Radiographers use of social media - SoMe in a Nordic perspective

INTRODUCTION

Social media (SoMe) is widely used as a communication platform in everyday life. Also, healthcare professionals have embraced SoMe as a communication tool for both peers and patients. It is becoming an interactive tool for discussing professionals' issues and a place where learning and education occur. This study explores the specific patterns of SoMe use for radiographers' in the Nordic countries. The aim of this survey was to investigate radiographers use of social platforms in a professional setting.

METHODS

A 29-item survey was prepared, and pilot-tested. The survey was produced in Danish a language that all Nordic countries master. In general, most Nordic languages are very similar. The survey was distributed by online platforms such as Facebook, LinkedIn, Twitter/X, and also distributed by newsletters by the Norwegian and Danish national radiographers societies. All data was collected anonymously. An Ethical Research approval was obtained from the University of Southern Denmark.

RESULTS

A total of 242 respondents completed the survey (Denmark n = 183, Norway n = 48, Sweden n = 8, and n = 3 from other Scandinavian countries). The respondents included 186 females, 52 males and four were undisclosed. On average, the respondents spent approximately 2 h and 23 min daily on SoMe, with 27 min specifically dedicated to content relevant to radiographers. Facebook was the preferred platform with 93 % (n = 226). A total of 5.4 % (n = 13) respondents had experienced contact from patients and/or next of kin, while 92 % (n = 222) reported no such interactions and 2.9 % (n = 7) were undisclosed. A total of 52.8 % (n = 128) used SoMe in relation to courses, conferences, or online meetings. This shows that time spent on content relevant to radiographers imply that SoMe can be a relevant tool for reaching radiographers.

CONCLUSION

The survey demonstrates radiographers' use of SoMe for personal and professional interest, with Facebook as the preferred social media platform. SoMe were mostly used during courses, conferences, or online meetings with half of the respondent reported using SoMe platforms during working hours. These results underscore the untapped potential of SoMe in professional healthcare settings. Additionally, the study offers insight into current practices, facilitating comparisons to identify trends in SoMe usage within the radiographer community.

IMPLICATIONS FOR PRACTICE

The findings advocate for the strategic use of SoMe by radiographers', emphasizing professional networking and knowledge sharing. However, clear guidelines are necessary to ensure patient confidentiality and data security in these digital interactions.

Liquid biopsy guides successful molecular targeted therapy of an inoperable pediatric brainstem neoplasm

Midline CNS tumors are occasionally inaccessible for surgical biopsies. In these instances, cell-free DNA (cfDNA) may serve as a viable alternative for molecular analysis and identification of targetable mutations. Here, we report a young child with an inoperable brainstem tumor in whom a stereotactic biopsy was deemed unsafe. The tumor progressed on steroids and after radiotherapy the patient developed hydrocephalus and received a ventriculoperitoneal shunt. Droplet digital PCR analysis of cfDNA from an intraoperative cerebrospinal fluid liquid biopsy revealed a BRAF V600 mutation enabling targeted treatment with MEK and BRAF inhibitors. The patient, now on trametinib and dabrafenib for 1 year, has had substantial tumor volume regression and reduction of contrast enhancement on MRIs and is making remarkable clinical progress. This case highlights that in a subset of CNS tumors, access to liquid biopsy analysis may be crucial to identify actionable therapeutic targets that would otherwise go undiscovered.

Sustained Survival Benefit in Recurrent Medulloblastoma by a Metronomic Antiangiogenic Regimen: A Nonrandomized Controlled Trial

Importance

Medulloblastoma recurrence in patients who have previously received irradiation has a dismal prognosis and lacks a standard salvage regimen.

Objective

To evaluate the response rate of pediatric patients with medulloblastoma recurrence using an antiangiogenic metronomic combinatorial approach (Medulloblastoma European Multitarget Metronomic Anti-Angiogenic Trial [MEMMAT]).

Design, Setting, and Participants

This phase 2, investigator-initiated, multicenter nonrandomized controlled trial assessed 40 patients with relapsed or refractory medulloblastoma without a ventriculoperitoneal shunt who were younger than 20 years at original diagnosis. Patients were enrolled between April 1, 2014, and March 31, 2021.

Interventions

Treatment consisted of daily oral thalidomide, fenofibrate, celecoxib, and alternating 21-day cycles of low-dose (metronomic) oral etoposide and cyclophosphamide, supplemented by intravenous bevacizumab and intraventricular therapy consisting of alternating etoposide and cytarabine.

Main Outcomes and Measures

The primary end point was response after 6 months of antiangiogenic metronomic therapy. Secondary end points included progression-free survival (PFS), overall survival (OS), and quality of life. Adverse events were monitored to assess safety.

Results

Of the 40 patients (median [range] age at treatment start, 10 [4-17] years; 25 [62.5%] male) prospectively enrolled, 23 (57.5%) achieved disease control after 6 months of treatment, with a response detected in 18 patients (45.0%). Median OS was 25.5 months (range, 10.9-40.0 months), and median PFS was 8.5 months (range, 1.7-15.4 months). Mean (SD) PFS at both 3 and 5 years was 24.6% (7.9%), while mean (SD) OS at 3 and 5 years was 43.6% (8.5%) and 22.6% (8.8%), respectively. No significant differences in PFS or OS were evident based on molecular subgroup analysis or the number of prior recurrences. In patients demonstrating a response, mean (SD) overall 5-year PFS was 49.7% (14.3%), and for patients who remained progression free for the first 12 months of treatment, mean (SD) 5-year PFS was 66.7% (16.1%). Treatment was generally well tolerated. Grade 3 to 4 treatment-related adverse events included myelosuppression, infections, seizures, and headaches. One heavily pretreated patient with a third recurrence died of secondary acute myeloid leukemia.

Conclusions and Relevance

This feasible and well-tolerated MEMMAT combination regimen demonstrated promising activity in patients with previously irradiated recurrent medulloblastoma. Given these results, this predominantly oral, well-tolerated, and outpatient treatment warrants further evaluation.

Trial Registration

ClinicalTrials.gov Identifier: NCT01356290.

Plant size, latitude, and phylogeny explain within-population variability in herbivory

Interactions between plants and herbivores are central in most ecosystems, but their strength is highly variable. The amount of variability within a system is thought to influence most aspects of plant-herbivore biology, from ecological stability to plant defense evolution. Our understanding of what influences variability, however, is limited by sparse data. We collected standardized surveys of herbivory for 503 plant species at 790 sites across 116° of latitude. With these data, we show that within-population variability in herbivory increases with latitude, decreases with plant size, and is phylogenetically structured. Differences in the magnitude of variability are thus central to how plant-herbivore biology varies across macroscale gradients. We argue that increased focus on interaction variability will advance understanding of patterns of life on Earth.

