1
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Chanda UL, Knapp C. A rare case of metastatic paraspinal rhabdomyosarcoma presenting with proptosis in an adult patient. Orbit 2024; 43:280-282. [PMID: 36131600 DOI: 10.1080/01676830.2022.2125537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
Secondary metastasis of rhabdomyosarcoma (RMS) to the orbit from a distant primary site is extremely rare in adults. In this article, we describe the case of a 24-year-old male presenting with proptosis, diplopia, and headaches concurrently with a histologically confirmed diagnosis of PAX3-FOXO1 positive paraspinal alveolar rhabdomyosarcoma. An orbital MRI revealed a fusiform mass arising from the inferior rectrus, displaying necrotic and irregular morphology consistent with malignancy. The patient is currently undergoing intensive chemotherapy. The objective of this case report is to highlight the rarity of an extraocular metastasis of RMS in an adult patient, alongside the importance of considering metastatic disease in a patient with fulminant unilateral proptosis.
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Affiliation(s)
- U Leo Chanda
- School of Medicine, University of Nottingham, Nottingham, UK
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2
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Allen‐Rhoades W, Lupo PJ, Scheurer ME, Chi Y, Kuttesch JF, Venkatramani R, Meyer WH, Mascarenhas L. Alveolar rhabdomyosarcoma has superior response rates to vinorelbine compared to embryonal rhabdomyosarcoma in patients with relapsed/refractory disease: A meta-analysis. Cancer Med 2023; 12:10222-10229. [PMID: 37016270 PMCID: PMC10225185 DOI: 10.1002/cam4.5749] [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] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/19/2023] [Accepted: 02/16/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Patients with alveolar rhabdomyosarcoma (ARMS) have inferior outcomes compared to patients with embryonal rhabdomyosarcoma (ERMS) and more effective chemotherapy options are needed for these patients. Vinorelbine is a semisynthetic vinca alkaloid that has clinical activity in relapsed rhabdomyosarcoma (RMS) when used alone or in combination with cyclophosphamide. AIMS The goal of our study was to evaluate whether RMS histology subtype influences response rate to vinorelbine alone or in combination. MATERIALS & METHODS Five Phase 2 trials that enrolled RMS patients were included in the meta-analysis. Two studies evaluated vinorelbine alone, two studies evaluated vinorelbine in combination with low dose oral cyclophosphamide, and one study evaluated vinorelbine and intravenous cyclophosphamide in combination with temsirolimus or bevacizumab. All RMS patients had relapsed or refractory disease and had received at least one prior therapy. Response was reported according to RECIST1.1 and was defined as a complete or partial response. Response data was obtained from published results or from trial principal investigator. RMS NOS patients were grouped with ERMS patients for this analysis. Summary estimates comparing differences between ARMS and ERMS response rates were generated using a random-effects model to account for heterogeneity among the studies. RESULTS One hundred fifty-six enrolled patients evaluable for response were included in the meta-analysis, 85 ARMS, 64 ERMS and 7 RMS-NOS. The combined effect generated from the random-effects model demonstrated a 41% increase (p = 0.001, 95% CI; 0.21-0.60) in response to vinorelbine as a single agent or in combination in patients with ARMS compared to patients with ERMS. There was no significant difference in the rate of progressive disease between patients with ARMS compared to ERMS (p = 0.1, 95%CI; -0.26-0.02). DISCUSSION Vinorelbine is an active agent for the treatment of relapsed or refractory RMS and a meta-analysis of Phase 2 studies shows that radiographic responses in patients with ARMS were significantly higher than ERMS or RMS-NOS. CONCLUSION These data support further investigation of vinorelbine in newly diagnosed patients with RMS particularly those with alveolar histology.
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Affiliation(s)
- Wendy Allen‐Rhoades
- Department of Pediatric and Adolescent MedicineMayo ClinicMinnesotaRochesterUSA
| | - Philip J. Lupo
- Department of PediatricsBaylor College of MedicineTexasHoustonUSA
| | | | - Yueh‐Yun Chi
- Cancer and Blood Disease Institute, Children's Hospital of Los Angeles, Norris Comprehensive Cancer Center and Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - John F. Kuttesch
- Department of PediatricsUniversity of New MexicoAlbuquerqueNew MexicoUSA
| | | | - William H. Meyer
- Department of PediatricsUniversity of Oklahoma Health Sciences CenterOklahoma CityOklahomaUSA
| | - Leo Mascarenhas
- Cancer and Blood Disease Institute, Children's Hospital of Los Angeles, Norris Comprehensive Cancer Center and Department of Pediatrics, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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3
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Danielli SG, Porpiglia E, De Micheli AJ, Navarro N, Zellinger MJ, Bechtold I, Kisele S, Volken L, Marques JG, Kasper S, Bode PK, Henssen AG, Gürgen D, Delattre O, Surdez D, Roma J, Bühlmann P, Blau HM, Wachtel M, Schäfer BW. Single-cell profiling of alveolar rhabdomyosarcoma reveals RAS pathway inhibitors as cell-fate hijackers with therapeutic relevance. Sci Adv 2023; 9:eade9238. [PMID: 36753540 PMCID: PMC9908029 DOI: 10.1126/sciadv.ade9238] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Rhabdomyosarcoma (RMS) is a group of pediatric cancers with features of developing skeletal muscle. The cellular hierarchy and mechanisms leading to developmental arrest remain elusive. Here, we combined single-cell RNA sequencing, mass cytometry, and high-content imaging to resolve intratumoral heterogeneity of patient-derived primary RMS cultures. We show that the aggressive alveolar RMS (aRMS) subtype contains plastic muscle stem-like cells and cycling progenitors that drive tumor growth, and a subpopulation of differentiated cells that lost its proliferative potential and correlates with better outcomes. While chemotherapy eliminates cycling progenitors, it enriches aRMS for muscle stem-like cells. We screened for drugs hijacking aRMS toward clinically favorable subpopulations and identified a combination of RAF and MEK inhibitors that potently induces myogenic differentiation and inhibits tumor growth. Overall, our work provides insights into the developmental states underlying aRMS aggressiveness, chemoresistance, and progression and identifies the RAS pathway as a promising therapeutic target.
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Affiliation(s)
- Sara G. Danielli
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zürich 8032, Switzerland
| | - Ermelinda Porpiglia
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology and Immunology, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Biomedicine, Aarhus University, Aarhus C 8000, Denmark
- Corresponding author. (B.W.S.); (M.W.); (E.P.)
| | - Andrea J. De Micheli
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zürich 8032, Switzerland
| | - Natalia Navarro
- Laboratory of Translational Research in Child and Adolescent Cancer, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona 08035, Spain
| | | | - Ingrid Bechtold
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zürich 8032, Switzerland
| | - Samanta Kisele
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zürich 8032, Switzerland
| | - Larissa Volken
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zürich 8032, Switzerland
| | - Joana G. Marques
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zürich 8032, Switzerland
| | - Stephanie Kasper
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zürich 8032, Switzerland
| | - Peter K. Bode
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Anton G. Henssen
- Department of Pediatric Oncology/Hematology, Charité–Universitätsmedizin Berlin, Berlin 13353, Germany
| | - Dennis Gürgen
- EPO Experimental Pharmacology and Oncology Berlin-Buch GmbH Berlin 13125, Germany
| | - Olivier Delattre
- INSERM U830, Équipe Labellisée LNCC, Diversity and Plasticity of Childhood Tumors Laboratory, PSL Research University, SIREDO Oncology Center, Institut Curie Research Center, Paris 75005, France
| | - Didier Surdez
- INSERM U830, Équipe Labellisée LNCC, Diversity and Plasticity of Childhood Tumors Laboratory, PSL Research University, SIREDO Oncology Center, Institut Curie Research Center, Paris 75005, France
- Balgrist University Hospital, Faculty of Medicine, University of Zurich (UZH), Zurich, Switzerland
| | - Josep Roma
- Laboratory of Translational Research in Child and Adolescent Cancer, Vall d’Hebron Research Institute, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona 08035, Spain
| | - Peter Bühlmann
- Seminar for Statistics, ETH Zürich, Zürich 8092, Switzerland
| | - Helen M. Blau
- Baxter Laboratory for Stem Cell Biology, Department of Microbiology and Immunology, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Marco Wachtel
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zürich 8032, Switzerland
- Corresponding author. (B.W.S.); (M.W.); (E.P.)
| | - Beat W. Schäfer
- Department of Oncology and Children’s Research Center, University Children’s Hospital of Zurich, Zürich 8032, Switzerland
- Corresponding author. (B.W.S.); (M.W.); (E.P.)
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4
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Darvishi E, Slemmons K, Wan Z, Mitra S, Hou X, Hugues Parmentier J, Eddie Loh YH, Helman LJ. Molecular mechanisms of Guadecitabine induced FGFR4 down regulation in alveolar rhabdomyosarcomas. Neoplasia 2020; 22:274-282. [PMID: 32464274 PMCID: PMC7251315 DOI: 10.1016/j.neo.2020.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 01/07/2023] Open
Abstract
Fibroblast growth factor receptor 4 (FGFR4) aberrant expression and activity have been linked to the pathogenesis of a variety of cancers including rhabdomyosarcomas (RMS). We found that treatment of alveolar rhabdomyosarcoma (aRMS) cells with Guadecitabine (SGI-110), a next-generation DNA methyltransferase inhibitor (DNMTi), resulted in a significant reduction of FGFR4 protein levels, 5 days post treatment. Chromatin immunoprecipitation-sequencing (ChIP-seq) in aRMS cells revealed attenuation of the H3K4 mono-methylation across the FGFR4 super enhancer without changes in tri-methylation of either H3K4 or H3K27. These changes were associated with a significant reduction in FGFR4 transcript levels in treated cells. These decreases in H3K4me1 in the FGFR4 super enhancer were also associated with a 240-fold increase in KDM5B (JARID1B) mRNA levels. Immunoblot and immunofluorescent studies also revealed a significant increase in the KDM5B protein levels after treatment in these cells. KDM5B is the only member of KDM5 (JARID1) family of histone lysine demethylases that catalyzes demethylation of H3K4me1. These data together suggest a pleiotropic effect of DNMTi therapy in aRMS cells, converging to significantly lower FGFR4 protein levels in these cells.
