurred. INTERPRETATION Irinotecan-temozolomide-dinutuximab met protocol-defined criteria for selection as the combination meriting further study whereas irinotecan-temozolomide-temsirolimus did not. Irinotecan-temozolomide-dinutuximab shows notable anti-tumour activity in patients with relapsed or refractory neuroblastoma. Further evaluation of biomarkers in a larger cohort of patients might identify those most likely to respond to this chemoimmunotherapeutic regimen. FUNDING National Cancer Institute.
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Affiliation(s)
- Rajen Mody
- CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL, USA
| | - Collin Van Ryn
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL, USA
| | - Alice L Yu
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA; Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
| | - Wendy B London
- Dana-Farber Cancer Institute and Harvard Medical School, Harvard University, Boston, MA, USA
| | - Barry L Shulkin
- St Jude Children's Research Hospital and the University of Tennessee Health Science Center, University of Tennessee, Memphis, TN, USA
| | | | - Sabah-E-Noor Servaes
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mitchell B Diccianni
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Paul M Sondel
- Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Julia G Bender
- Columbia University Medical Center, Columbia University, New York, NY, USA
| | - John M Maris
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie R Park
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Rochelle Bagatell
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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41
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Cross NM, Stanescu AL, Rudzinski ER, Hawkins DS, Parisi MT. Vaginal Ewing Sarcoma: An Uncommon Clinical Entity in Pediatric Patients. J Clin Imaging Sci 2017; 7:17. [PMID: 28589056 PMCID: PMC5433652 DOI: 10.4103/jcis.jcis_96_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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] [Received: 10/13/2016] [Accepted: 02/24/2017] [Indexed: 11/25/2022] Open
Abstract
Ewing sarcoma, including classical Ewing sarcoma of the bone and primitive neuroectodermal tumors arising in bone or extraosseous primary sites, is a highly aggressive childhood neoplasm. We present two cases of Ewing sarcoma arising from the vagina in young girls. Previously reported cases in literature focused on their pathologic rather than radiographic features. We describe the spectrum of multimodality imaging appearances of Ewing sarcoma at this unusual primary site. Awareness of vaginal Ewing tumors may facilitate prompt diagnosis and lead to a different surgical approach than the more commonly encountered vaginal rhabdomyosarcoma.
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Affiliation(s)
- Nathan M Cross
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Erin R Rudzinski
- Department of Pathology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Douglas S Hawkins
- Cancer and Blood Disorders Center, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
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42
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Abstract
PET/CT, the most common form of hybrid imaging, has transformed oncologic imaging and is increasingly being used for nononcologic applications as well. Performing PET/CT in children poses unique challenges. Not only are children more sensitive to the effects of radiation than adults but, following radiation exposure, children have a longer postexposure life expectancy in which to exhibit adverse radiation effects. Both the PET and CT components of the study contribute to the total patient radiation dose, which is one of the most important risks of the study in this population. Another risk in children, not typically encountered in adults, is potential neurotoxicity related to the frequent need for general anesthesia in this patient population. Optimizing pediatric PET/CT requires making improvements to both the PET and the CT components of the procedure while decreasing the potential for risk. This can be accomplished through judicious performance of imaging, the use of recommended pediatric 18fluorine-2-fluoro-2-deoxy-d-glucose (18F-FDG) administered activities, thoughtful selection of pediatric-specific CT imaging parameters, careful patient preparation, and use of appropriate patient immobilization. In this article, we will review a variety of strategies for radiation dose optimization in pediatric 18F-FDG-PET/CT focusing on these processes. Awareness of and careful selection of pediatric-specific CT imaging parameters designed for appropriate diagnostic, localization, or attenuation correction only CT, in conjunction with the use of recommended radiotracer administered activities, will help to ensure image quality while limiting patient radiation exposure. Patient preparation, an important determinant of image quality, is another focus of this review. Appropriate preparative measures are even more crucial in children in whom there is a higher incidence of brown fat, which can interfere with study interpretation. Finally, we will discuss measures to improve the patient experience, the resource use, the departmental workflow, and the diagnostic performance of the study through the use of appropriate technology, all in the context of minimizing procedure-related risks.