Patient involvement and expectations during CT scans. Tinkering to involve patients and offer care in radiographic practice

INTRODUCTION

This study investigated how patients expected and experienced to be put first and cared for in diagnostic imaging settings and how putting the patient first was operationalized in practice.

METHODS

A qualitative field study was conducted in two Danish hospitals to investigate patients' expectations and experiences of care and involvement during CT examinations. Data collection methods included semi-structured interviews and participant observations of five examination cases. Three Computed Tomography (CT) guided lung biopsy intervention studies and two conventional CT studies of the chest of patients being investigated for lung cancer in Fast Track Cancer Referral Programs (FTCRP) were included.

RESULTS

Patients reported low expectations of receiving care and being involved during examinations. Perceptions of receiving care predominantly consisted of being received in a kind, personalized manner. Expectations of involvement in the procedure were reported in terms of readiness to do as they were told, complying with requests put to each patient. Concepts of care and involvement were challenged in their formal meanings and found to be entangled in complex interactions within sociotechnical boundaries.

CONCLUSION

Patient's expectations of receiving care and being involved in the diagnostic imaging procedures, were expressed in noncommittal terms, and were overshadowed by patients' focus on getting through the examination, in order to get an answer to their tentative diagnose. The concepts of care and patient involvement were negotiated and reconceptualized within the sociotechnical framework of the diagnostic imaging situation of the individual patient. The concept of "tinkering" is suggested as a means of understanding how patientcare is performed during diagnostic imaging procedures.

IMPLICATIONS FOR PRACTICE

Issues were identified that may help professionals to put "the patient first", thus, improving patient centered care.

Register-based and genetic studies of Prader-Willi syndrome show a high frequency of gonadal tumors and a possible mechanism for tumorigenesis through imprinting relaxation

Prader-Willi syndrome (PWS) is a rare disease caused by a lack of expression of inherited imprinted genes in the paternally derived Prader-Willi critical region on chromosome 15q11.2-q13. It is characterized by poor feeding and hypotonia in infancy, intellectual disability, behavioral abnormalities, dysmorphic features, short stature, obesity, and hypogonadism. PWS is not a known cancer predisposition syndrome, but previous investigations regarding the prevalence of cancer in these patients suggest an increased risk of developing specific cancer types such as myeloid leukemia and testicular cancer. We present the results from a Swedish national population-based cohort study of 360 individuals with PWS and 18,000 matched comparisons. The overall frequency of cancer was not increased in our PWS cohort, but we found a high frequency of pediatric cancers. We also performed whole-genome sequencing of blood- and tumor-derived DNAs from a unilateral dysgerminoma in a 13-year-old girl with PWS who also developed bilateral ovarian sex cord tumors with annular tubules. In germline analysis, there were no additional findings apart from the 15q11.2-q13 deletion of the paternal allele, while a pathogenic activating KIT mutation was identified in the tumor. Additionally, methylation-specific multiplex ligation-dependent probe amplification revealed reduced methylation at the PWS locus in the dysgerminoma but not in the blood. In conclusion, our register-based study suggests an increased risk of cancer at a young age, especially testicular and ovarian tumors. We found no evidence of a general increase in cancer risk in patients with PWS. However, given our limited observational time, further studies with longer follow-up times are needed to clarify the lifetime cancer risk in PWS. We have also described the second case of locus-specific loss-of-imprinting in a germ cell tumor in PWS, suggesting a possible mechanism of carcinogenesis.

Supratentorial CNS-PNETs in children; a Swedish population-based study with molecular re-evaluation and long-term follow-up

BACKGROUND

Molecular analyses have shown that tumours diagnosed as supratentorial primitive neuro-ectodermal tumours of the central nervous system (CNS-PNETs) in the past represent a heterogenous group of rare childhood tumours including high-grade gliomas (HGG), ependymomas, atypical teratoid/rhabdoid tumours (AT/RT), CNS neuroblastoma with forkhead box R2 (FOXR2) activation and embryonal tumour with multi-layered rosettes (ETMR). All these tumour types are rare and long-term clinical follow-up data are sparse. We retrospectively re-evaluated all children (0-18 years old) diagnosed with a CNS-PNET in Sweden during 1984-2015 and collected clinical data.

METHODS

In total, 88 supratentorial CNS-PNETs were identified in the Swedish Childhood Cancer Registry and from these formalin-fixed paraffin-embedded tumour material was available for 71 patients. These tumours were histopathologically re-evaluated and, in addition, analysed using genome-wide DNA methylation profiling and classified by the MNP brain tumour classifier.

RESULTS

The most frequent tumour types, after histopathological re-evaluation, were HGG (35%) followed by AT/RT (11%), CNS NB-FOXR2 (10%) and ETMR (8%). DNA methylation profiling could further divide the tumours into specific subtypes and with a high accuracy classify these rare embryonal tumours. The 5 and 10-year overall survival (OS) for the whole CNS-PNET cohort was 45% ± 12% and 42% ± 12%, respectively. However, the different groups of tumour types identified after re-evaluation displayed very variable survival patterns, with a poor outcome for HGG and ETMR patients with 5-year OS 20% ± 16% and 33% ± 35%, respectively. On the contrary, high PFS and OS was observed for patients with CNS NB-FOXR2 (5-year 100% for both). Survival rates remained stable even after 15-years of follow-up.

CONCLUSIONS

Our findings demonstrate, in a national based setting, the molecular heterogeneity of these tumours and show that DNA methylation profiling of these tumours provides an indispensable tool in distinguishing these rare tumours. Long-term follow-up data confirms previous findings with a favourable outcome for CNS NB-FOXR2 tumours and poor chances of survival for ETMR and HGG.

Prospective registration of symptoms and times to diagnosis in children and adolescents with central nervous system tumors: A study of the Swedish Childhood Cancer Registry

BACKGROUND

The elapsed time taken to diagnose tumors of the central nervous system in children and adolescents varies widely. The aim of the present study was to investigate such diagnostic time intervals at a national level in Sweden as they correlate with clinical features.

METHODS

Data prospectively accumulated over a 4-year period in the Swedish Childhood Cancer Registry from patients aged 0-18 years were pooled, and diagnostic time intervals were analyzed considering tumor location, tumor type, patient age and sex, initial symptoms, and clinical timelines. All six pediatric oncology centers in Sweden contributed to collection of data. Time points for calculating the total diagnostic interval (TDI) defined as the time from symptom onset to diagnosis were reported in 257 of 319 patients (81%).