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MESH Headings
- Antineoplastic Agents/pharmacology
- Azacitidine/analogs & derivatives
- Azacitidine/pharmacology
- Cell Line, Tumor
- Cell Proliferation/drug effects
- Chromatin Immunoprecipitation Sequencing
- Down-Regulation/drug effects
- Enhancer Elements, Genetic
- Histones/metabolism
- Humans
- Jumonji Domain-Containing Histone Demethylases/metabolism
- Lysine/metabolism
- Nuclear Proteins/metabolism
- Receptor, Fibroblast Growth Factor, Type 4/genetics
- Receptor, Fibroblast Growth Factor, Type 4/metabolism
- Repressor Proteins/metabolism
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/genetics
- Rhabdomyosarcoma, Alveolar/metabolism
- Rhabdomyosarcoma, Alveolar/pathology
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Affiliation(s)
- Emad Darvishi
- Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Katherine Slemmons
- Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Zesheng Wan
- Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Sheetal Mitra
- Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Xiaogang Hou
- Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jean Hugues Parmentier
- Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Lee J Helman
- Division of Hematology-Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Bisogno G, De Salvo GL, Bergeron C, Gallego Melcón S, Merks JH, Kelsey A, Martelli H, Minard-Colin V, Orbach D, Glosli H, Chisholm J, Casanova M, Zanetti I, Devalck C, Ben-Arush M, Mudry P, Ferman S, Jenney M, Ferrari A. Vinorelbine and continuous low-dose cyclophosphamide as maintenance chemotherapy in patients with high-risk rhabdomyosarcoma (RMS 2005): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol 2019; 20:1566-1575. [PMID: 31562043 DOI: 10.1016/s1470-2045(19)30617-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [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: 05/25/2019] [Revised: 08/06/2019] [Accepted: 08/19/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND For more than three decades, standard treatment for rhabdomyosarcoma in Europe has included 6 months of chemotherapy. The European paediatric Soft tissue sarcoma Study Group (EpSSG) aimed to investigate whether prolonging treatment with maintenance chemotherapy would improve survival in patients with high-risk rhabdomyosarcoma. METHODS RMS 2005 was a multicentre, open-label, randomised, controlled, phase 3 trial done at 102 hospitals in 14 countries. We included patients aged 6 months to 21 years with rhabdomyosarcoma who were considered to be at high risk of relapse: those with non-metastatic incompletely resected embryonal rhabdomyosarcoma occurring at unfavourable sites with unfavourable age (≥10 years) or tumour size (>5 cm), or both; those with any non-metastatic rhabdomyosarcoma with nodal involvement; and those with non-metastatic alveolar rhabdomyosarcoma but without nodal involvement. Patients in remission after standard treatment (nine cycles of ifosfamide, vincristine, dactinomycin with or without doxorubicin, and surgery or radiotherapy, or both) were randomly assigned (1:1) to stop treatment or continue maintenance chemotherapy (six cycles of intravenous vinorelbine 25 mg/m2 on days 1, 8, and 15, and daily oral cyclophosphamide 25 mg/m2, on days 1-28). Randomisation was done by use of a web-based system and was stratified (block size of four) by enrolling country and risk subgroup. Neither investigators nor patients were masked to treatment allocation. The primary outcome was disease-free survival in the intention-to-treat population. Secondary outcomes were overall survival and toxicity. This trial is registered with EudraCT, number 2005-000217-35, and ClinicalTrials.gov, number NCT00339118, and follow-up is ongoing. FINDINGS Between April 20, 2006, and Dec 21, 2016, 371 patients were enrolled and randomly assigned to the two groups: 186 to stop treatment and 185 to receive maintenance chemotherapy. Median follow-up was 60·3 months (IQR 32·4-89·4). In the intention-to-treat population, 5-year disease-free survival was 77·6% (95% CI 70·6-83·2) with maintenance chemotherapy versus 69·8% (62·2-76·2) without maintenance chemotherapy (hazard ratio [HR] 0·68 [95% CI 0·45-1·02]; p=0·061), and 5-year overall survival was 86·5% (95% CI 80·2-90·9) with maintenance chemotherapy versus 73·7% (65·8-80·1) without (HR 0·52 [95% CI 0·32-0·86]; p=0·0097). Toxicity was manageable in patients who received maintenance chemotherapy: 136 (75%) of 181 patients had grade 3-4 leucopenia, 148 (82%) had grade 3-4 neutropenia, 19 (10%) had anaemia, two (1%) had thrombocytopenia, and 56 (31%) had an infection. One (1%) patient had a grade 4 non-haematological toxicity (neurotoxicity). Two treatment-related serious adverse events occurred: one case of inappropriate antidiuretic hormone secretion and one of a severe steppage gait with limb pain, both of which resolved. INTERPRETATION Adding maintenance chemotherapy seems to improve survival for patients with high-risk rhabdomyosarcoma. This approach will be the new standard of care for patients with high-risk rhabdomyosarcoma in future EpSSG trials. FUNDING Fondazione Città della Speranza, Association Léon Berard Enfant Cancéreux, Clinical Research Hospital Program (French Ministry of Health), and Cancer Research UK.
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Affiliation(s)
- Gianni Bisogno
- Haematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy.
| | - Gian Luca De Salvo
- Clinical Research Unit, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Christophe Bergeron
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - Soledad Gallego Melcón
- Servicio de Oncología y Hematología Pediatrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Johannes H Merks
- Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands; Department of Paediatric Oncology, Emma Children's Hospital-Academic Medical Center Amsterdam, Netherlands
| | - Anna Kelsey
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
| | - Helene Martelli
- Department of Paediatric Surgery, Hôpital Bicêtre-Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | | | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | - Heidi Glosli
- Department of Paediatric Research and Department of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Julia Chisholm
- Children and Young Peoples Unit, Royal Marsden Hospital, Sutton, Surrey, UK
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ilaria Zanetti
- Haematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Christine Devalck
- Paediatric Haematology and Oncology, Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Myriam Ben-Arush
- Joan and Sanford Weill Pediatric Hematology Oncology and Bone Marrow Transplantation Division, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Peter Mudry
- University Children's Hospital Brno, Czech Republic
| | - Sima Ferman
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, UK
| | - Andrea Ferrari
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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6
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Casey DL, Wexler LH, Wolden SL. Worse Outcomes for Head and Neck Rhabdomyosarcoma Secondary to Reduced-Dose Cyclophosphamide. Int J Radiat Oncol Biol Phys 2019; 103:1151-1157. [PMID: 30508617 PMCID: PMC6441953 DOI: 10.1016/j.ijrobp.2018.11.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 09/29/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Recent trends, including the use of proton therapy and administration of reduced doses of cyclophosphamide, have been adapted in head and neck (HN) rhabdomyosarcoma (RMS) to reduce late morbidity. Our primary goal was to analyze local control and survival outcomes after photon versus proton irradiation in pediatric patients with HN-RMS, with the secondary goal of analyzing the effect of cyclophosphamide dose on disease outcomes. METHODS AND MATERIALS This single-institution cohort study comprised 76 pediatric HN-RMS patients treated with definitive chemoradiation from 2000 to 2018. Fifty-one patients (67%) received intensity modulated photon radiation therapy, and 25 (33%) received proton therapy. RESULTS Local failure (LF) at 2 years was 12.5% for parameningeal RMS and 0% for orbital RMS and other head and neck sites (P = .24). Patients treated with protons were more likely to have received reduced-dose cyclophosphamide (P < .0001). The 2-year LF was 7.9% in the intensity modulated photon radiation therapy cohort versus 14.6% in the proton cohort (P = .07), with no difference in survival outcomes. Cumulative cyclophosphamide dose was significantly associated with 2-year LF: 0% for cumulative dose of >20 g/m2 versus 15.3% for ≤20 g/m2 (P = .04). In parameningeal RMS patients (n = 59), both cumulative cyclophosphamide dose and dose intensity were associated with LF (P = .01). There was a trend toward worse event-free survival for parameningeal RMS patients who received reduced-dose-intensity cyclophosphamide (59.2% vs 70.6%, P = .11). CONCLUSIONS Both dose-intensity and cumulative cyclophosphamide dose seem to play an important role in achieving local control for HN-RMS patients treated with either protons or photons. Longer follow-up is needed to further assess disease outcomes with proton therapy.
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MESH Headings
- Adolescent
- Antineoplastic Agents, Alkylating/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy/methods
- Cyclophosphamide/administration & dosage
- Female
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Male
- Neoplasm Recurrence, Local
- Proton Therapy/adverse effects
- Proton Therapy/methods
- Proton Therapy/statistics & numerical data
- Radiotherapy Dosage
- Radiotherapy, Adjuvant/methods
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Radiotherapy, Intensity-Modulated/statistics & numerical data
- Relative Biological Effectiveness
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/mortality
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Rhabdomyosarcoma, Alveolar/surgery
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/mortality
- Rhabdomyosarcoma, Embryonal/radiotherapy
- Rhabdomyosarcoma, Embryonal/surgery
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leonard H Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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7
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Adamus A, Peer K, Ali I, Lisec J, Falodun A, Frank M, Seitz G, Engel N. Berberis orthobotrys - A promising herbal anti-tumorigenic candidate for the treatment of pediatric alveolar rhabdomyosarcoma. J Ethnopharmacol 2019; 229:262-271. [PMID: 30315865 DOI: 10.1016/j.jep.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/04/2018] [Accepted: 10/07/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Berberis orthobotrys (BORM) is a medical plant with a long history in traditional usage for the treatment of wounds, cancer, gastrointestinal malady and several other diseases. Our previous studies identified the endemic Pakistani plant Berberis orthobotrys Bien. ex Aitch. as promising source for the treatment of breast cancer and osteosarcoma. AIM OF THE STUDY The present study was aimed to evaluate the anti-cancer properties of 26 plant derived extracts and compounds including the methanolic root extract of Berberis orthobotrys (BORM) on pediatric alveolar rhabdomyosarcoma (RMA), which is known to develop drug resistance, metastatic invasion and potential tumor progression. MATERIALS AND METHODS The main anti-tumor activity of BORM was verified by focusing on morphological, cell structural and metabolic alterations via metabolic profiling, cell viability measurements, flow cytometry, western blotting and diverse microscopy-based methods using the human RMA cell line Rh30. RESULTS Exposure of 25 µg/ml BORM exerts an influence on the cell stability, the degradation of oncosomes as well as the shutdown of the metabolic activity of RMA cells, primarily by downregulation of the energy metabolism. Therefore glycyl-aspartic acid and N-acetyl serine decreased moderately, and uracil increased intracellularly. On healthy, non-transformed muscle cells BORM revealed very low metabolic alterations and nearly no cytotoxic impact. Furthermore, BORM is also capable to reduce Rh30 cell migration (~50%) and proliferation (induced G2/M cycle arrest) as well as to initiate apoptosis confirmed by reduced Bcl-2, Bax and PCNA expression and induced PARP-1 cleavage. CONCLUSIONS The study provides the first evidence, that BORM treatment is effective against RMA cells with low side effects on healthy cells.