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Affiliation(s)
- Marguerite T Parisi
- Departments of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA.
| | - Mohammed S Bermo
- Department of Nuclear Medicine, University of Washington School of Medicine, Seattle, WA
| | - Adam M Alessio
- Departments of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Susan E Sharp
- Departments of Radiology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinatti, OH
| | - Michael J Gelfand
- Departments of Radiology, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinatti, OH
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
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Abstract
Considerable debate remains regarding how best to incorporate 18F-FDG-PET/CT into clinical practice for pediatric sarcomas. Although there is a clear role for 18F-FDG-PET/CT in staging pediatric sarcoma, the value of 18F-FDG-PET/CT in prognostication for pediatric sarcomas remains unclear. In osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma, 18F-FDG-PET/CT may be most useful in the identification of skeletal metastases, where the literature consistently suggests that it has improved sensitivity and specificity as compared to bone scintigraphy. The role of the imaging modality in the identification of pulmonary metastatic disease is less clear. Further controversy exists regarding the use of 18F-FDG-PET/CT in predicting outcome. Several studies, particularly in osteosarcoma, suggest changes in the maximal standardized uptake value (SUVmax) that can predict histologic response following neoadjuvant chemotherapy as well as overall outcome. Conversely, studies are conflicting regarding the use of 18F-FDG-PET/CT as a prognostic tool in Ewing sarcoma and rhabdomyosarcoma. The role of 18F-FDG-PET/CT in pediatric nonrhabdomyosarcoma soft tissue sarcomas is unknown at this time. Although most studies have been small and retrospective, in certain histologic subtypes, there is a clear role for the use of this imaging modality. Additional prospective and larger studies are needed to fully determine how best to incorporate 18F-FDG-PET/CT into treatment regimens for pediatric sarcomas in the future.
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Affiliation(s)
| | - Marguerite T Parisi
- Departments of Radiology and Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - Barry L Shulkin
- Diagnostic Imaging Department, Saint Jude Children's Research Hospital, Memphis, TN
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44
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Treves ST, Gelfand MJ, Fahey FH, Parisi MT. 2016 Update of the North American Consensus Guidelines for Pediatric Administered Radiopharmaceutical Activities. J Nucl Med 2016; 57:15N-18N. [PMID: 27909182] [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: 06/06/2023] Open
Affiliation(s)
- S Ted Treves
- Harvard Medical School/Brigham and Women's Hospital, Boston, MA
| | | | - Frederic H Fahey
- Harvard Medical School/Boston Children's Hospital, Boston, MA; and
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45
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Parisi MT, Eslamy H, Mankoff D. Management of Differentiated Thyroid Cancer in Children: Focus on the American Thyroid Association Pediatric Guidelines. Semin Nucl Med 2016; 46:147-64. [PMID: 26897719 DOI: 10.1053/j.semnuclmed.2015.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
First introduced in 1946, radioactive iodine (I-131) produces short-range beta radiation with a half-life of 8 days. The physical properties of I-131 combined with the high degree of uptake in the differentiated thyroid cancers (DTCs) led to the use of I-131 as a therapeutic agent for DTC in adults. There are two indications for the potential use of I-131 therapy in pediatric thyroid disorders: nonsurgical treatment of hyperthyroidism owing to Graves' disease and the treatment of children with intermediate- and high-risk DTC. However, children are not just miniature adults. Not only are children and the pediatric thyroid gland more sensitive to radiation than adults but also the biologic behavior of DTC differs between children and adults as well. As opposed to adults, children with DTC typically present with advanced disease at diagnosis; yet, they respond rapidly to therapy and have an excellent prognosis that is significantly better than that in adult counterparts with advanced disease. Unfortunately, there are also higher rates of local and distant disease recurrence in children with DTC compared with adults, mandating lifelong surveillance. Further, children have a longer life expectancy during which the adverse effects of I-131 therapy may become manifest. Recognizing the differences between adults and children with DTC, the American Thyroid Association commissioned a task force of experts who developed and recently published a guideline to address the unique issues related to the management of thyroid nodules and DTC in children. This article reviews the epidemiology, diagnosis, staging, treatment, therapy-related effects, and suggestions for surveillance in children with DTC, focusing not only on the differences between adults and children with this disease but also on the latest recommendations from the inaugural pediatric management guidelines of the American Thyroid Association.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA; Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA.