RESULTS

The time from symptom onset to the first healthcare consultation, median 2.6 weeks, did not vary significantly between patients categorized according to tumor type or location. The median TDI was 8.3 weeks for the 4-year study period. Patients with optic pathway glioma (TDI 26.6 weeks), those with tumors of the spinal cord (TDI 25.9 weeks), and those with midline tumors (TDI 24.6 weeks) had the longest lead times. Additionally, older age, too few initial symptoms, and seeking initial redress outside an emergency ward were factors associated with a longer time to diagnosis.

CONCLUSION

This study identified several factors associated with delayed diagnosis of central nervous system tumors among Swedish children and adolescents. These novel data ought to help direct future efforts toward clinical improvement.

DNA methylation profiling improves routine diagnosis of paediatric CNS tumours: a prospective population-based study

AIMS

Paediatric brain tumours are rare and establishing a precise diagnosis can be challenging. Analysis of DNA methylation profiles has been shown to be a reliable method to classify central nervous system (CNS) tumours with high accuracy. We aimed to prospectively analyse CNS tumours diagnosed in Sweden, to assess the clinical impact of adding DNA methylation-based classification to standard paediatric brain tumour diagnostics in an unselected cohort.

METHODS

All CNS tumours diagnosed in children (0-18 years) during 2017-2020 were eligible for inclusion provided sufficient tumour material was available. Tumours were analysed using genome-wide DNA methylation profiling and classified by the MNP brain tumour classifier. The initial histopathological diagnosis was compared to the DNA methylation-based classification. For incongruent results, a blinded re-evaluation was performed by an experienced neuropathologist.

RESULTS

240 tumours with a histopathology-based diagnosis were profiled. A high-confidence methylation score of 0.84 or more was reached in 78% of the cases. In 69%, the histopathological diagnosis was confirmed and for some of these also refined, 6% were incongruent and the re-evaluation favoured the methylation-based classification. In the remaining 3% of cases, the methylation class was non-contributory. The change in diagnosis would have had a direct impact on the clinical management in 5% of all patients.

CONCLUSIONS

Integrating DNA methylation-based tumour classification into routine clinical analysis improves diagnostics and provides molecular information that is important for treatment decisions. The results from methylation profiling should be interpreted in the context of clinical and histopathological information.

PATH-08. DNA methylation profiling improves routine diagnostics of paediatric CNS tumours: a prospective population-based study

AIMS: Paediatric brain tumours are rare and establishing a precise diagnosis can be challenging. Analysis of DNA methylation profiles has been shown to be a reliable method to classify central nervous system (CNS) tumours with high accuracy. We aimed to prospectively analyse CNS tumours diagnosed in Sweden, to assess the clinical impact of adding DNA methylation-based classification to standard paediatric brain tumour diagnostics in an unselected cohort. Methods: All CNS tumours diagnosed in children (0-18 years) during 2017-2020 were eligible for inclusion provided sufficient tumour material was available. Tumours were analysed using genome-wide DNA methylation profiling and classified by the MNP brain tumour classifier. The initial histopathological diagnosis was compared to the DNA methylation-based classification. For incongruent results, a blinded re-evaluation was performed by an experienced neuropathologist. Results: 240 tumours with a histopathology-based diagnosis were profiled. A high-confidence methylation score of 0.84 or more was reached in 78% of the cases. In 69%, the histopathological diagnosis was confirmed and for some of these also refined, 6% were incongruent and the re-evaluation favoured the methylation-based classification. In the remaining 3% of cases, the methylation class was non-contributory or could not be predicted. The change in diagnosis would have had a direct impact on the clinical management in 5% of all patients.Conclusions: Integrating DNA methylation-based tumour classification into routine clinical analysis improves diagnostics and molecular information important for treatment decisions. The results from methylation profiling should be interpreted in the context of clinical and histopathological information.

ETMR-10. Retrospective molecular re-evaluation of CNS PNETs; a population-based study

BACKGROUND: The heterogeneous group of tumors, primitive neuro-ectodermal tumors of the central nervous system (CNS-PNETs), is a group of rare childhood embryonal tumors associated with a poor prognosis. In recent years, molecular analyzes have shown that CNS-PNETs consist of high-grade gliomas (HGG), ependymomas, different embryonal entities like atypical teratoid /rhabdoid tumors (AT/RT), CNS neuroblastoma FOXR2 and embryonal tumor with multi-layered rosettes (ETMR). Each of these tumor types is unusual and long-term clinical follow-up data are sparse. METHODS: We retrospectively re-evaluated all children (0-18 years old) diagnosed with a CNS-PNET in Sweden during 1984-2015. In total, 88 supratentorial CNS-PNETs were identified in the Swedish Childhood Cancer Registry and from these formalin-fixed paraffin-embedded tumor material was available for 69 patients. All tumors were reviewed histopathologically by an experienced neuropathologist and were analyzed using genome-wide DNA methylation profiling and classified by the MNP brain tumor classifier. RESULTS: The largest entities, after re-evaluation, were HGG (30%), CNS NB-FOXR2 (12%), AT/RT (10%) and ETMR (8%). Some tumors were difficult to classify and will be further evaluated molecularly. Some examples: Best treatment results were seen for patients with CNS-NB FOXR2 (5-year PFS: 100%) where all patients had received craniospinal radiotherapy (CSI). Patients with ETMR were all very young and survival data show early progression and poor survival (5-year OS 34%). CONCLUSIONS: Although the patient material is relatively small, it is population-based with long follow-up times. Our findings are in line with other studies and shows that CSI is important for cure for CNS-NB FOXR2 and that intensive multi-modal therapies needs to be evaluated in up-front studies for these rare embryonal tumors.

Improving forest management by implementing best suitable timber harvesting methods

Efficient forest operations are required for the provision of biodiversity and numerous ecosystem services, such as wood production, carbon sequestration, protection against natural hazards and recreation. In numerous countries, under difficult terrain conditions, the costs of forest management and harvesting are not covered by timber revenue. One possible option to increase the cost-effectiveness of the forestry sector is the application of state-of-the-art harvesting and extraction techniques, so-called best suitable harvesting methods. We present a case study from Switzerland, where a lack of competitiveness in the forestry sector is of particular interest, with the aim of quantifying the efficiency gains if estimated best suitable harvesting methods were to be rigorously applied instead of the currently applied harvesting methods. For this purpose, we developed a spatial decision support system to allocate estimated best suitable harvesting methods to plots, while concurrently considering hauling route limitations, extraction route properties and stand characteristics. Our approach was based on productivity models and supported with expert-defined decision trees. The evaluation of the estimated best suitable harvesting methods and the comparison with the currently applied harvesting methods were completed for all 6500 National Forest Inventory (NFI) plots in Switzerland. We draw the following three major conclusions from our study: First, our modeling approach is an effective method to allocate estimated best suitable harvesting methods to NFI plots. Second, applying estimated best suitable harvesting methods would lead to cost reductions, in particular in the regions that include steep terrain and where harvesting mainly relies on cable- and air based extraction methods. Third, assuming an average timber price of 75 CHF m ^-3, 64 % instead of 52 % of the forest area could be harvested economically over the whole country if estimated best suitable methods were applied. This advantage would mainly be caused by a shift towards more mechanized harvesting methods. Improving the cost-effectiveness of the forestry sector is of high global relevance, as the increased use of domestic timber resources is a cost-efficient way to reduce atmospheric carbon emissions. The methodological framework described here was developed for Switzerland in particular, but it could be applied to Central Europe and other parts of Europe with a large amount of mountain forests.