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Affiliation(s)
- Anna Adamus
- Department of Pediatric Surgery, University Hospital Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Katharina Peer
- Department of Pediatric Surgery, University Hospital Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Iftikhar Ali
- Department of Chemistry, Karakoram International University, 15100 Gilgit, Pakistan
| | - Jan Lisec
- Division 1.7 Analytical Chemistry, Federal Institute for Materials Research and Testing (BAM), Richard-Willstätter-Straße 11, Berlin 12489 Germany
| | - Abiodun Falodun
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Benin, Benin City 300001, Nigeria
| | - Marcus Frank
- Medical Biology and Electron Microscopy Centre, Rostock University Medical Center, Strempelstraße 14, Rostock 18057, Germany
| | - Guido Seitz
- Department of Pediatric Surgery, University Hospital Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Nadja Engel
- Department of Pediatric Surgery, University Hospital Marburg, Baldingerstraße, 35033 Marburg, Germany; Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, Rostock University Medical Center, Schillingallee 35, 18057 Rostock, Germany.
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8
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Lu H, Qin J, Wang Z. Pleural Alveolar Rhabdomyosarcoma. Clin Lab 2017; 63:1745-1748. [PMID: 29035460 DOI: 10.7754/clin.lab.2017.170529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Alveolar rhabdomyosarcoma (ARMS) commonly occurring in children and adolescents, is a rare and aggressive soft tissue malignancy. Here, a rare case of pleural ARMS is reported in a boy presenting dyspnea for two weeks. The pathology of a biopsy specimen from pleura showed ARMS. PAX3-FKHR fusion protein is positive and the PAX7-FKHR fusion protein is negative as detected by fluorescence in situ hybridization. The prognosis of this patient was poor and nonresponsive to chemotherapy.
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9
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Gryder BE, Yohe ME, Chou HC, Zhang X, Marques J, Wachtel M, Schaefer B, Sen N, Song Y, Gualtieri A, Pomella S, Rota R, Cleveland A, Wen X, Sindiri S, Wei JS, Barr FG, Das S, Andresson T, Guha R, Lal-Nag M, Ferrer M, Shern JF, Zhao K, Thomas CJ, Khan J. PAX3-FOXO1 Establishes Myogenic Super Enhancers and Confers BET Bromodomain Vulnerability. Cancer Discov 2017; 7:884-899. [PMID: 28446439 DOI: 10.1158/2159-8290.cd-16-1297] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 03/20/2017] [Accepted: 04/21/2017] [Indexed: 01/05/2023]
Abstract
Alveolar rhabdomyosarcoma is a life-threatening myogenic cancer of children and adolescent young adults, driven primarily by the chimeric transcription factor PAX3-FOXO1. The mechanisms by which PAX3-FOXO1 dysregulates chromatin are unknown. We find PAX3-FOXO1 reprograms the cis-regulatory landscape by inducing de novo super enhancers. PAX3-FOXO1 uses super enhancers to set up autoregulatory loops in collaboration with the master transcription factors MYOG, MYOD, and MYCN. This myogenic super enhancer circuitry is consistent across cell lines and primary tumors. Cells harboring the fusion gene are selectively sensitive to small-molecule inhibition of protein targets induced by, or bound to, PAX3-FOXO1-occupied super enhancers. Furthermore, PAX3-FOXO1 recruits and requires the BET bromodomain protein BRD4 to function at super enhancers, resulting in a complete dependence on BRD4 and a significant susceptibility to BRD inhibition. These results yield insights into the epigenetic functions of PAX3-FOXO1 and reveal a specific vulnerability that can be exploited for precision therapy.Significance: PAX3-FOXO1 drives pediatric fusion-positive rhabdomyosarcoma, and its chromatin-level functions are critical to understanding its oncogenic activity. We find that PAX3-FOXO1 establishes a myoblastic super enhancer landscape and creates a profound subtype-unique dependence on BET bromodomains, the inhibition of which ablates PAX3-FOXO1 function, providing a mechanistic rationale for exploring BET inhibitors for patients bearing PAX-fusion rhabdomyosarcoma. Cancer Discov; 7(8); 884-99. ©2017 AACR.This article is highlighted in the In This Issue feature, p. 783.
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Affiliation(s)
| | - Marielle E Yohe
- Genetics Branch, NCI, NIH, Bethesda, Maryland
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | | | - Xiaohu Zhang
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Rockville, Maryland
| | | | | | | | | | - Young Song
- Genetics Branch, NCI, NIH, Bethesda, Maryland
| | - Alberto Gualtieri
- Department of Oncohematology, Ospedale Pediatrico Bambino Gesù Research Institute, Rome, Italy
| | - Silvia Pomella
- Department of Oncohematology, Ospedale Pediatrico Bambino Gesù Research Institute, Rome, Italy
| | - Rossella Rota
- Department of Oncohematology, Ospedale Pediatrico Bambino Gesù Research Institute, Rome, Italy
| | | | - Xinyu Wen
- Genetics Branch, NCI, NIH, Bethesda, Maryland
| | | | - Jun S Wei
- Genetics Branch, NCI, NIH, Bethesda, Maryland
| | | | - Sudipto Das
- Laboratory of Proteomics and Analytical Technologies, Advanced Technologies Center, NCI, Frederick, Maryland
| | - Thorkell Andresson
- Laboratory of Proteomics and Analytical Technologies, Advanced Technologies Center, NCI, Frederick, Maryland
| | - Rajarshi Guha
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Rockville, Maryland
| | - Madhu Lal-Nag
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Rockville, Maryland
| | - Marc Ferrer
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Rockville, Maryland
| | - Jack F Shern
- Genetics Branch, NCI, NIH, Bethesda, Maryland
- Pediatric Oncology Branch, Center for Cancer Research, NCI, NIH, Bethesda, Maryland
| | - Keji Zhao
- Systems Biology Center, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Craig J Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, NIH, Rockville, Maryland
| | - Javed Khan
- Genetics Branch, NCI, NIH, Bethesda, Maryland.
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10
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Sanford E, Wolbrink T, Mack J, Rowe RG. Severe Tumor Lysis Syndrome and Acute Pulmonary Edema Requiring Extracorporeal Membrane Oxygenation Following Initiation of Chemotherapy for Metastatic Alveolar Rhabdomyosarcoma. Pediatr Blood Cancer 2016; 63:928-30. [PMID: 26713672 PMCID: PMC5849391 DOI: 10.1002/pbc.25879] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 10/17/2015] [Revised: 11/24/2015] [Accepted: 11/28/2015] [Indexed: 11/10/2022]
Abstract
We present an 8-year-old male with metastatic alveolar rhabdomyosarcoma (ARMS) who developed precipitous cardiopulmonary collapse with severe tumor lysis syndrome (TLS) 48 hr after initiation of chemotherapy. Despite no detectable pulmonary metastases, acute hypoxemic respiratory failure developed, requiring extracorporeal membrane oxygenation (ECMO). Although TLS has been reported in disseminated ARMS, this singular case of life-threatening respiratory deterioration developing after initiation of chemotherapy presented unique therapeutic dilemmas. We review the clinical aspects of this case, including possible mechanisms of respiratory failure, and discuss the role of ECMO utilization in pediatric oncology.
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Affiliation(s)
- Ethan Sanford
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Anesthesiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Traci Wolbrink
- Department of Anesthesia and Critical Care Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Jennifer Mack
- Dana-Farber Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
| | - R. Grant Rowe
- Dana-Farber Boston Children’s Cancer and Blood Disorders Center, Boston, Massachusetts
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11
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Kephart JJG, Tiller RGJ, Crose LES, Slemmons KK, Chen PH, Hinson AR, Bentley RC, Chi JTA, Linardic CM. Secreted Frizzled-Related Protein 3 (SFRP3) Is Required for Tumorigenesis of PAX3-FOXO1-Positive Alveolar Rhabdomyosarcoma. Clin Cancer Res 2015; 21:4868-80. [PMID: 26071485 DOI: 10.1158/1078-0432.ccr-14-1797] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 07/21/2014] [Accepted: 05/25/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE Rhabdomyosarcoma (RMS) is a soft tissue sarcoma associated with the skeletal muscle lineage. Of the two predominant subtypes, known as embryonal (eRMS) and alveolar (aRMS), aRMS has the poorer prognosis, with a five-year survival rate of <50%. The majority of aRMS tumors express the fusion protein PAX3-FOXO1. As PAX3-FOXO1 has proven chemically intractable, this study aims to identify targetable proteins that are downstream from or cooperate with PAX3-FOXO1 to support tumorigenesis. EXPERIMENTAL DESIGN Microarray analysis of the transcriptomes of human skeletal muscle myoblasts expressing PAX3-FOXO1 revealed alteration of several Wnt pathway gene members, including secreted frizzled related protein 3 (SFRP3), a secreted Wnt pathway inhibitor. Loss-of-function using shRNAs against SFRP3 was used to interrogate the role of SFRP3 in human aRMS cell lines in vitro and conditional murine xenograft systems in vivo. The combination of SFRP3 genetic suppression and the chemotherapeutic agent vincristine was also examined. RESULTS In vitro, suppression of SFRP3 inhibited aRMS cell growth, reduced proliferation accompanied by a G1 arrest and induction of p21, and induced apoptosis. In vivo, doxycycline-inducible suppression of SFRP3 reduced aRMS tumor growth and weight by more than three-fold, in addition to increasing myogenic differentiation and β-catenin signaling. The combination of SFRP3 suppression and vincristine was more effective at reducing aRMS cell growth in vitro than either treatment alone, and ablated tumorigenesis in vivo. CONCLUSIONS SFRP3 is necessary for the growth of human aRMS cells both in vitro and in vivo and is a promising new target for investigation in aRMS.