| | - Hedieh Eslamy
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - David Mankoff
- Department of Nuclear Medicine, University of Pennsylvania, Philadelphia, PA
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46
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Baheti AD, Iyer RS, Parisi MT, Ferguson MR, Weinberger E, Stanescu AL. "Children are not small adults": avoiding common pitfalls of normal developmental variants in pediatric imaging. Clin Imaging 2016; 40:1182-1190. [PMID: 27575281 DOI: 10.1016/j.clinimag.2016.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 04/18/2016] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
Abstract
Imaging of children is complicated with a vast array of normal variants, congenital or developmental disorders, and age-dependent differential considerations. We present imaging findings of several common anatomic variants as well as physiological and maturational processes that occur in children. We compare and contrast them with pathological entities so that the reader can successfully distinguish them when interpreting pediatric imaging examinations. The content has been accrued from the authors' collective experience at a tertiary-care pediatric hospital, teaching and consulting with radiology trainees and clinicians, as well as a comprehensive review of the literature, and is intended to represent a useful error prevention tool for radiologists interpreting pediatric studies.
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Affiliation(s)
- Akshay D Baheti
- Department of Radiology, Seattle Children's Hospital and the University of Washington, Seattle.
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital and the University of Washington, Seattle
| | - Marguerite T Parisi
- Department of Radiology, Seattle Children's Hospital and the University of Washington, Seattle
| | - Mark R Ferguson
- Department of Radiology, Seattle Children's Hospital and the University of Washington, Seattle
| | - Edward Weinberger
- Department of Radiology, Seattle Children's Hospital and the University of Washington, Seattle
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital and the University of Washington, Seattle
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47
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Mody R, Naranjo A, Van Ryn C, Yu AL, London WB, Shulkin BL, Parisi MT, Servaes SEN, Dicciani MB, Sondel PM, Maris JM, Park JR, Bagatell R. Phase II randomized trial of irinotecan/temozolomide (I/T) with temsirolimus (TEM) or dinutuximab plus granulocyte colony stimulating factor (DIN/GMCSF) in children with refractory or relapsed neuroblastoma: A report from the Children’s Oncology Group (COG). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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)
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
| | - Collin Van Ryn
- Children's Oncology Group Statistics and Data Center; University of Florida, Gainesville, FL
| | | | - Wendy B. London
- Dana-Farber Cancer Institute, Children's Hospital, Boston, MA
| | | | | | | | | | | | - John M. Maris
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie R. Park
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA
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48
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DuBois SG, Mody R, Van Ryn C, Naranjo A, Kreissman SG, Baker D, Parisi MT, Shulkin BL, Maris JM, Batra V, Park JR, Matthay KK, Yanik GA. Clinical, biologic, and outcome differences according to MIBG avidity in children with neuroblastoma: A report from the Children’s Oncology Group (COG). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10526] [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)
- Steven G. DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | | | - Collin Van Ryn
- Children's Oncology Group Statistics and Data Center; University of Florida, Gainesville, FL
| | - Arlene Naranjo
- Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, FL
| | | | - David Baker
- Princess Margaret Hospital for Children, Perth, Australia
| | | | | | - John M. Maris
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Vandana Batra
- Childrens Hospital of Philadelphia, Philadelphia, PA
| | - Julie R. Park
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA
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49
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Harrison DJ, Parisi MT, Shulkin BL, Chi YY, Anderson JR, Mi X, Malempati S, Mascarenhas L, McCowage GB, Weigel B, Wolden SL, Yock TI, Rodeberg DA, Hayes-Jordan AA, Teot LA, Spunt SL, Meyer WH, Hawkins DS. 18F 2Fluoro-2deoxy-D-glucose positron emission tomography (FDG-PET) response to predict event-free survival (EFS) in intermediate risk (IR) or high risk (HR) rhabdomyosarcoma (RMS): A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group (COG). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.10549] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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)
| | | | | | | | | | - Xinlei Mi
- Children's Oncology Group, Gainesville, FL
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50
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Parisi MT, Eslamy H, Park JR, Shulkin BL, Yanik GA. 131I-Metaiodobenzylguanidine Theranostics in Neuroblastoma: Historical Perspectives; Practical Applications. Semin Nucl Med 2016; 46:184-202. [DOI: 10.1053/j.semnuclmed.2016.02.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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