LGG-06. COMPREHENSIVE GENOMIC CHARACTERIZATION AND INTEGRATED CLINICAL ANALYSIS OF LOW-GRADE GLIOMAS IN CHILDREN WITH NEUROFIBROMATOSIS TYPE 1

Background

Low-grade gliomas (LGGs) arising in children with neurofibromatosis type 1 (NF1) are usually not biopsied. To identify secondary genetic alterations or molecular features that may contribute to pathogenesis and correlate with clinical behavior, we initiated a comprehensive molecular and clinical analysis of pediatric NF1-LGGs.

Methods

NF1-LGGs were analysed by whole-genome sequencing (31), targeted gene panel sequencing (9), RNAseq transcriptomal profiling (33) and genome-wide DNA methylation analysis (67). Clinical annotation was available for 48 subjects.

Results

Most LGGs harbored bi-allelic NF1 inactivation as the sole genetic abnormality, but 11% had additional alterations (FGFR1 mutation, n=3; PIK3CA mutation, n=2; homozygous 9p21 deletion, n=2; MYB:QKI fusion, n=1; SETD2 mutation, n=1; EGFR amplification, n=1). FGFR1 mutation conferred additional growth advantage in multiple complementary murine Nf1 models. 88% of NF1-LGGs resembled sporadic pilocytic astrocytoma (PA) by methylation, higher than that based on histology. Non-PA methylation patterns included low-grade glial/glioneuronal tumors, rosette-forming glioneuronal tumors, MYB/MYBL1-altered glioma, and high-grade astrocytoma with piloid features (2 tumors histologically diagnosed as LGG). In total, 18% of samples were classified as non-PA and/or harbored an additional non-NF1 mutation. Non-PA methylation class tumors were more likely to harbor an additional non-NF1 mutation (p=0.005). 7.7% of optic pathway hypothalamic gliomas (OPHGs) had other mutations or were not classified by methylation as PA, compared with 20.6% of NF1-LGGs arising elsewhere. There was no difference based on age for the presence of an additional non-NF1 mutation or non-PA methylation class.

Conclusions

Given the overall low occurrence of non-NF1 mutations or non-PA methylation class tumors in this series, routine clinical biopsy of typically-appearing NF1-LGG may not be indicated, particularly for children with OPHG. Biopsy should be considered for non-OPHG tumors refractory to conventional treatment. As additional agents are developed and treatment strategies evolve, the rationale for biopsy of NF1-LGG may become stronger.

Age and DNA methylation subgroup as potential independent risk factors for treatment stratification in children with atypical teratoid/rhabdoid tumors

BACKGROUND

Controversy exists as to what may be defined as standard of care (including markers for stratification) for patients with atypical teratoid/rhabdoid tumors (ATRTs). The European Rhabdoid Registry (EU-RHAB) recruits uniformly treated patients and offers standardized genetic and DNA methylation analyses.

METHODS

Clinical, genetic, and treatment data of 143 patients from 13 European countries were analyzed (2009-2017). Therapy consisted of surgery, anthracycline-based induction, and either radiotherapy or high dose chemotherapy following a consensus among European experts. Fluorescence in situ hybridization, multiplex ligation-dependent probe amplification, and sequencing were employed for assessment of somatic and germline mutations in SWItch/sucrose nonfermentable related, matrix associated, actin dependent regulator of chromatin, subfamily B (SMARCB1). Molecular subgroups (ATRT-SHH, ATRT-TYR, and ATRT-MYC) were determined using DNA methylation arrays, resulting in profiles of 84 tumors.

RESULTS

Median age at diagnosis of 67 girls and 76 boys was 29.5 months. Five-year overall survival (OS) and event-free survival (EFS) were 34.7 ± 4.5% and 30.5 ± 4.2%, respectively. Tumors displayed allelic partial/whole gene deletions (66%; 122/186 alleles) or single nucleotide variants (34%; 64/186 alleles) of SMARCB1. Germline mutations were detected in 26% of ATRTs (30/117). The patient cohort consisted of 47% ATRT-SHH (39/84), 33% ATRT-TYR (28/84), and 20% ATRT-MYC (17/84). Age <1 year, non-TYR signature (ATRT-SHH or -MYC), metastatic or synchronous tumors, germline mutation, incomplete remission, and omission of radiotherapy were negative prognostic factors in univariate analyses (P < 0.05). An adjusted multivariate model identified age <1 year and a non-TYR signature as independent negative predictors of OS: high risk (<1 y + non-TYR; 5-y OS = 0%), intermediate risk (<1 y + ATRT-TYR or ≥1 y + non-TYR; 5-y OS = 32.5 ± 8.7%), and standard risk (≥1 y + ATRT-TYR, 5-y OS = 71.5 ± 12.2%).

CONCLUSIONS

Age and molecular subgroup status are independent risk factors for survival in children with ATRT. Our model warrants validation within future clinical trials.

HeProMo: A decision support tool to estimate wood harvesting productivities

In the field of forestry, one of the most economically important ecosystem service is the provision of timber. The need to calculate the economic effects of forest management in the short, medium, and long term is increasing. Forest operations or timber harvesting, which comprises felling, processing, and transport of trees or timber, are responsible for a large part of the costs and environmental impacts associated to forest management or enterprises. From a decision maker’s perspective, it is essential to estimate working productivity and production costs under given operating conditions before any operation is conducted. This work addresses the lack of a valid collection of models that allows estimating time, productivities, and costs of labor and machinery for the most important forest operations in forest stands under Central European conditions. To create such models, we used data from forest enterprises, manual time studies, and the literature. This work presents a decision support tool that estimates the wood harvesting productivities of 12 different kinds of forest operations under Central European conditions. It includes forest operations using chainsaws, harvesters, skidders, forwarders, chippers, cable and tower yarders, and helicopters. In addition, the tool covers three models for wood volume estimation. The tool is written in Java and available open-source under the Apache License. This work shows how the tool can be used by describing its graphical user interface (GUI) and its application programming interface (API) that facilitates bulk processing of scientific data. Carefully selected default values allow estimations without knowing all input variables in detail. Each model is accompanied by an in-depth documentation where the forest operation, input variables, formulas, and statistical background are given. We conclude that HeProMo is a very useful tool for applications in forest practice, research, and teaching.