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MESH Headings
- Animals
- Antineoplastic Agents, Phytogenic/pharmacology
- Apoptosis/drug effects
- Apoptosis/genetics
- Cell Line, Tumor
- Cell Proliferation
- Cell Transformation, Neoplastic/genetics
- Cluster Analysis
- Disease Models, Animal
- Forkhead Box Protein O1
- Forkhead Transcription Factors/genetics
- G1 Phase Cell Cycle Checkpoints/drug effects
- G1 Phase Cell Cycle Checkpoints/genetics
- Gene Expression Profiling
- Gene Expression Regulation, Neoplastic
- Glycoproteins/genetics
- Humans
- Intracellular Signaling Peptides and Proteins
- Mice
- Myoblasts/drug effects
- Myoblasts/metabolism
- PAX3 Transcription Factor
- Paired Box Transcription Factors/genetics
- RNA Interference
- RNA, Small Interfering/genetics
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/genetics
- Rhabdomyosarcoma, Alveolar/mortality
- Rhabdomyosarcoma, Alveolar/pathology
- Tumor Burden/drug effects
- Vincristine/pharmacology
- Wnt Proteins/antagonists & inhibitors
- Wnt Signaling Pathway/drug effects
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Julie J G Kephart
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina
| | - Rosanne G J Tiller
- School of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lisa E S Crose
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Katherine K Slemmons
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina
| | - Po-Han Chen
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina
| | - Ashley R Hinson
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Rex C Bentley
- School of Medicine, Duke University Medical Center, Durham, North Carolina. Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Jen-Tsan Ashley Chi
- School of Medicine, Duke University Medical Center, Durham, North Carolina. Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina
| | - Corinne M Linardic
- Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, North Carolina. School of Medicine, Duke University Medical Center, Durham, North Carolina. Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
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12
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Aielli F, Giusti R, Rughetti A, dell'Orso L, Ficorella C, Porzio G. Rapid resolution of refractory chemotherapy-induced oral mucositis with platelet gel-released supernatant in a pediatric cancer patient: a case report. J Pain Symptom Manage 2014; 48:e2-4. [PMID: 25131890 DOI: 10.1016/j.jpainsymman.2014.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 06/16/2014] [Accepted: 06/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Federica Aielli
- "L'Aquila per la Vita" Home Care Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital-"Sapienza", University of Rome, Rome, Italy
| | - Anna Rughetti
- Division of Transfusion Medicine, Department of Health Sciences, "San Salvatore" Hospital, L'Aquila, Italy
| | - Luigi dell'Orso
- Division of Transfusion Medicine, Department of Health Sciences, "San Salvatore" Hospital, L'Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology Department, University of L'Aquila, L'Aquila, Italy
| | - Giampiero Porzio
- "L'Aquila per la Vita" Home Care Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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13
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Abstract
A 40-year-old male presented with 2 weeks of left facial pain, nasal congestion, dysphonia, and epistaxis along with left-sided epiphora. CT showed a large infiltrative mass centered in the left maxillary sinus with extension into the left orbit, bilateral paranasal sinuses, nasal cavity, and bilateral enlarged cervical lymph nodes. Biopsy results confirmed adult alveolar rhabdomyosarcoma (RMS). Systemic workup confirmed bilateral cervical lymph node metastasis. Currently the patient is undergoing chemotherapy. We describe a rare case of adult paranasal sinus RMS with orbital invasion.
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14
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Cárdenas-Perilla R, Simó-Perdigó M, Barios-Profitós M, Castell-Conesa J. Unilateral breast metastasis from alveolar rhabdomyosarcoma in adult detected by ¹⁸F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2014; 34:148-9. [PMID: 25053243 DOI: 10.1016/j.remn.2014.05.005] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/14/2014] [Accepted: 05/21/2014] [Indexed: 11/15/2022]
Affiliation(s)
- R Cárdenas-Perilla
- Nuclear Medicine Deparment, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
| | - M Simó-Perdigó
- Nuclear Medicine Deparment, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Barios-Profitós
- Nuclear Medicine Deparment, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - J Castell-Conesa
- Nuclear Medicine Deparment, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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15
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Casey DL, Wexler LH, LaQuaglia MP, Meyers PA, Wolden SL. Patterns of failure for rhabdomyosarcoma of the perineal and perianal region. Int J Radiat Oncol Biol Phys 2014; 89:82-7. [PMID: 24725692 DOI: 10.1016/j.ijrobp.2014.01.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE To analyze prognostic factors and patterns of failure for rhabdomyosarcoma of the perineal and perianal region (PRMS), with an emphasis on radiation therapy for locoregional control. METHODS AND MATERIALS Detailed records of all 14 patients treated for PRMS at Memorial Sloan-Kettering Cancer Center between 1998 and 2012 were reviewed. The Kaplan-Meier method was used to assess the event-free survival (EFS) and overall survival (OS), and a competing-risks analysis was used to assess the cumulative incidence of local, regional, and distant failures. RESULTS Median age was 15.8 years (range, 1.1-31.9 years). High-risk features were identified: 9 of 14 patients (64%) had group 3 disease and 3 of 14 (21%) had group 4; 11 of 14 tumors (78%) were alveolar; 12 of 14 tumors (86%) were ≥5 cm; and 9 of 14 patients (64%) had involved lymph nodes (N1). Of those aged ≥10 years at diagnosis, 9 of 10 (90%) had alveolar histology, all had tumors ≥5 cm, and 8 of 10 (80%) presented with N1 disease. The rates of local, regional, and distant failure at 5 years were 17%, 31%, and 52%, respectively. Although 3 of the 4 patients with regional failure received nodal irradiation, only one of the nodal failures occurred in the radiation therapy field. The 5-year EFS was 33%, and OS was 39%. Age ≥10 years was associated with poor outcomes: EFS was 13% in patients aged ≥10 years, compared with 75% in those aged <10 years (P=.04); the OS was 13% in patients aged ≥10 years, compared with 100% in those aged <10 years (P=.04). CONCLUSIONS Patients with PRMS, especially those aged ≥10 years, present with poor prognostic features and continue to have poor outcomes. Given the high incidence of regional node recurrence, we recommend prophylactic ilioinguinal lymph node irradiation for all patients aged ≥10 years. For children aged <10 years, nodal evaluation is essential to determine the role for lymph node irradiation.
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Affiliation(s)
- Dana L Casey
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Leonard H Wexler
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Michael P LaQuaglia
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Paul A Meyers
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
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16
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17
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Schoofs G, Braeye L, Vanheste R, Verswijvel G, Debiec-Rychter M, Sciot R. Hepatic rhabdomyosarcoma in an adult: a rare primary malignant liver tumor. Case report and literature review. Acta Gastroenterol Belg 2011; 74:576-581. [PMID: 22319971] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Rhabdomyosarcomas are malignant tumors that display features of striated muscle differentiation. They are the most common soft-tissue sarcomas among children and young adults. In mature adults however there are very rare. The liver as a primary site in adults has only been described in 12 cases. We report a case of a primary alveolar rhabdomyosarcoma of the liver in a 59 year old female, confirmed by histological examination using immunohistochemical analysis (positive actin, desmin, vimentin and myogenin staining) and fluorescent in situ hybridization (FISH) analysis (positivity for PAX3/FOXO1A fusion). The patient underwent primary surgical resection, but presented a few weeks after surgery already with recurrent disease in the abdomen and bone metastasis. Despite initial good response to chemotherapy (doxorubicin/ifosfamide) and stable disease at 12 months after diagnosis, the patient died 31 months after the first presentation secondary to complicated abundant abdominal recurrent disease. We further present a review of the literature on published similar cases since 1979.
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Affiliation(s)
- G Schoofs
- Department of Gastroenterology, University Hospital Leuven, Belgium.
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18
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Liapis K, Alevizopoulos N, Delimpasi S, Apostolidis J, Harhalakis N, Rontogianni D, Nikiforakis E. Alveolar rhabdomyosarcoma mimicking acute leukemia at presentation. J BUON 2009; 14:529-530. [PMID: 19810151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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19
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Cannon GM, Polsky EG, Bellinger MF. Metastatic intratesticular alveolar rhabdomyosarcoma discovered after induction of systemic chemotherapy. Urology 2007; 69:982.e13-5. [PMID: 17482950 DOI: 10.1016/j.urology.2007.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 01/29/2006] [Revised: 01/21/2007] [Accepted: 02/18/2007] [Indexed: 11/23/2022]
Abstract
Alveolar rhabdomyosarcoma is an aggressive cancer that can metastasize to a variety of organs. We present what we believe to be the first reported case of metastatic intratesticular rhabdomyosarcoma in a patient presenting with testicular pain shortly after the induction of systemic chemotherapy. The published data regarding this unusual condition are reviewed.