MBCL-43. RECURRENT MEDULLOBLASTOMA – LONG-TERM SURVIVAL WITH A “MEMMAT” BASED ANTIANGIOGENIC APPROACH

INTRODUCTION

Patients with recurrent medulloblastoma have a poor prognosis with only around 8% of patients surviving at 5 years irrespective of salvage therapy used. We report on 29 patients from four institutions treated with a “MEMMAT” based antiangiogenic combination therapy.

PATIENTS AND METHODS

From 11/2006 to 06/2016, 29 patients were diagnosed with a recurrent medulloblastoma (19 first, 10 multiple recurrences). Median age at start of antiangiogenic therapy was 10 years (range 1–27). Subgroup of medulloblastoma was available in 18 patients and was group 3 or 4 in all except two (one WNT, one SHH-infant). For their current relapse patients received an antiangiogenic combination therapy consisting of bevacizumab, thalidomide, celecoxib, fenofibrate, and etoposide, alternating with cyclophosphamide and augmented with intraventricular therapy (etoposide and liposomal cytarabine).

RESULTS

As of 01/2020, 8/29 patients are alive at a median of 44 months after recurrence. 6/8 surviving patients are currently in CCR between 66 and 134 months after recurrence that prompted MEMMAT therapy. Two patients are again in remission after intercurrent relapses 105 and 102 months after first starting MEMMAT therapy. Five patients died of another cause (accident, leukemia, septicemia). OS (median 44 months) was 44±10% at 5 years and 39±10% at 10 years, PFS was 33±10% at 5 years and 28 ±9% at 10 years. Therapy was well tolerated and toxicities were manageable.

CONCLUSION

Our results suggest that antiangiogenic metronomic chemotherapy has clinical activity in recurrent medulloblastoma. Further investigation with an international phase II study is ongoing (MEMMAT; ClinicalTrials.gov Identifier: NCT01356290).

Transcatheter interventions of coarctation of the aorta (CoA): a multinational population-based registry – procedural complications

Background

Patients with a native or re CoA with an invasively meassured peak to peak gardient &gt;20 mmHg have a guideline indication for intervention. The decision regarding transcatheter versus surgical intervention depends on a variety of factors including location and complexity of CoA, patient/parent preference and availability of a team capable to perform the intevention with a low rate of complications. The aim of the present analysis was to describe factors associated with risk for procedural complications during transcatheter interventions in CoA. Separate anlysis was done for complications at intervention site and at access site.

Methods

All consecutive patients undergoing catheter interventions for CoA from 1st of January 2000 to 31st of December 2016 were identified by each of the particpating nine centers. The nine centers perform all catheter interventions for CoA for a complete population coverage of 25 millions inhabitants. A common protocol was filled out from medical records. Exclusion criteria were weight less than 20 kg at the time of intervention or Norwood surgery for hypoplastic left heart surgery. Complications at the intervention site included aneurysm formation, dissection of the aorta, extravasation of the aorta or neurological impairment. Complications at the access site was defined as any complication that prolonged the hospital stay.

Results

590 interventions were performed on 520 patients: two interventions n=76, three: n=11, four n=2 and one patient underwent five interventions. There was no mortality in relation to the procedure or during the hospitalisation. The age span of the patients was wide; 4–79 years old (median= 23). 51% had a native CoA, 42% post surgery re-CoA, 22% had had a previous catheter intervention. In 160 (27%) of the interventions balloon dilatation only was performed. Overall, procedural succes was 87%, n=513, 44 procedures (8%) were partially successful and 9 procedures (2%) were not successful. 512 (87%) had one day in hospital stay and 17 patients (6%) had a hospital stay longer than 3 days. In 11 procedures (1.9%) at least one complication occurred at the intervention site; (6 aneurysm formation, 3 neurological impairment, 3 dissection of aorta, 2 extra vasation of aorta), nine of them without prolonged hospital stay. In 25 procedures (4.2%) at least one complications at the access site was observed. Access site complications were associated with older age (mean 38 years (10–79))

Conclusions

In a large, multicenter registry with complete follow-up, complications at the intervention site occurred in 1.9% and at the access site in 4.2% of interventions. Transcatheter intervention of CoA can be performed with low risk of complications.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): ALF-LUA, Gothenburg Heart and Lung Foundation

Strengthening core competences of medical and public health students for public health emergencies

Background

The importance of public health capacity development with a focus on public health emergencies and humanitarian assistance is continuously increasing at the global scale. In the time of Public Health Emergencies of International Concern is crucial to provide basic training in core public health competences to all health professionals, including students. Faculty of Medicine & Dentistry, Palacký University Olomouc, Czech Republic (full ASPHER member), implemented in medical as well as public health curricula new topics focused on core competences of health professionals in the area of public health emergencies and humanitarian assistance.

Objectives

To strengthen competences and skills of medical as well as public health students to prepare them better for public health emergencies and humanitarian assistance in the time of increasing risk of global public health emergencies. New modules were proposed and tested in all education programmes at our Faculty of Medicine & Dentistry, Palacký University Olomouc (CZ): General Medicine (Czech and English programmes), Dentistry (Czech and English programmes) and Public Health (Czech programme).

Results

New modules on Public Health Emergencies, including preparedness, responses, risk management and risk communication were successfully tested in all education programmes during the academic year 2018/19 and fully implemented for the academic year 2019/20. New module has blended learning structure based on combination of face-to-face seminars and exercises with e-learning parts, including self-assessment. New module is presented in details.

Conclusions

This new education module fully supports international recommendations to strengthen public health competences and skills of medical as well as public health students to be ready for any unexpected public health emergencies at all levels, in particular at the local community level. COVID-19 pandemic confirmed.

Supported by university project CZ.02.69/0.0/16_015/0002337

Key messages

Medical and public health students with competences and skills on public health emergencies and humanitarian assistance will be an asset for any public health emergency of international concern.

New education module on public health emergencies will support both medical and public health students to be prepared for risk communication, advocacy and action if needed and called to action.

Review of pandemic plans, varying international approaches focusing on medical students’ contribution

A review of pandemic plans and international approaches to pandemics focusing on the responsibilities of medical students should they be called to help in times of need. Are there specific guidelines or competencies in place with respect to medical students? Are medical students being utilised to their maximal capability when compared across different nations on an international basis? These questions were kept in mind during the evaluation and analysis of publicly available pandemic plans and other international systems concerning the approach to pandemics. The main differences, strengths and weaknesses of these responses will be highlighted. The presentation will conclude with proposals of the specific role medical students could play in the pandemic response and the importance of their contribution on an international level.

Future visions for medical education, the importance of public health themes in education and beyond

Steps for the future improvement of competencies evaluation and fulfilment were studied, with the eventual goal of the unification of guidelines internationally to ensure the standardisation and uniformity of the quality of medical education. The future vision for the integration of public health into medical education curriculums, highlighting the importance of public health in medical education and its application in a wide variety of situations across medical education and beyond in practise as a medical professional in a range of specialities. The need for ways to increase engagement of medical students within public health issues will also be discussed.

Personal experiences of medical school education: methods to evaluate competency and ways to improve

Personal experiences of medical school education and the manner in which it is delivered will be discussed. Examples of approaches used for student evaluation of different competencies and the methods to track their progress and development were identified. They were appraised, with their strengths and weaknesses discussed. Ideas to improve the approaches for competencies assessment in medical students were also explored.

Comparing European guidelines for medical student education focusing on emergency preparedness

A review of a variety of European guidelines for the assessment of medical students and their education, progression and preparedness for practise post-medical school. The various approaches were compared and contrasted with the advantages and disadvantages of each being evaluated. Their approaches towards emergency situation preparedness, or lack thereof, were also assessed.

ASPHER V4 Working Group supports the road map for professionalising the public health workforce

Background

The ASPHER V4 Working Group (WG) was established in 2016 and officially launched during the 9th European Public Health Conference in Vienna. One of the key objectives of the WG is to strengthen public health capacity development in V4 countries. The WG supports the implementation of the recently reviewed European Action Plan for Strengthening Public Health Capacities (EAP). The EAP’s review highlighted the need to focus further action on four enabling Essential Public Health Functions (EPHOs) including human resources for public health. This is why the WG is heavily involved in the recent development of a new Road map for professionalising the public health workforce, one of the products of the recently established Coalition of Partners (CoP) that was convened by the WHO Regional Office for Europe in close cooperation with ASPHER and Maastricht University.

Objectives

Supporting the WHO CoP with a focus on development and further implementation of a new Road map for professionalising public health workforce in V4 countries. Using a new rapid assessment tool to evaluate the state of the public health profession in the Czech Republic. Sharing the report on the current state of public health professions in the Czech Republic with the WG and using it as a comparison of the current state in all V4 countries.

Results

Key strengths and weaknesses of the first rapid assessment of the current state of the public health profession in the Czech Republic are presented. Key actions are proposed for the WG: a) Preparation of a grant proposal to the International V4 Fund and b) Continuing active involvement in CoP activities.

Conclusions

The rapid assessment tool for evaluating the state of the public health profession was successfully implemented in the Czech Republic with the close cooperation of academia, researchers, policy makers and practitioners. The summary confirms that further work on the professionalization of the public health workforce is needed.

Key messages

ASPHER V4 WG is strongly involved in the development of a new road map for professionalising the public health workforce, coordinated by the WHO CoP, ASPHER and Maastricht University. Summary of the first rapid assessment of the current state of the public health profession in the Czech Republic confirms the importance of further action in this area of work.

Towards a consensus on rheological models for elastography in soft tissues

A rising wave of technologies and instruments are enabling more labs and clinics to make a variety of measurements related to tissue viscoelastic properties. These instruments include elastography imaging scanners, rheological shear viscometers, and a variety of calibrated stress-strain analyzers. From these many sources of disparate data, a common step in analyzing results is to fit the measurements of tissue response to some viscoelastic model. In the best scenario, this places the measurements within a theoretical framework and enables meaningful comparisons of the parameters against other types of tissues. However, there is a large set of established rheological models, even within the class of linear, causal, viscoelastic solid models, so which of these should be chosen? Is it simply a matter of best fit to a minimum mean squared error of the model to several data points? We argue that the long history of biomechanics, including the concept of the extended relaxation spectrum, along with data collected from viscoelastic soft tissues over an extended range of times and frequencies, and the theoretical framework of multiple relaxation models which model the multi-scale nature of physical tissues, all lead to the conclusion that fractional derivative models represent the most succinct and meaningful models of soft tissue viscoelastic behavior. These arguments are presented with the goal of clarifying some distinctions between, and consequences of, some of the most commonly used models, and with the longer term goal of reaching a consensus among different sub-fields in acoustics, biomechanics, and elastography that have common interests in comparing tissue measurements.

Diagnostics and treatment of diffuse intrinsic pontine glioma: where do we stand?

Introduction

Diffuse intrinsic pontine glioma (DIPG) is a rare clinically, neuro-radiologically, and molecularly defined malignancy of the brainstem with a median overall survival of approximately 11 months. Our aim is to evaluate the current tendency for its treatment in Europe in order to develop (inter)national consensus guidelines.

Methods

Healthcare professionals specialized in DIPG were asked to fill in an online survey with questions regarding usual treatment strategies at diagnosis and at disease progression in their countries and/or their centers, respectively.

Results

Seventy-four healthcare professionals responded to the survey, of which 87.8% were pediatric oncologists. Only 13.5% of the respondents biopsy all of their patients, 41.9% biopsy their patients infrequently. More than half of the respondents (54.1%) treated their patients with radiotherapy only at diagnosis, whereas 44.6% preferred radiotherapy combined with chemotherapy. When the disease progresses, treatment strategies became even more diverse, and the tendency for no treatment increased from 1.4% at diagnosis to 77.0% after second progression. 36.5% of the healthcare professionals treat children younger than 3 years differently than older children at diagnosis. This percentage decreased, when the disease progresses. Most of the participants (51.4%) included less than 25% of their patients in clinical trials.

Conclusion

This survey demonstrates a large heterogeneity of treatment regimens, especially at disease progression. We emphasize the need for international consensus guidelines for the treatment of DIPG, possible by more collaborative clinical trials.

Electronic supplementary material

The online version of this article (10.1007/s11060-019-03287-9) contains supplementary material, which is available to authorized users.

Intracystic interferon-alpha in pediatric craniopharyngioma patients: an international multicenter assessment on behalf of SIOPE and ISPN

Background

Craniopharyngiomas are frequent hypothalamo-pituitary tumors in children, presenting predominantly as cystic lesions. Morbidity from conventional treatment has focused attention on intracystic drug delivery, hypothesized to cause fewer clinical consequences. However, the efficacy of intracystic therapy remains unclear. We report the retrospective experiences of several global centers using intracystic interferon-alpha.

Methods

European Société Internationale d'Oncologie Pédiatrique and International Society for Pediatric Neurosurgery centers were contacted to submit a datasheet capturing pediatric patients with cystic craniopharyngiomas who had received intracystic interferon-alpha. Patient demographics, administration schedules, adverse events, and outcomes were obtained. Progression was clinical or radiological (cyst reaccumulation, novel cysts, or solid growth).