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Affiliation(s)
- Glenn M Cannon
- Department of Urology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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20
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Hanke CA, Roessler J, Stegmaier S, Koscielniak E, Niemeyer CM, Kontny U. Alveolar rhabdomyosarcoma mimicking lymphoma with bone marrow involvement. Eur J Pediatr 2007; 166:505-6. [PMID: 17008999 DOI: 10.1007/s00431-006-0269-y] [Citation(s) in RCA: 5] [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: 03/29/2006] [Accepted: 07/19/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Christof Andreas Hanke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, University of Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany
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21
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Seitz G, Warmann SW, Vokuhl CO, Heitmann H, Treuner C, Leuschner I, Fuchs J. Effects of standard chemotherapy on tumor growth and regulation of multidrug resistance genes and proteins in childhood rhabdomyosarcoma. Pediatr Surg Int 2007; 23:431-9. [PMID: 17211591 DOI: 10.1007/s00383-006-1852-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The prognosis of rhabdomyosarcoma (RMS) in advanced stages is still sobering. Therapy is limited due to local tumor recurrence, development of metastases and multidrug resistance. The aim of this study was to investigate the development of multidrug resistance in cell lines and in xenografts of alveolar and embryonal RMS treated according to the German Soft Tissue Sarcoma Study (CWS). Alveolar and embryonal RMS cell lines were treated with Vincristine, Topotecan, Carboplatin, Actinomycin D, or Ifosfamide. Expression levels of resistance-associated genes were assessed using Real time-PCR. Nude mice (NMRI nu/nu, n = 10 per group) underwent xenotransplantation of human embryonal or alveolar RMS. Animals were treated with standard chemotherapeutic drugs Vincristine, Topotecan, Carboplatin, Actinomycin D, or Ifosfamide according to treatment schedules of the CWS-study. Tumor sizes were measured and relative tumor volumes were calculated. Animals were sacrificed after 20 days and standard histology, Real-time-PCR for MDR1-, MRP-, LRP- and MDM2-gene as well as immunohistochemistry for MDR1-, LRP-, and MRP-protein were performed. In the cell lines, an up-regulation of MDR-1 gene was found in alveolar rhabdomyosarcoma. In embryonal rhabdomyosarcoma, an up-regulation of LRP and MRP was found. Standard chemotherapy of alveolar rhabdomyosarcoma resulted in a significant reduction of tumor growth (P < 0.05) in all groups. In embryonal rhabdomyosarcoma strongest effects were found after treatment with Ifosfamide, Vincristine and Carboplatin (P < 0.05). RT-PCR revealed a MDR1-dependent mechanism in alveolar rhabdomyosarcoma. In embryonal rhabdomyosarcoma, MDR1 occurred to a lower degree. Immunohistochemistry revealed correlating expression levels of multidrug resistance-associated proteins. The use of established chemotherapy on human RMS in vivo had strong effects on xenografts compared to their controls. In all cases, there was only a reduction of tumor growth, but not a complete eradication of the tumors. Chemotherapy seemed to upregulate the expression of resistance-associated genes in vitro and in vivo. The mechanism of multidrug resistance depends on the tumor subtype. Therefore, further investigations will be required to evaluate multidrug resistance in patients and to investigate new modalities for a reversal of multidrug resistance.
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MESH Headings
- Analysis of Variance
- Animals
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Disease Models, Animal
- Drug Administration Schedule
- Drug Resistance, Neoplasm/drug effects
- Drug Resistance, Neoplasm/genetics
- Female
- Gene Expression Regulation, Neoplastic/drug effects
- Gene Expression Regulation, Neoplastic/genetics
- Genes, MDR/genetics
- Humans
- Immunohistochemistry/methods
- Mice
- Mice, Nude
- Multidrug Resistance-Associated Proteins/drug effects
- Multidrug Resistance-Associated Proteins/metabolism
- Neoplasm Proteins/drug effects
- Polymerase Chain Reaction/methods
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/genetics
- Rhabdomyosarcoma, Alveolar/pathology
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/genetics
- Rhabdomyosarcoma, Embryonal/pathology
- Soft Tissue Neoplasms/drug therapy
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/pathology
- Xenograft Model Antitumor Assays
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Affiliation(s)
- Guido Seitz
- Department of Pediatric Surgery, University Children's Hospital, Hoppe-Seyler-Strasse 1, 72076 Tuebingen, Germany.
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22
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Ehlers JP, Penne RB, Eagle RC, Carrasco JR. Alveolar rhabdomyosarcoma presenting as an acute orbital mass in the medial rectus muscle. Ophthalmic Plast Reconstr Surg 2007; 23:149-51. [PMID: 17413634 DOI: 10.1097/iop.0b013e318033137c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rhabdomyosarcoma is the most common pediatric primary neoplasm in the orbit, often presenting with rapid proptosis and orbital symptoms. We describe a 15-year-old girl who presented with an acute mass in her medial rectus muscle that was subsequently diagnosed as widely disseminated alveolar rhabdomyosarcoma. To our knowledge, this represents the first reported case in which an enlarged extraocular muscle was the initial manifestation of disseminated alveolar rhabdomyosarcoma.
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Affiliation(s)
- Justis P Ehlers
- Department of Medical Education, Wills Eye Hospital, Philadelphia, Pennsylvania 19107, USA
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23
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Douglas JG, Arndt CAS, Hawkins DS. Delayed radiotherapy following dose intensive chemotherapy for parameningeal rhabdomyosarcoma (PM-RMS) of childhood. Eur J Cancer 2007; 43:1045-50. [PMID: 17368885 DOI: 10.1016/j.ejca.2007.01.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 11/30/2006] [Accepted: 01/24/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the local control rates and survival rates of patients with Group III parameningeal rhabdomyosarcoma (PM-RMS) treated with a dose intensive chemotherapy regimen followed by irradiation. MATERIALS AND METHODS Twenty-six patients with group III, PM-RMS were enrolled in a prospective pilot trial at the Mayo Clinic, Rochester, MN and Children's Hospital and Regional Medical Center Seattle, WA. The median age at diagnosis was 8.5 years (range 1.5-19 years). The male to female patient ratio was 1.6:1. Twenty-three patients had embryonal histology with the remaining three alveolar. Risk factors indicating high risk disease included intracranial extension (10 patients), base of skull erosion (12 patients), and cranial nerve palsy (10 patients). The median follow-up period for all patients was 82 months (range 17-148 months). Patients were treated with an intensified chemotherapy regimen followed by definitive local irradiation at week 12 following further chemotherapy. The median time from initiation of chemotherapy to irradiation was 16 weeks (range 6-23). The median dose delivered was 50.4Gy (50.4-66.6Gy). RESULTS Response was assessed after the fourth course of chemotherapy. Three patients exhibited a complete response, 22 a partial response, and 1 patient had no response after two cycles of chemotherapy and proceeded to irradiation at week 6. The 5-year estimated event free survival was 81% (+/-15%, 95% CI). Two patients died from progressive metastatic disease; 1 patient died from secondary malignancy; and 2 patients died from locally progressive disease. The 5-year local control rate was 92% (+/-10.6%, 95% CI). CONCLUSIONS Treatment of group III PM-RMS patients with neo-adjuvant, intensive chemotherapy with a delay in irradiation resulted in excellent local-regional control rates and survival rates and may allow for a response-based radiotherapy approach.
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Affiliation(s)
- James G Douglas
- Department of Radiation Oncology, University of Washington Affiliated Hospitals, Seattle, WA, United States
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Phillips DC, Martin S, Doyle BT, Houghton JA. Sphingosine-induced apoptosis in rhabdomyosarcoma cell lines is dependent on pre-mitochondrial Bax activation and post-mitochondrial caspases. Cancer Res 2007; 67:756-64. [PMID: 17234787 DOI: 10.1158/0008-5472.can-06-2374] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [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] [Indexed: 11/16/2022]
Abstract
Sphingolipids is the collective term ascribed to components of the sphingomyelin cycle. Modulation of the cellular levels of individual sphingolipids can induce a diverse range of cellular responses including apoptosis, proliferation, and cell cycle arrest. We present data showing that rhabdomyosarcoma cell lines, independent of lineage (alveolar rhabdomyosarcoma and embryonal rhabdomyosarcoma), are particularly sensitive to the induction of apoptosis as a result of an elevation in the cellular levels of sphingosine (D-erythro-sphingosine). Sphingosine-mediated apoptosis does not require its metabolism to the related proapoptotic molecule ceramide and is stereospecific because exposure of the rhabdomyosarcoma cell line RD to the L-erythro and DL-threo isoforms of sphingosine did not induce apoptosis. Importantly, for efficient induction of apoptosis, sphingosine required Bax activation and consequential translocation to the mitochondria. This resulted in selective mitochondrial release of cytochrome c and Smac/Diablo but not other mitochondrial related factors (apoptosis-inducing factor, endonuclease G, and HtrA2/Omi). Using small interfering RNA, reduced Bax expression conferred the impaired release of mitochondrial cytochrome c to the cytoplasm following sphingosine exposure, inhibiting the induction of apoptosis. Furthermore, dissipation of the inner mitochondrial membrane potential and enhanced production of reactive oxygen species were not observed. Bax activation and cytochrome c release were independent of caspases; however, caspase-3 and caspase-9 activity distal to the mitochondria was essential for the execution of apoptosis.
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Affiliation(s)
- Darren C Phillips
- Division of Molecular Therapeutics, Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA, and UMR 7175-LC1, Pharmacologie et Physicochimie, Faculté de Pharmacie, Université Louis Pasteur, Illkirch, France
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25
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Milanovic R, Vlajcic Z, Zic R, Stanec S, Rudman F, Stanec Z. Alveolar rhabdomyosarcoma of the hand in a 2 year-old child. J Hand Surg Eur Vol 2007; 32:109-10. [PMID: 17049698 DOI: 10.1016/j.jhsb.2006.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 08/22/2006] [Accepted: 08/31/2006] [Indexed: 02/03/2023]
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Affiliation(s)
- Yutaka Saikawa
- Department of Pediatrics, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa, Japan
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27
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Abstract
We report a case of bifocal rhabdomyosarcoma involving the hand and thigh in an 11-year-old female. We highlight the importance of a thorough clinical examination and an aggressive surgical approach in which each lesion is treated as a separate primary.
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Affiliation(s)
- H J Siegel
- Department of Surgery and Section of Orthopaedic Oncology, University of Alabama, Birmingham, Alabama 35294, USA.
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Puri DR, Wexler LH, Meyers PA, La Quaglia MP, Healey JH, Wolden SL. The challenging role of radiation therapy for very young children with rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2006; 65:1177-84. [PMID: 16682130 DOI: 10.1016/j.ijrobp.2006.02.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 02/03/2006] [Accepted: 02/06/2006] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate local control and toxicity for very young children treated with multimodality therapy for rhabdomyosarcoma (RMS). METHODS AND MATERIALS From 1990 to 2004, 20 patients<or=36 months at diagnosis were treated at our institution. Nineteen underwent chemotherapy (CMT), surgery and/or intraoperative high-dose-rate brachytherapy (IOHDR), and external-beam radiation (EBRT). Median age was 17 months. Sites included extremity (7), trunk (5), parameningeal (4), orbit (1), head/neck (1), bladder/prostate (1). Histologies consisted of 10 embryonal (53%) and 9 alveolar/undifferentiated (47%). Ten had delayed gross total resection (GTR) at median time of 17 weeks after the start of CMT, and 8 of these underwent IOHDR. Median interval between start of CMT and EBRT was 18 weeks. Median EBRT dose was 36 Gy. EBRT technique was either intensity-modulated (11), three-dimensional (3), or two-dimensional (5). Functional outcome was assessed for patients alive>or=1 year after diagnosis (15) in terms of mild, moderate, or severe deficits. RESULTS Median follow-up was 33 months for survivors and 23 months for all patients. Two-year actuarial local control, event-free survival, disease-specific survival, and overall survival were 84%, 52%, 74%, and 62%, respectively. All patients who began EBRT<or=18 weeks after the start of CMT had their disease controlled locally. Five have mild deficits and 10 have no deficits. CONCLUSIONS A reduced dose of 36-Gy EBRT after delayed GTR may maximize local control while minimizing long-term sequelae for very young children with RMS, but unresectable tumors (e.g., parameningeal) require higher doses. Normal-tissue-sparing techniques such as intensity-modulated radiation therapy and IOHDR are encouraged. Local control may be maximized when EBRT begins <or=18 weeks after initiation of CMT, but further study is warranted. Longer follow-up is required to determine the full extent of late effects.
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Affiliation(s)
- Dev R Puri
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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29
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Affiliation(s)
- Leslie M Passmore
- Department of Pathology and Laboratory Medicine, University of South Florida College of Medicine, Tampa, Florida 33601, USA
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30
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Abstract
BACKGROUND Alveolar rhabdomyosarcoma is an uncommon malignant soft tissue tumor rarely found in the genital tract. This tumor is associated with a poor prognosis, especially in the adult population. Equally as rare are non-puerperal uterine inversions secondary to sarcomas. CASE A 21-year-old obese woman was initially evaluated with excessive vaginal bleeding. On exam, a large pedunculated mass protruding from the cervix was seen and biopsy of this mass revealed an alveolar rhabdomyosarcoma. The patient was treated with adjuvant chemotherapy consisting of VAC (Vincristine, Actinomycin, and Cyclophosphamide) for a presumed cervical rhabdomyosarcoma. After five cycles of chemotherapy the patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, at which time a complete uterine inversion was noted with the tumor located at the fundus of the uterus. Final pathology showed alveolar rhabdomyosarcoma of the uterus. The patient then received additional postoperative VAC regimen for a total of 10 treatments and remains in good health with no evidence of disease 20 months from diagnosis. CONCLUSION This case report describes the only reported case of uterine inversion secondary to alveolar rhabdomyosarcoma of the uterus and discusses current therapeutic options for adults.
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Affiliation(s)
- Ashley S Case
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 618 South 19th Street, Old Hillman Building, Room 340, Birmingham, AL 35233, USA.
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31
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Abstract
The authors report a case of severe dactinomycin-induced thrombocytopenia in a child with alveolar rhabdomyosarcoma. The phenomenon is consistent with an immune process leading to the formation of platelet-specific antibodies. This study shows that this can be induced even with the first dose of actinomycin, and its persistence is unpredictably prolonged and does not correlate linearly in an inverted fashion with the platelet count. It will be important to identify the subsets of patients who can develop this phenomenon by molecular techniques and to define the exact mechanism in vitro leading to formation of these antibodies. This would facilitate profiling the therapy, preventing the need for multiple platelet transfusions with their obvious hazards.
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Affiliation(s)
- Soumen Khatua
- Division of Pediatric Oncology, Tata Memorial Hospital, Mumbai, India.
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32
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Ozeki Z, Kobayashi S, Machida T, Kobayashi T, Oka K, Ishizaka K, Oka T. [Alveolar rhabdomyosarcoma originating in spermatic cord: a case report]. Hinyokika Kiyo 2004; 50:653-5. [PMID: 15518135] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A 19-year-old man visited our hospital complaining of swelling of the left inguinal region. A thumb head-sized tumor was palpated through the skin on the left spermatic cord. Tumor resection was performed because it was dissected easily apart from the left spermatic cord. Pathological examination revealed alveolar rhabdomyosarcoma with positive surgical margin. Computed tomographic scanning revealed no retroperitoneal lymph node swelling, and there were no clinical findings of distant metastasis (clinical stage I). Radical inguinal orchiectomy with combined chemotherapy using vincristine, dactinomycin, and ifosfamide (VAI) was performed. He has been alive without any recurrence for 8 years and 8 months after the surgery.
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Affiliation(s)
- Zen Ozeki
- Department of Urology, Kanto Central Hospital
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33
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Abstract
PURPOSE The authors present here 5 cases of continent urinary diversion in rhabdomyosarcoma applying a recently described technique for the Mitrofanoff Principle devised by the authors. METHODS Two previously irradiated rhabdomyosarcoma patients presenting with residual bladder disease and massive sensitive urinary urgency underwent a transverse colonic reservoir with catheterizable stoma. Two other patients presenting with a Bricker conduit underwent conversion into an ileal reservoir. One patient underwent reconstruction after a cystectomy. RESULTS All patients were continent and able to perform continent intermittent catheterization. CONCLUSIONS The technique proved to be feasible for this group of patients. The authors believe that because of its simplicity, it should be an option of continent urinary diversion when the Mitrofanoff Principle is considered.
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Affiliation(s)
- Ricardo G Freitas
- Division of Pediatric Urology, Department of Surgery/Pediatrics, Federal University of São Paulo, São Paulo, Brazil
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36
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Abstract
The target of rapamycin, mTOR, acts as a sensor for mitogenic stimuli, such as insulin-like growth factors and cellular nutritional status, regulating cellular growth and division. As many tumors are driven by autocrine or paracrine growth through the type-I insulin-like growth factor receptor, mTOR is potentially an attractive target for molecular-targeted treatment. Further, a rationale for anticipating tumor-selective activity based on transforming events frequently identified in malignant disease is becoming established.
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Affiliation(s)
- P J Houghton
- Department of Molecular Pharmacology, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA.
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McMulkin HM, Yanchar NL, Fernandez CV, Giacomantonio C. Sentinel lymph node mapping and biopsy: a potentially valuable tool in the management of childhood extremity rhabdomyosarcoma. Pediatr Surg Int 2003; 19:453-6. [PMID: 12740706 DOI: 10.1007/s00383-003-0956-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2002] [Indexed: 02/06/2023]
Abstract
Multimodal therapy, involving surgery, chemotherapy and radiation, now dominates the management of rhabdomyosarcoma (RMS) in childhood. Yet, despite improvements in these practices, extremity tumors continue to fare relatively poorly. Several investigators have identified prognostic factors that can be used to direct therapy and predict outcome. These factors include histology and metastatic disease, the latter requiring accurate staging to identify. The presence of lymph node metastases has been shown to be of prognostic significance and is incorporated into pre-treatment staging schemes. Up to 50% of all surgically evaluated nodes and 17% of clinically negative nodes in extremity RMS may harbor tumor, underscoring the increased risk of understaging the disease if accurate lymph node dissection is not undertaken. Despite its importance, there appears to be no standard format by which regional nodal status is evaluated in extremity RMS. Sentinel lymph node mapping and biopsy are a minimally invasive technique, currently used in the staging of adult breast cancer and melanoma. In adults, the technique is associated with optimum nodal yield and low morbidity. We describe a case in which sentinel node mapping and dissection were used to easily and accurately stage a distal upper extremity alveolar RMS in a child with clinically and radiologically negative regional lymph nodes. The procedure yielded no positive nodes, was associated with no morbidity and spared the child more extensive radiotherapy. We propose the further evaluation of this simple and innovative technique in the overall management of this childhood malignancy.
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Affiliation(s)
- H M McMulkin
- General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Chen C, Shu HKG, Goldwein JW, Womer RB, Maity A. Volumetric considerations in radiotherapy for pediatric parameningeal rhabdomyosarcomas. Int J Radiat Oncol Biol Phys 2003; 55:1294-9. [PMID: 12654440 DOI: 10.1016/s0360-3016(02)04290-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the influence of radiation volume on outcome in pediatric parameningeal rhabdomyosarcomas (PM-RMSs). METHODS AND MATERIALS Thirty patients ranging in age from 2 to 18 years (median 6) with PM-RMS were treated at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia between August 1988 and December 1999. The histologic subtypes included embryonal (n = 26), alveolar (n = 3), and undifferentiated (n = 1). Twenty-seven patients had Group III and three had Group IV disease. Twenty-seven patients underwent biopsy only and three subtotal resection. All patients were treated with multiple-agent chemotherapy and external beam radiotherapy. In 8 patients, all of whom had intracranial tumor extension, the tumor and whole brain were treated as the initial volume. In the remaining patients, most of those treated before 1992 were treated to the prechemotherapy (CMT) tumor volume for the entire treatment up to the total dose, which ranged from 45 to 59.4 Gy (median dose 57.9). In contrast, patients treated after 1992 generally received radiation initially to the pre-CMT volume (30.6-40 Gy; median dose 36) followed by a conedown to the post-CMT volume to a final dose of 41.4-55.2 Gy (median 50.4). RESULTS With a median follow-up of 6.2 years (range 2.1-13.3), the actuarial 5-year overall survival, progression-free survival, and local control rate for the entire group was 82%, 76%, and 76%, respectively. Seven failures and five deaths have been documented. In univariate analysis, histologic type, tumor size, and age at diagnosis were found to be predictive of overall survival and local control. No statistically significant difference in overall survival or local control was seen between patients who received a conedown to the post-CMT volume (n = 13) and patients in whom the pre-CMT volume was included for the entire treatment (n = 9). CONCLUSION Radiotherapy delivered to children with PM-RMS using a shrinking field technique with a post-CMT volume boost was effective and appears to give results comparable to those of patients in whom the pre-CMT volume was treated for the entire course. The use of such tailored treatment fields is likely to lead to fewer late effects and warrants further investigation.