Results

Fifty-six children (median age, 6.3 y) from 21 international centers were identified. Median follow-up from diagnosis was 5.1 years (0.3-17.7 y). Lesions were cystic (n = 22; 39%) or cystic/solid (n = 34; 61%). Previous progression was treated in 43 (77%) patients before interferon use. In such cases, further progression was delayed by intracystic interferon compared with the preceding therapy for cystic lesions (P = 0.0005). Few significant attributable side effects were reported. Progression post interferon occurred in 42 patients (median 14 mo; 0-8 y), while the estimated median time to definitive therapy post interferon was 5.8 (1.8-9.7) years.

Conclusions

Intracystic interferon-alpha can delay disease progression and potentially offer a protracted time to definitive surgery or radiotherapy in pediatric cystic craniopharyngioma, yet demonstrates a favorable toxicity profile compared with other therapeutic modalities-important factors for this developing age group. A prospective, randomized international clinical trial assessment is warranted.

Intradiscal pressure in the degenerated porcine intervertebral disc

Measuring intradiscal pressure is one way of mechanically assessing the discs degenerative state. In this study, the load-bearing capacity of degenerated and their adjacent lumbar intervertebral discs was evaluated using two different injury models. Seventeen adolescent pigs were divided into two groups, an annulus injury group and an endplate injury group. The annulus injury group was subjected to a stab incision in the L3-L4 disc, whereas the endplate injury group received a cranial endplate perforation of the L4 vertebral body. Both groups were biomechanically evaluated three months later using a miniaturized servohydraulic testing machine across L2-L4 and with two pressure needles inserted into the nucleus pulposus of the L2-L3 and L3-L4 discs. Linear relationships between the intradiscal pressure and the applied load were determined within the load range studied. When comparing the ratio of the injured to the adjacent disc pressure, the endplate injury was lower (mean value 0.31) than the annulus injury (mean value 0.51). The pressures in the discs adjacent to the degenerated level were found to be slightly higher. This increase can be expected due to a redistribution in mobility demands in segments adjacent to those with increased stiffness, i.e. degenerated intervertebral discs.

Reactive changes in the adolescent porcine spine with disc degeneration due to endplate injury

Degenerative and reactive structural alterations occurring after experimentally-induced disc degeneration were evaluated using a porcine model. A cranial perforation was made through the L4 vertebral endplate into the nucleus pulposus. Three months later, the lumbar intervertebral disc and adjacent vertebrae were dissected, fixed in formalin and further processed for histopathological analyses. The results showed that there were nucleus pulposus fragments, rather than a distinct border between the nucleus and annulus fibrosus. The central lamellae were distorted and delamination of the outer anterior layers was observed. Blood vessels emerged from the adjacent tissue, penetrated the annulus and branched into the residues of the nucleus. Nerve fibres accompanying the blood vessels could be recognized in the disc within the connective scar tissue. The epiphyseal cartilage plates in the vertebrae were hypertrophic in several areas and there was bone formation directed towards the centre of the vertebral body and the disc. Hypertrophic hyaline cartilage, newly formed bone and scar tissue filled the injury canal. A slight chronic inflammatory reaction was evident along vascular buds. The reactive changes dominated over the degenerated features in the operated disc. Physiological loading enhanced the infiltration of various tissue types characterizing immature cartilage formation. Prominent neovascularisation of the central parts of the disc is likely to be of key importance in turning the degenerative features of the remaining tissue into reactive healthy structures.

Cerebellar mutism syndrome in children with brain tumours of the posterior fossa

Background

Central nervous system tumours constitute 25% of all childhood cancers; more than half are located in the posterior fossa and surgery is usually part of therapy. One of the most disabling late effects of posterior fossa tumour surgery is the cerebellar mutism syndrome (CMS) which has been reported in up to 39% of the patients but the exact incidence is uncertain since milder cases may be unrecognized. Recovery is usually incomplete. Reported risk factors are tumour type, midline location and brainstem involvement, but the exact aetiology, surgical and other risk factors, the clinical course and strategies for prevention and treatment are yet to be determined.

Methods

This observational, prospective, multicentre study will include 500 children with posterior fossa tumours. It opened late 2014 with participation from 20 Nordic and Baltic centres. From 2016, five British centres and four Dutch centres will join with a total annual accrual of 130 patients. Three other major European centres are invited to join from 2016/17. Follow-up will run for 12 months after inclusion of the last patient. All patients are treated according to local practice. Clinical data are collected through standardized online registration at pre-determined time points pre- and postoperatively. Neurological status and speech functions are examined pre-operatively and postoperatively at 1–4 weeks, 2 and 12 months. Pre- and postoperative speech samples are recorded and analysed. Imaging will be reviewed centrally. Pathology is classified according to the 2007 WHO system. Germline DNA will be collected from all patients for associations between CMS characteristics and host genome variants including pathway profiles.

Discussion

Through prospective and detailed collection of information on 1) differences in incidence and clinical course of CMS for different patient and tumour characteristics, 2) standardized surgical data and their association with CMS, 3) diversities and results of other therapeutic interventions, and 4) the role of host genome variants, we aim to achieve a better understanding of risk factors for and the clinical course of CMS - with the ultimate goal of defining strategies for prevention and treatment of this severely disabling condition.

Trial registration

Clinicaltrials.gov: NCT02300766, date of registration: November 21, 2014.

A comparative perspective on longevity: the effect of body size dominates over ecology in moths

Both physiologically and ecologically based explanations have been proposed to account for among-species differences in lifespan, but they remain poorly tested. Phylogenetically explicit comparative analyses are still scarce and those that exist are biased towards homoeothermic vertebrates. Insect studies can significantly contribute as lifespan can feasibly be measured in a high number of species, and the selective forces that have shaped it may differ largely between species and from those acting on larger animals. We recorded adult lifespan in 98 species of geometrid moths. Phylogenetic comparative analyses were applied to study variation in species-specific values of lifespan and to reveal its ecological and life-history correlates. Among-species and between-gender differences in lifespan were found to be notably limited; there was also no evidence of phylogenetic signal in this trait. Larger moth species were found to live longer, with this result supporting a physiological rather than ecological explanation of this relationship. Species-specific lifespan values could not be explained by traits such as reproductive season and larval diet breadth, strengthening the evidence for the dominance of physiological determinants of longevity over ecological ones.