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MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy
- Cranial Irradiation/methods
- Cyclophosphamide/administration & dosage
- Dactinomycin/administration & dosage
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Etoposide/administration & dosage
- Female
- Follow-Up Studies
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/surgery
- Humans
- Ifosfamide/administration & dosage
- Life Tables
- Male
- Nasopharyngeal Neoplasms/drug therapy
- Nasopharyngeal Neoplasms/mortality
- Nasopharyngeal Neoplasms/pathology
- Nasopharyngeal Neoplasms/radiotherapy
- Nasopharyngeal Neoplasms/surgery
- Neoplasm Staging
- Pennsylvania/epidemiology
- Radiotherapy, Adjuvant
- Radiotherapy, High-Energy/methods
- Retrospective Studies
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/mortality
- Rhabdomyosarcoma, Alveolar/pathology
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Rhabdomyosarcoma, Alveolar/surgery
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/mortality
- Rhabdomyosarcoma, Embryonal/pathology
- Rhabdomyosarcoma, Embryonal/radiotherapy
- Rhabdomyosarcoma, Embryonal/surgery
- Survival Analysis
- Treatment Outcome
- Vincristine/administration & dosage
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Affiliation(s)
- Changhu Chen
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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40
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Milanovic R, Zganjer M, Cizmić A, Pajić A. Rhabdomyosarcoma of the hand. Med Pediatr Oncol 2001; 37:481. [PMID: 11745881 DOI: 10.1002/mpo.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Anderson J, Gordon T, McManus A, Mapp T, Gould S, Kelsey A, McDowell H, Pinkerton R, Shipley J, Pritchard-Jones K. Detection of the PAX3-FKHR fusion gene in paediatric rhabdomyosarcoma: a reproducible predictor of outcome? Br J Cancer 2001; 85:831-5. [PMID: 11556833 PMCID: PMC2375077 DOI: 10.1054/bjoc.2001.2008] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Rhabdomyosarcoma has 2 major histological subtypes, embryonal and alveolar. Alveolar histology is associated with the fusion genes PAX3-FKHR and PAX7-FKHR. Definition of alveolar has been complicated by changes in terminology and subjectivity. It is currently unclear whether adverse clinical behaviour is better predicted by the presence of these fusion genes or by alveolar histology. We have determined the presence of the PAX3/7-FKHR fusion genes in 91 primary rhabdomyosarcoma tumours using a combination of classical cytogenetics, FISH and RT-PCR, with a view to determining the clinical characteristics of tumours with and without the characteristic translocations. There were 37 patients with t(2;13)/PAX3-FKHR, 8 with t(1;13) PAX7-FKHR and 46 with neither translocation. One or other of the characteristic translocations was found in 31/38 (82%) of alveolar cases. Univariate survival analysis revealed the presence of the translocation t(2;13)/PAX3-FKHR to be an adverse prognostic factor. With the difficulties in morphological diagnosis of alveolar rhabdomyosarcoma on increasingly used small needle biopsy specimens, these data suggest that molecular analysis for PAX3-FKHR will be a clinically useful tool in treatment stratification in the future. This hypothesis requires testing in a prospective study. Variant t(1;13)/PAX7-FKHR appears biologically different, occurring in younger patients with more localised disease.
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MESH Headings
- Adolescent
- Adult
- Antineoplastic Agents/therapeutic use
- Artificial Gene Fusion
- Child
- Child, Preschool
- Chromosomes, Human, Pair 13/genetics
- Chromosomes, Human, Pair 2/genetics
- DNA-Binding Proteins/genetics
- Female
- Forkhead Box Protein O1
- Forkhead Transcription Factors
- Homeodomain Proteins/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Infant
- Male
- Muscle Proteins/genetics
- Neoplasm Proteins/genetics
- PAX3 Transcription Factor
- PAX7 Transcription Factor
- Paired Box Transcription Factors
- Reverse Transcriptase Polymerase Chain Reaction
- Rhabdomyosarcoma, Alveolar/diagnosis
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/genetics
- Rhabdomyosarcoma, Embryonal/diagnosis
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/genetics
- Survival Analysis
- Transcription Factors/genetics
- Translocation, Genetic
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Affiliation(s)
- J Anderson
- Section of Paediatric Oncology, Institute of Cancer Research, Sutton, Surrey, UK
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43
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Lovett BD, Lo Nigro L, Rappaport EF, Blair IA, Osheroff N, Zheng N, Megonigal MD, Williams WR, Nowell PC, Felix CA. Near-precise interchromosomal recombination and functional DNA topoisomerase II cleavage sites at MLL and AF-4 genomic breakpoints in treatment-related acute lymphoblastic leukemia with t(4;11) translocation. Proc Natl Acad Sci U S A 2001; 98:9802-7. [PMID: 11493704 PMCID: PMC55533 DOI: 10.1073/pnas.171309898] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [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] [Accepted: 06/19/2001] [Indexed: 11/18/2022] Open
Abstract
We analyzed the der(11) and der(4) genomic breakpoint junctions of a t(4;11) in the leukemia of a patient previously administered etoposide and dactinomycin by molecular and biochemical approaches to gain insights about the translocation mechanism and the relevant drug exposure. The genomic breakpoint junctions were amplified by PCR. Cleavage of DNA substrates containing the normal homologues of the MLL and AF-4 translocation breakpoints was examined in vitro upon incubation with human DNA topoisomerase IIalpha and etoposide, etoposide catechol, etoposide quinone, or dactinomycin. The der(11) and der(4) genomic breakpoint junctions both involved MLL intron 6 and AF-4 intron 3. Recombination was precise at the sequence level except for the overall gain of a single templated nucleotide. The translocation breakpoints in MLL and AF-4 were DNA topoisomerase II cleavage sites. Etoposide and its metabolites, but not dactinomycin, enhanced cleavage at these sites. Assuming that DNA topoisomerase II was the mediator of the breakage, processing of the staggered nicks induced by DNA topoisomerase II, including exonucleolytic deletion and template-directed polymerization, would have been required before ligation of the ends to generate the observed genomic breakpoint junctions. These data are inconsistent with a translocation mechanism involving interchromosomal recombination by simple exchange of DNA topoisomerase II subunits and DNA-strand transfer; however, consistent with reciprocal DNA topoisomerase II cleavage events in MLL and AF-4 in which both breaks became stable, the DNA ends were processed and underwent ligation. Etoposide and/or its metabolites, but not dactinomycin, likely were the relevant exposures in this patient.
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MESH Headings
- Antigens, Neoplasm
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Catechols/pharmacology
- Child
- Chromosome Breakage
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 11/ultrastructure
- Chromosomes, Human, Pair 4/genetics
- Chromosomes, Human, Pair 4/ultrastructure
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- DNA Topoisomerases, Type II/metabolism
- DNA, Neoplasm/drug effects
- DNA-Binding Proteins/genetics
- Dactinomycin/administration & dosage
- Dactinomycin/adverse effects
- Dactinomycin/pharmacology
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Etoposide/pharmacology
- Female
- Histone-Lysine N-Methyltransferase
- Humans
- Ifosfamide/administration & dosage
- Isoenzymes/metabolism
- Models, Genetic
- Molecular Sequence Data
- Myeloid-Lymphoid Leukemia Protein
- Neoplasm Proteins/metabolism
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Nuclear Proteins/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/chemically induced
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Proto-Oncogenes
- Radiotherapy, Adjuvant
- Recombination, Genetic
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/radiotherapy
- Soft Tissue Neoplasms/drug therapy
- Soft Tissue Neoplasms/radiotherapy
- Transcription Factors
- Transcriptional Elongation Factors
- Translocation, Genetic/genetics
- Vincristine/administration & dosage
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Affiliation(s)
- B D Lovett
- Division of Oncology, Research Institute, Children's Hospital of Philadelphia, PA 19104, USA
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Abstract
PURPOSE DNA repair enzymes have a critical role in cellular maintenance and survival. The enzyme apurinic/apyrimidinic endonuclease/redox factor 1 (APE/ref1), a key protein in the base excision repair pathway, displays both repair and redox control. We examined the role of APE/ref1 in pediatric embryonal and alveolar rhabdomyosarcomas (ARMS). MATERIALS AND METHODS Using an immunohistochemical method, fixed tissue from 31 newly diagnosed pediatric rhabdomyosarcomas were evaluated for expression of APE/ref1. Tissue was obtained from Indiana University and the Cooperative Human Tissue Network. RESULTS We demonstrated high levels of expression within the localized and metastatic embryonal rhabdomyosarcomas. This contrasted with both localized and metastatic ARMS, which had low levels of APE/ref1 expression. This histology-specific difference proved to be significant (P = 0.003). Furthermore, the expression within all tumors examined was localized to the nucleus and did not differ between localized and metastatic tumors. CONCLUSIONS We propose several hypotheses to explain this histology-specific expression of APE/ref1 in pediatric rhabdomyosarcomas. Because the majority of ARMS expressed either the PAX3/FKHR or PAX7/FKHR fusion transcript, the low level of expression may be related to the redox activity of APE/ref1. The low levels may also be related to the bioreductive activity of APE/ref 1.
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MESH Headings
- Adolescent
- Biotransformation/physiology
- Carbon-Oxygen Lyases/biosynthesis
- Carbon-Oxygen Lyases/genetics
- Carbon-Oxygen Lyases/physiology
- Cell Nucleus/enzymology
- Child
- Child, Preschool
- DNA Repair
- DNA, Neoplasm/metabolism
- DNA-(Apurinic or Apyrimidinic Site) Lyase
- DNA-Binding Proteins/genetics
- DNA-Binding Proteins/physiology
- Daunorubicin/pharmacokinetics
- Drug Resistance, Neoplasm
- Feedback
- Female
- Forkhead Box Protein O1
- Forkhead Transcription Factors
- Gene Expression Regulation, Neoplastic
- Humans
- Infant
- Male
- Models, Biological
- Neoplasm Metastasis
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Neoplasm Proteins/physiology
- Oxidation-Reduction
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/enzymology
- Rhabdomyosarcoma, Alveolar/genetics
- Rhabdomyosarcoma, Alveolar/pathology
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/enzymology
- Rhabdomyosarcoma, Embryonal/genetics
- Rhabdomyosarcoma, Embryonal/pathology
- Single-Blind Method
- Soft Tissue Neoplasms/drug therapy
- Soft Tissue Neoplasms/enzymology
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/pathology
- Transcription Factors/genetics
- Transcription Factors/physiology
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Affiliation(s)
- B Thomson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, USA.
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45
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Pappo AS, Lyden E, Breneman J, Wiener E, Teot L, Meza J, Crist W, Vietti T. Up-front window trial of topotecan in previously untreated children and adolescents with metastatic rhabdomyosarcoma: an intergroup rhabdomyosarcoma study. J Clin Oncol 2001; 19:213-9. [PMID: 11134215 DOI: 10.1200/jco.2001.19.1.213] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [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] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the antitumor activity and toxicity of topotecan, used alone and in combination with conventional therapy, in patients with metastatic rhabdomyosarcoma (RMS). PATIENTS AND METHODS Forty-eight patients younger than 21 years of age with newly diagnosed metastatic RMS received 2.0 to 2.4 mg/m(2) of topotecan intravenously daily for 5 days every 21 days before standard therapy. Two courses were given in the absence of progressive disease or excessive toxicity and response was assessed. Patients with at least a partial response (PR) to topotecan proceeded to therapy with alternating courses of vincristine 1.5 mg/m(2), dactinomycin 1.5 mg/m(2), and cyclophosphamide 2.2 g/m(2) (VAC) and vincristine 1.5 mg/m(2), topotecan 0.75 mg/m(2) daily x 5, and cyclophosphamide 250 mg/m(2) daily x 5. Patients who did not respond to topotecan received continuation therapy with VAC alone. RESULTS The overall response rate to topotecan was 46% (complete response, 4%; partial response 42%). Unexpectedly, patients with alveolar RMS had a higher rate of response (65%) than those with embryonal RMS (28%; P: = .08). The most common grade 3 or 4 toxicities were neutropenia (67%), anemia (33%), thrombocytopenia (25%), and infection (21%). Two-year failure-free survival and survival estimates were 24% and 46%, respectively. Response to window therapy did not correlate with survival. CONCLUSION The high response rate and acceptable toxicity profile of topotecan in children with advanced RMS support further evaluation of this agent in phase III trials. The superior responses in alveolar RMS are of interest.
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Affiliation(s)
- A S Pappo
- Intergroup Rhabdomyosarcoma Study Group representing the Children's Cancer Group, Arcadia, CA 91066-6012, USA
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46
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Lafay-Cousin L, Plouvier P, Méchinaud F, Boutard P, Oberlin O. High-dose thiotepa and hematopoietic stem cell transplantation in pediatric malignant mesenchymal tumors: a phase II study. Bone Marrow Transplant 2000; 26:627-32. [PMID: 11035368 DOI: 10.1038/sj.bmt.1702573] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prognosis of metastatic malignant mesenchymal tumors (MMT) remains poor. Given the chemosensitivity of these neoplasms, a phase II study of high-dose thiotepa (HDT) was performed to evaluate the efficacy of this drug in this particular subset of pediatric tumors. Between 1986 and 1998, 18 patients, previously treated with conventional therapy for metastatic or refractory MMT, entered the study. Thiotepa was administered at a daily dose of 300 mg/m2 for 3 consecutive days. Hematopoietic stem cell rescue, consisting of bone marrow transplantation or peripheral stem cell transplantation, was performed 2 days after completion of HDT. A response exceeding 50% was observed in 6/18 patients (response rate 33%). Toxicity was severe but never led to death. HDT used at a dose of 900 mg/m2 yields measurable anti-tumor activity in previously treated patients. The next step in these particularly poor prognosis metastatic MMT will be to investigate HDT combined with other drugs, known to be efficient at high doses.
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MESH Headings
- Adolescent
- Antineoplastic Agents, Alkylating/adverse effects
- Antineoplastic Agents, Alkylating/therapeutic use
- Child
- Child, Preschool
- Combined Modality Therapy
- Dose-Response Relationship, Drug
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Male
- Neoplasms, Germ Cell and Embryonal/drug therapy
- Neoplasms, Germ Cell and Embryonal/therapy
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/therapy
- Rhabdomyosarcoma, Embryonal/drug therapy
- Rhabdomyosarcoma, Embryonal/therapy
- Sarcoma/drug therapy
- Sarcoma/pathology
- Sarcoma/therapy
- Thiotepa/adverse effects
- Thiotepa/therapeutic use
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Affiliation(s)
- L Lafay-Cousin
- Service d'Oncologie Pédiatrique, Institut Gustave Roussy, Villejuif, France
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47
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Reinecke P, Gerharz CD, Thiele KP, Jänig U, Schäfer KL, Aul C, Gabbert HE. Temporary remission of an alveolar rhabdomyosarcoma diagnosed and treated as acute leukemia. Leuk Lymphoma 2000; 36:405-9. [PMID: 10674913 DOI: 10.3109/10428190009148862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 29-year-old man with alveolar rhabdomyosarcoma was considered to be suffering from acute leukemia. A bone marrow aspirate had revealed extensive infiltration by atypical blast-like cells which were interpreted as acute lymphoblastic leukemia. Although there was no confirmation of this diagnosis by immunophenotyping chemotherapy with a protocol suited for the treatment of acute lymphoblastic leukemia was started prior to histological analysis and resulted in a complete temporary remission after the first cycle. Histological analysis of a bone marrow biopsy revealed an alveolar rhabdomyosarcoma, as further confirmed by molecular genetic analysis. Two months after the end of chemotherapy, there was an extensive recurrence and the patient died one year after initial diagnosis with chemotherapy refractory disease. In conclusion, rhabdomyosarcoma should always be included in the differential diagnosis of systemic diseases with extensive bone marrow infiltration by tumor cells which could otherwise be misinterpreted as a haematological malignancy.
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Affiliation(s)
- P Reinecke
- Institute of Pathology, Heinrich-Heine-University, Düsseldorf, Germany
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48
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Rossbach HC, Lacson A, Grana NH, Barbosa JL. Duchenne muscular dystrophy and concomitant metastatic alveolar rhabdomyosarcoma. J Pediatr Hematol Oncol 1999; 21:528-30. [PMID: 10598666] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The authors report the concomitant occurrence of Duchenne muscular dystrophy (DMD) and alveolar rhabdomyosarcoma (RMS). A 4-year-old boy presented with symptoms involving his neuromuscular system that affected primarily his left hip and leg. Duchenne muscular dystrophy was diagnosed. Seven months later, metastatic alveolar RMS in the ipsilateral pelvis was documented. The diagnosis of one major disorder affecting striated muscle (DMD) may have prevented the early detection of another (RMS).
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Affiliation(s)
- H C Rossbach
- Division of Pediatric Hematology/Oncology, All Children's Hospital, University of South Florida College of Medicine, St. Petersburg, USA
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49
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de Camargo B, Salateo R, Gutierrez y Lamelas R, Cardoso H, Hayashi M, Arias V. Unusual clinical evolution of a paratesticular alveolar rhabdomyosarcoma in a child. Med Pediatr Oncol 1999; 33:422-4. [PMID: 10491559 DOI: 10.1002/(sici)1096-911x(199910)33:4<422::aid-mpo20>3.0.co;2-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- B de Camargo
- Pediatric Department, Hospital do Cancer, São Paulo, Brazil.
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50
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Thomson B, Hawkins D, Felgenhauer J, Radich J. RT-PCR evaluation of peripheral blood, bone marrow and peripheral blood stem cells in children and adolescents undergoing VACIME chemotherapy for Ewing's sarcoma and alveolar rhabdomyosarcoma. Bone Marrow Transplant 1999; 24:527-33. [PMID: 10482938 DOI: 10.1038/sj.bmt.1701939] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peripheral blood stem cell support allows dose intensification of multiple cycle chemotherapy for metastatic tumors, including pediatric sarcomas. The VACIME protocol (vincristine, adriamycin, cyclophosphamide, ifosfamide, mesna and etoposide) utilizes peripheral blood stem cells (PBSC) collected following the treatment cycle as support for subsequent dose- and time-intensive chemotherapy. A critical assumption is that PBSC collected in this manner will be purged of residual tumor cells in vivo. We tested this assumption using sensitive reverse-transcriptase polymerase chain reaction (RT-PCR) to assess the presence of the characteristic translocations of the Ewing's sarcoma family of tumors (ESFT) and alveolar rhabdomyosarcoma (ARMS), t(11;22), and t(2;13), respectively. We used RT-PCR to evaluate 122 samples of peripheral blood (PB), bone marrow (BM) and PBSC collected from 12 pediatric patients with metastatic ESFT and ARMS. The samples included pre-therapy BM and PB, as well as BM, PB, and PBSC collections at various times in the VACIME treatment course. Molecular evidence of tumor contamination was detected in 1/40 PBSC collections from 12 patients. In all patients, we documented clearance of disease by RT-PCR in peripheral blood and bone marrow by week 9 of the VACIME protocol. In vivo purging in combination with the intensive VACIME regime appears to be effective in removing tumor cells from PBSC, bone marrow, and peripheral blood as detected by RT-PCR.
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MESH Headings
- Adolescent
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow/pathology
- Bone Marrow Purging
- Bone Neoplasms/blood
- Bone Neoplasms/drug therapy
- Bone Neoplasms/genetics
- Child
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 11/ultrastructure
- Chromosomes, Human, Pair 13/genetics
- Chromosomes, Human, Pair 13/ultrastructure
- Chromosomes, Human, Pair 2/genetics
- Chromosomes, Human, Pair 2/ultrastructure
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 22/ultrastructure
- Combined Modality Therapy
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/adverse effects
- DNA-Binding Proteins/genetics
- Doxorubicin/administration & dosage
- Doxorubicin/adverse effects
- Etoposide/administration & dosage
- Etoposide/adverse effects
- Female
- Forkhead Box Protein O1
- Forkhead Transcription Factors
- Hematopoietic Stem Cell Transplantation
- Hematopoietic Stem Cells/drug effects
- Humans
- Ifosfamide/administration & dosage
- Ifosfamide/adverse effects
- Male
- Mesna/administration & dosage
- Mesna/adverse effects
- Neoplasm Proteins/genetics
- Neoplastic Cells, Circulating
- Oncogene Proteins, Fusion/genetics
- PAX3 Transcription Factor
- Paired Box Transcription Factors
- Proto-Oncogene Protein c-fli-1
- RNA-Binding Protein EWS
- Reverse Transcriptase Polymerase Chain Reaction
- Rhabdomyosarcoma, Alveolar/blood
- Rhabdomyosarcoma, Alveolar/drug therapy
- Rhabdomyosarcoma, Alveolar/genetics
- Sarcoma, Ewing/blood
- Sarcoma, Ewing/drug therapy
- Sarcoma, Ewing/genetics
- Sensitivity and Specificity
- Soft Tissue Neoplasms/blood
- Soft Tissue Neoplasms/drug therapy
- Soft Tissue Neoplasms/genetics
- Transcription Factors/genetics
- Translocation, Genetic
- Vincristine/administration & dosage
- Vincristine/adverse effects
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Affiliation(s)
- B Thomson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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