New Brain Tumor Entities Emerge from Molecular Classification of CNS-PNETs

Primitive neuroectodermal tumors of the central nervous system (CNS-PNETs) are highly aggressive, poorly differentiated embryonal tumors occurring predominantly in young children but also affecting adolescents and adults. Herein, we demonstrate that a significant proportion of institutionally diagnosed CNS-PNETs display molecular profiles indistinguishable from those of various other well-defined CNS tumor entities, facilitating diagnosis and appropriate therapy for patients with these tumors. From the remaining fraction of CNS-PNETs, we identify four new CNS tumor entities, each associated with a recurrent genetic alteration and distinct histopathological and clinical features. These new molecular entities, designated "CNS neuroblastoma with FOXR2 activation (CNS NB-FOXR2)," "CNS Ewing sarcoma family tumor with CIC alteration (CNS EFT-CIC)," "CNS high-grade neuroepithelial tumor with MN1 alteration (CNS HGNET-MN1)," and "CNS high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR)," will enable meaningful clinical trials and the development of therapeutic strategies for patients affected by poorly differentiated CNS tumors.

Injectable silver nanosensors: in vivo dosimetry for external beam radiotherapy using positron emission tomography

Development of safe and efficient radiotherapy routines requires quantification of the delivered absorbed dose to the cancer tissue in individual patients. In vivo dosimetry can provide accurate information about the absorbed dose delivered during treatment. In the current study, a novel silver-nanosensor formulation based on poly(vinylpyrrolidinone)-coated silver nanoparticles formulated in a gelation matrix composed of sucrose acetate isobutyrate has been developed for use as an in vivo dosimeter for external beam radiotherapy. In situ photonuclear reactions trigger the formation of radioactive (106)Ag, which enables post treatment verification of the delivered dose using positron emission tomography imaging. The silver-nanosensor was investigated in a tissue equivalent thorax phantom using clinical settings and workflow for both standard fractionated radiotherapy (2 Gy) and stereotactic radiotherapy (10- and 22 Gy) in a high-energy beam setting (18 MV). The developed silver-nanosensor provided high radiopacity on the planning CT-scans sufficient for patient positioning in image-guided radiotherapy and provided dosimetric information about the absorbed dose with a 10% and 8% standard deviation for the stereotactic regimens, 10 and 22 Gy, respectively.

When should placebo surgery as a control in clinical trials be carried out?

Placebo surgery – often maligned as ‘sham surgery’ – is a tough sell to patients and to many clinicians. But could surgical research benefit from increased use of placebo control groups?

Treating youth in pain: Comparing tailored behavioural medicine treatment provided by physical therapists in primary care with physical exercises

OBJECTIVES

To study the efficacy of tailored behavioural medicine treatment within a physical therapy framework.

METHODS

The study was a randomized controlled study (RCT): tailored behavioural medicine treatment (EXT) delivered by physical therapists (PTs) was compared with exercise-based treatment (CT). Thirty-two adolescents (mean age 14.3 years) with persistent pain participated. Data on pain-related disability and school attendance (primary outcomes), pain intensity, catastrophizing, fear of movement and self-efficacy were collected.

RESULTS

The pain-related disability measured by the Functional Disability Inventory (FDI) resulted in mean score change of EXT = -18 and CT = -11, respectively. A significant change within both groups was found (EXT p = 0.003, CT p = 0.001), and a large effect size for FDI between the conditions was demonstrated (AUC of 0.77). For school attendance post-treatment, no difference was found between conditions. For secondary outcomes, a significant improvement in pain intensity and pain catastrophizing was found for the EXT and self-efficacy for the CT groups but no statistically significant difference between the two conditions was detected. Caution should be given to the small sample size, as it may affect the interpretation and generalizability of the results.

CONCLUSION

In this study, differences between tailored behavioural medicine treatment delivered by PTs and exercise-based treatment could not be demonstrated, although the effect size was large. Patients who received either treatment demonstrated significant changes over time in pain-related disability. The low number of participants and suboptimal tailoring of the psychological components may partly explain the failure to demonstrate differences between groups, and future studies are warranted.

Radiation therapy and concurrent topotecan followed by maintenance triple anti-angiogenic therapy with thalidomide, etoposide, and celecoxib for pediatric diffuse intrinsic pontine glioma

BACKGROUND

Despite major treatment attempts, the prognosis for pediatric diffuse intrinsic pontine gliomas (DIPGs) remains dismal. Gliomas are highly vascularized tumors, suggesting that the prevention of vessel formation by anti-angiogenic treatment might be effective.

PROCEDURE

Forty-one pediatric patients with DIPG were treated according to the Angiocomb protocol, starting with radiotherapy combined with topotecan and followed by anti-angiogenic triple medication consisting of thalidomide, etoposide, and celecoxib. Overall survival, radiological response, quality of life, requirement of corticosteroids, and adverse effects were monitored. Eight patients treated with only radiotherapy were used as controls.

RESULTS

For study patients, the 12 and 24 months overall survival was 61% and 17%, respectively. The median overall survival was 12 months (range 4-60 months). Four radiological complete responses were seen, of which two were transient. Radiologically, 56% of the tumors reduced in size and 78% in signal intensity. Study patients were able to visit school or daycare and walk for a significantly longer time compared to controls (Log Rank 0.036 and 0.008, respectively). Adverse effects were generally minor.

CONCLUSIONS

The Angiocomb protocol created a noticeable share of long-term survivors and was well tolerated, suggesting that anti-angiogenic therapy for patients with DIPG should be studied more in the future.

A 10-year experience of outcome in chemotherapy-treated hereditary retinoblastoma

PURPOSE

The aim is to report the 10-year retrospective experience of systemic chemotherapy for a population-based group of patients with hereditary retinoblastoma at a national referral centre. The outcomes include control rates, treatment side-effects, adjuvant therapy, failure rate, survival, secondary cancers and visual acuity.

METHODS

All patients (n = 24, 46 eyes) diagnosed with retinoblastoma and treated with systemic chemotherapy at a national referral centre during 2001-2011 were included. Data were extracted from medical records.

RESULTS

The patients were followed for a mean of 60 months (range 13-144). Four-six cycles of VEC was administered to all newly diagnosed group B/C/D/E eyes with bilateral disease and 83% (38 of 46) responded to the treatment. None of the patients discontinued chemotherapy because of adverse reactions. Altogether 26% (12 of 46) of the eyes received second-line therapy (other than thermotherapy, cryotherapy and chemotherapy). The failure rate was 35% (16 of 46) and mortality rate 0%. None of the patients developed CNS manifestations (metastases or trilateral retinoblastoma). One of the patients developed a second primary tumour (osteosarcoma) 4 years following retinoblastoma diagnosis. Altogether 17% (4 of 24) patients received radiation therapy, 28% (13 of 46) of the eyes had to be enucleated, and one patient underwent bilateral enucleation. The age-correlated visual acuity was mean of 73% of expected visual acuity.

CONCLUSION

Group A/B retinoblastomas have a distinct chemotherapy response, while group C/D/E tumours do not respond as well. The success rate was 65%; while patients have a good prognosis for life, approximately one-third of all hereditary cases received radiation therapy or underwent enucleation.